Inga Ellzey

Billing CPT codes that start with "17" - the destruction codes - remain a source of confusion for both billers and providers. Destruction means that you are destroying lesions using one of several methods. The most common methods in dermatology include liquid nitrogen, electrodessication and curettage, laser and the use of chemicals. Below is a snapshot summary of the destruction codes.

Healthcare issues are heating up. Take, for example, recovery audit contractors (RACs), Z-Picks (bounty hunters for the commercial carriers), Obamacare being challenged in the U.S. Supreme Court, the Office of Inspector General (OIG) "hit list" targeting providers for overpayments, fraud and abuse allegations, and 5010 playing havoc with our claims processing system. What else can go wrong?

Next to biopsies and the destruction of premalignant lesions, the third most common bread-and-butter service for dermatologists is the destruction of benign lesions (CPT codes 17110 and 17111). In this article, we will discuss the proper use of these codes, rules that govern their use and bundling issues

With the introduction of new Mohs codes and changes in the definitions of the destruction codes for premalignant and benign lesions, lots of questions and concerns are being generated from not only physicians but their billing staffs as well.

Although the CPT coding changes affecting dermatology for 2007 were not numerous, they were some of the most significant ever.

Q A patient had a biopsy and the pathology report showed the lesion to be a basal cell carcinoma. We schedule the patient back for an excision. We sent the excision tissue out again. The final pathology came back showing no residual cancer cells; only scar tissue.

I do a lot of complicated skin cancer repairs and I have never really been very sure of the correct way to code for this particular type of closure: the purse string repair. I have spoken with several of my colleagues and everyone seems to be coding this differently. I have also scoured the CPT book with no real hints at what I should code. What do you think?

It's no big news to anyone doing medical billing that getting paid gets more and more time consuming. It seems that each month carriers devise new schemes not to pay us. The latest one is that CPT code 17000 is denied when billed with another service, but 17003 is paid. When asked why the 17000 code was not paid, carriers state it is bundled into the other surgical service billed, such as 11100. They state they are following CPT guidelines. Where is that written?

Q: Is there a way for me to charge for dressing changes in my office?

More and more dermatologists are providing some level of cosmetic service to their patients. The menu of services available to dermatologic patients is wide ranging from high-end anti-aging skin products to liposuction. Botox injections, chemical peels using new drugs, and biologics provide huge opportunities for dermatologists to get on the "cash" bandwagon.

Q: As HIPAA moves ahead at full speed, it has brought my attention to many other issues in our practice ?? among them chart audits. We have four physicians and two physician assistants in our practice. I plan to perform chart audits personally but don't know where to start. How do I get started?

Q: It is not a common practice, but there are certain situations when a patient has a very ill-defined skin cancer. Since I am not a Mohs surgeon, I must rely on a local laboratory for my pathology services. When I am uncomfortable with the excision, meaning that I am unsure whether all the margins will be clear, I don't want to spend an hour or so doing a flap or a graft only to have to tear it out if I get a pathology report back with a dirty margin.

Q: My doctors commonly use the following example in their dictation: "IDN back, no other suspicious lesions noted on complete general cutaneous skin exam." Would this documentation support a 99213, 99202, or 99242 level of care since six body areas are required to meet the documentation guidelines for the examination?

Many dermatology practices are experiencing high patient demand for appointments and are expanding their services. The result frequently necessitates adding providers to the practice.