It has taken 20 years, but now it’s official: The Centers for Medicare and Medicaid Services (CMS) has granted reimbursement codes to reflectance confocal microscopy (RCM), a noninvasive tool for identifying benign lesions, which can spare patients from needing biopsies, as well as detect malignant lesions.
RCM imaging got a category I current procedural terminology (CPT) reimbursement code, paving the way for RCM to become a more widely used in dermatology and other specialties. The new dermatology code values for RCM imaging of skin are CPT codes 96931, 96932, 96933, 96934, 96935 and 96936.
Research published January 2017 in Lasers in Surgery and Medicine highlights RCM imaging’s history, as well as challenges and opportunities for RCM in practice. Thousands of patients have been spared biopsies of benign lesions thanks to the noninvasive approach, the authors write.
One of the authors, dermatologist Anthony Rossi, M.D., tells Dermatology Times that dermatologists should note the use of noninvasive imaging represents a unique way to visualize skin and skin pathology, both in vivo and ex vivo. In addition to dermoscopy, there are many modalities available today that can help diagnose malignancies or benign neoplasms, as well as inflammatory changes.
“RCM has been helpful in my practice for equivocal lesions on visual and dermoscopic inspection,” according to Dr. Rossi, assistant attending of dermatology, Mohs micrographic and laser surgery at Memorial Sloan Kettering Cancer Center in New York, N.Y.
“The use of RCM allows me to have a cellular resolution look into the skin of these difficult lesions on the head and neck, without altering the skin. It has allowed me to assess for biopsy or monitoring, as well as plan my surgical margins needed for facial melanoma excisions. It has also allowed me to monitor skin cancer response to nonsurgical therapies.”
Dermatologists might not realize the cellular level resolution they can achieve with RCM, and they might not know there are in vivo and ex vivo RCM devices, according to Dr. Rossi.
“There are two in vivo devices—a static confocal microscope and a handheld microscope,” he says.
While most dermatologists do not have this technology at the moment, there are multiple centers around the world, including Memorial Sloan Kettering Cancer Center, that are pioneering RCM technology, according to Dr. Rossi.
For now, CMS has approved CPT codes for the static confocal microscope (not the handheld), for image acquisition and image interpretation. The relative value unit (RVU) value that has been put forth is 2.92 for image acquisition only of the first lesion and 1.28 for RCM interpretation of the first lesion. These are comparable to those of a cutaneous biopsy and pathologic interpretation respectively, according to Dr. Rossi.
“The promising aspect of confocal is not only the ability to detect malignant lesions but also to potentially cut down on the rate of biopsying benign lesions, similar to dermoscopy in that the lesion can be imaged and monitored over time,” he says. “While there is a learning curve associated with interpreting RCM features, dermatologists who are already familiar with reading skin pathology and dermoscopy may find confocal a natural extension.”
Disclosure: Dr. Rossi has received travel support from Mavig.