Topics: Medical Billing, Dermatology
Your dermatology practice performs medical and surgical services for your clients; as such, your medical billing strategy needs an understanding of both medical and surgical dermatology CPT codes.
For the new year, we’ve compiled this handy list of essential dermatology CPT codes and relevant medical billing tips to help you and your practice succeed! Be sure to bookmark this page for easy reference and keep reading to learn more!
- Why You Need Accurate Dermatology CPT Codes
- Essential Dermatology CPT Codes
- Evaluation/Management (E/M) CPT Codes and Billing Tips for Dermatologists
- Dermatology CPT Codes with Modifiers
Why You Need Accurate Dermatology CPT Codes
The foundation for an optimized healthcare revenue cycle is set in utilizing accurate and appropriate dermatology CPT codes. When you have the correct codes that are appropriate for the services rendered and the SOAP notes or other medical documentation to back it up, your claims are more likely to be accepted upon the first submission.
Whether it’s due to accidentally typing in the wrong number, not noting the CPT code that best suits services rendered, or some other reason, reworking rejected claims takes time and money.
Ideally, your practice should have a 95% clean claims rate – meaning that 95% of your claims are successfully processed on the first submission. In reality, most practices have a clean claims rate between 75% and 85%, which means that 15-25% of claims have to be reworked.
If each claim costs $25 to rework and you have an average 100 claims that need to be reworked each month, that adds up to a hefty $2,500 a month and $30,000 per year! One essential step you can take to avoid these costs is to ensure each claim uses the correct dermatology CPT codes.
Essential Dermatology CPT Codes
These dermatology CPT codes are essential for your practice:
Skin Biopsy Dermatology CPT Codes
When a skin biopsy is performed by a dermatologist, skin samples are removed from the surface of the skin to be further examined.
- 11102: Tangential biopsy of skin; single lesion
- 11103: Tangential biopsy of skin; each separate or additional lesion
- 11104: Punch biopsy of kin; single lesion
- 11105: Punch biopsy of skin; each separate/additional lesion
- 11106: Incisional biopsy of skin; single lesion
- 11107: Incisional biopsy of skin; each separate/additional lesion
- 40490: Biopsy of lip
- 69100: Biopsy of external ear
Lesion Removal Dermatology CPT Codes
Lesions can be benign, premalignant, or malignant, and may be removed by any method, including electrosurgery, cryosurgery, laser, or chemical treatment. If multiple lesions are removed, multiple dermatology CPT codes may be used.
- 17000: Destruction of premalignant lesions (eg, actinic keratoses); first lesion
- 17003: Destruction of premalignant lesions (eg, actinic keratoses); 2 – 14 lesions
- 17110: Destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions
Excisions of Lesions Dermatology CPT Codes
Excising a lesion involves the surgical removal of lesions and the surrounding tissue.
- 11403: Excision, benign lesion including margins; trunk, arms, or legs
- 11603: Excision, malignant lesion including margins; trunk, arms, or legs
Mohs Micrographic Surgery Dermatology CPT Codes
Mohs micrographic surgery involves the removal of skin cancer; this surgery is typically conducted in several stages, including the removal of tumor tissue and pathologic examination.
- 17311: Mohs micrographic technique on head, neck, hands, feet; first stage
- 17312: Mohs micrographic technique on head, neck, hands, feet; each additional stage
- 17313: Mohs micrographic technique on trunk, arms, and legs; first stage
- 17314: Mohs micrographic technique on trunk, arms, and legs; each additional stage
Pathology CPT Codes for Dermatologists
Pathology procedures study skin and tissue at the microscopic cellular level.
- 88304: Level III – surgical pathology, gross & microscopic exam
- 88305: Level IV – surgical pathology, gross & microscopic exam
- 88312: Special stain including interpretation and report
- 88341: Immunohistochemistry or immunocytochemistry
Laser Therapy and Phototherapy Treatments CPT Codes
Laser therapy utilizes different laser wavelengths to treat a variety of skin conditions and can be used for cosmetic purposes. On the other hand, phototherapy treatments use UV light to treat skin conditions such as eczema and psoriasis. These dermatology CPT codes are as follows:
- 96920 and 96921: Laser treatment for inflammatory skin disease
- 96900: Actinotherapy (UV light)
- 96910: Photochemotherapy; tar and ultraviolet B or petrolatum and ultraviolet B
- 96567: Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions
- J7308: Aminolevulinic acid HCL for topical administration
Evaluation/Management (E/M) CPT Codes and Billing Tips for Dermatologists
When submitting a claim with E/M codes, it’s important to clarify if the patient was new or returning to your practice.
- New patient: An individual who hasn’t received any services from a physician/non-physician practitioner (NPP) or any other physician of the same specialty who belongs to the same practice within the last 3 years
- Returning patient: An individual who has received services from a physician/NPP or anyone else of the same specialty and who belongs to your practice within the last 3 years
Furthermore, it’s important to know that you can bill based on time allotted or based on the complexity of your patient.
For time-based E/M medical billing, use these codes:
- 99202: 15-29 minutes
- 99203: 30-44 minutes
- 99204: 45-59 minutes
- 99205: 60-74 minutes
If billing based on complexity, use these CPT codes:
- 99212: Straightforward level of complexity, minimal risk or chance of complications (approximately 10-19 minutes)
- 99213: Low level of complexity, low risk or chance of complications (approx. 20-29 minutes)
- 99214: Moderate complexity, moderate risk, or chance of complications (30-39 minutes)
- 99215: High complexity, high risk, or chance of complications (40-54 minutes)
Dermatology CPT Codes with Modifiers
Some medical billing codes for dermatologists can have modifiers included; these are as follows:
- Modifier 25: This should only be used along with E/M CPT codes for patients who are established with the practice; don’t use it for claims with new patients or in conjunction with other dermatology CPT codes
- Modifier 59: The 59 modifier is attached to other dermatology CPT codes to indicate a service or procedure was distinct or separate from others performed on the same day
Transform Your Medical Billing with NCG Medical
Balancing your dermatology practice’s appointments, SOAP notes, billing and coding, all the while delivering top-quality care to your patients can be overwhelming. Save time, energy, and streamline your healthcare revenue cycle by bundling your practice management with outsourced dermatology insurance and Medicare billing from NCG Medical!
As an experienced EMR and insurance billing provider for dermatology practices, the medical billing experts here at NCG Medical can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your dermatology practice grow rather than worrying about insurance billing.