Biopsy billing an important revenue source for dermatology practices

June 1, 2010

The biopsy is a major revenue source for dermatology practices, emphasizing the need for correct biopsy billing practices. Dermatology practices tend to make mistakes in two key areas: basing their billing on intent, and in misrepresenting services.

Key Points

Casselberry, Fla. - The biopsy is a major revenue source for dermatology practices, emphasizing the need for correct biopsy billing practices.

Bill for what you do

"I want to dispel that," Ms. Ellzey says. "You bill based on what you did and what you documented. So, if you are doing a biopsy, and you document that in your medical record - regardless of what the final diagnosis is - that is what you said you did. You do not change that down the road because the diagnosis came out malignant."

It is important to understand what a biopsy is, according to billing practices. The biopsy involves taking a sampling of a piece of skin, whether it is a lesion or some sort of dermatitis, in order to diagnose the condition.

"We should not confuse (the biopsy) with removing a lesion. You do not biopsy a lesion and remove it at the same time, because then you are miscoding. The biopsy is a distinct animal," Ms. Ellzey says. "You cannot say it is a Chihuahua when it is a German shepherd."

Consistency counts

Dermatologists should avoid using contradictory terms when documenting a skin biopsy. These include excisional biopsy, shave removal biopsy and incisional biopsy.

"The biggest mistake that dermatologists make is that they will use the punch instrument on a mole, and do a full-thickness excision instead of a biopsy. If it comes back benign, dermatologists (might) either leave it as a biopsy - which is misrepresenting the service because they actually did a full-thickness excision - or they will change it to a full-thickness excision. But their op notes still say 'punch biopsy.' So, it is incomplete and inconsistent. The documentation does not support what you did," Ms. Ellzey says.

Using a punch to remove a nevus or mole is usually an excision, because, in essence, the dermatologist removes the entire lesion. And this is where dermatologists might make yet another billing mistake, which occurs when the lesion comes back malignant and the dermatologist has to re-excise it. Thinking that they cannot bill for two excisions, some dermatologists will charge the first one as a biopsy and the second as an excision.

"Well, no!" Ms. Ellzey says. "If you excised it the first time, you did a full-thickness excision."

The message here, she says, is that if a dermatologist is using a punch and doing a full-thickness removal of a lesion, the dermatologist is doing an excision - not a biopsy. If the lesion is benign, then this is an excision using the 11400 series of codes. If the lesion comes back malignant, then the dermatologist should use the 11600 series, indicating that he or she is going to go back and do a second excision to get the margins clean, according to Ms. Ellzey.