The final rule in the Federal Register for dermatology diagnostic codes and reimbursement, scheduled to start January 1, 2020, is different from what was originally proposed.
“The final rule will no longer collapse the two codes into two sets,” said Brett Coldiron, M.D., a clinical associate professor of dermatology at the University of Cincinnati in Ohio. “Instead, there will be new evaluation and management codes that will benefit dermatology because they are based on medical decision-making.”
In addition, the expected loss of the global periods (follow-up patient visits built into the original code) and the modifier 25 (performing two significantly different procedures on the same day, with separate allowable billing for each) have at least been temporarily shelved by the Centers for Medicare and Medicaid Services (CMS).
“But CMS is hinting that it may indeed remove the global periods from our codes next year,” said Dr. Coldiron, who provided a legislative and regulatory update at the Fall Clinical Dermatology Conference. “That would be catastrophic for dermatology,” representing on average a $100,000 reduction in annual income from Medicare alone for each practicing dermatologist.
“If the legislation passes, we will have to try to turn around and bill the patients for those follow-up visits, which will not be very popular,” said Dr. Coldiron. “Can you imagine asking granny to pay a co-pay to have her sutures removed from a procedure ten days ago?”
Dr. Coldiron is the current chair of SkinPAC.
Coldiron B. Legislative and Regulatory update and its impact on you. Presented at the Fall Clinical Dermatology Conference; October 17, 2019; Las Vegas, NV.