Practice Management

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.

National report - While dermatology's visual nature makes it ideal for image-rich electronic applications - from teledermatology to training for residents - few dermatologists have embraced comprehensive systems such as electronic medical records (EMRs), sources say. But they predict this will change with the healthcare industry's growing emphasis on efficiency and accountability.

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

But when it comes to 17000 and Mohs codes, used almost exclusively by dermatologists, Dr. Pariser says, "We have no one with whom to form alliances. We're stuck out on our own."

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.

The insurance companies with whom you do business appreciate your services but they are ultimately responsible for ensuring that their business - not yours - stays healthy.

Washington - Doctors will see a 5 percent cut in Medicare reimbursement rates next year. But the government will pay physicians more to counsel patients on ways to improve their health, according to the Associated Press.

Survey results recently released by the American College of Physician Executives paint a grim picture of physician morale across the United States. The survey indicates that nearly 60 percent of physicians have considered leaving the practice of medicine for varied reasons including: declining reimbursement, increasing patient loads, lack of respect and loss of autonomy.

Imaging services represented some 14 percent of 2005 spending that is considered in the formula used to calculate Medicare rates, and 27 percent of the total spending increase between 2004 and 2005.

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?

A hospital may provide your practice a qualifying EHR or e-prescribing system and forego - or donate - up to 85 percent of the system's cost.

Q A new patient who just moved into town was seen for a dark mole on the chin. After taking the appropriate history and doing an exam, the dermatologist decided to perform a diagnostic biopsy. The patient also indicated she had been treated for acne in the past and asked for a prescription refill. Would the diagnosis for the new patient E/M visit be the neoplasm of undetermined nature (e.g. 238.2) or should I attach the acne diagnosis? I remember reading that the primary diagnosis is the reason the patient came into the office and that should be used as the diagnosis for the office visit. However, many times carriers don't pay if there is only one diagnosis for both the procedure and the E/M visit. Would I be committing fraud if I used the acne diagnosis for the office visit?

Toronto - The most important way to avoid having dissatisfied cosmetic patients is to emphasize good patient selection, an expert says.

In a study comparing traditional cannula use on one thigh and the power cannula on the other, Dr. Katz found that bruising, swelling and pain were significantly reduced on the side on which the power cannula was used.

From cash payments to fee-for-service insurance to gatekeepers to HMOs, PPOs and IPAs; from high deductibles to wellness exam reimbursement - the saga of insurance coverage is ever-changing.

Dermatologists and other physicians can expect increased pressure to provide prescriptions electronically as one method of reducing medication errors, which the Institute of Medicine (IOM) of the National Academies says harm at least 1.5 million people every year.

Evaluation and management (E/M) services continue to be one of the most complicated issues in dermatologic billing. Whether it's how to document properly based on the level of care provided or getting paid for the various types of E/M services when procedures are billed on the same date of service, it all seems to be an uphill climb.

The debates over what to do with medical malpractice are complex and now longstanding.

American Academy of Dermatology President Stephen Stone, M.D., outlines an ambitious and ongoing agenda for the AAD that includes efforts to correct problems with the national iPLEDGE registry, to improve Medicare reimbursement and reform medical liability, and to protect the scope of practice of the specialty.

On an ongoing basis, our office receives denials from managed care plans stating that repair codes are bundled or "incidental to" the excision codes.

Dermatologists and other physicians who establish interoperable electronic health records systems in their practices can expect to be rewarded with increased compensation under the pay for performance policies being established at the Centers for Medicare and Medicaid Services (CMS).

There is grave concern in the academic community about the limited number of young physicians, including dermatologists, who are opting for careers in private practice instead of choosing a career in academics. The obvious question that arises is, will there be enough professors of dermatology in years to come to train the next generation? If there aren't a sufficient number of dermatology faculty members to train new dermatologists, who will be capable of providing high-quality care to patients with serious skin disease?

CPT codes 17000, 17003 and 17004 are the bread-and-butter codes ofmost dermatologists. Actinic keratoses, warts and other benignlesions such as seborrheic keratoses, condylomata and papillomataare the most common types of lesions treated by the destructionmethod. Per CPT, the definition of destruction means "the ablationof benign, premalignant or malignant tissues by any method, with orwithout curettement, including local anesthesia, and not usuallyrequiring closure.

Common legal issues facing physicians who perform cosmetic laser treatments include medical malpractice, as well as issues related to physician extenders and the Health Insurance Portability and Accountability Act (HIPAA), an expert says.

Are you thinking about hiring a physician extender? Or did you justhire one? If so, be sure you know how to bill payers for theservices that these nonphysicians provide in your dermatologypractice.