27 Mar Dermatology Billing’s Unique Challenges
Coding is Key When It Comes to Dermatology Billing
Dermatology billing services has its own unique set of circumstances and needs, just like any subsection of medical billing. Here are some ways that dermatology billing stands out.
The major problem with dermatology billing—what really results in delayed or rejected claims—lies in coding. It’s easy to misunderstand dermatology billing codes, and that cuts two ways. Medical professionals often either upcode or undercode for dermatology billing services.
Upcoding
Upcoding is billing for a higher level of service than what was actually delivered to a patient—for example, billing for a comprehensive exam when there was only a problem-focused exam. Upcoding can also occur when medical professionals confuse excisions and biopsies. While an excision is a surgical procedure where an entire lesion or growth is removed, with surrounding healthy tissue, a biopsy only extracts a small of sample from the lesion or growth to perform a diagnosis. An excision is clearly a more involved procedure than a biopsy, but if you’re billing for an excision when you performed a biopsy, you’re upcoding.
Undercoding
Undercoding occurs when a dermatologist performs a more extensive procedure than what the claim bills for. In other words, the doctor did more work than they will be paid for. Your office must avoid undercoding if you’re to be reimbursed sufficiently for the services you deliver.
Two examples of undercoding result from dermatology billing coding mistakes regarding cryotherapy and electrosurgery, which are the two most prevalent methods for destroying malignant growths in dermatology. You’re undercoding if you’re dermatologist and you utilize cryotherapy to destroy a malignant growth, but by mistake, you bill for a less complex procedure, like a simple excision. Another example of undercoding would be if you employed electrosurgery to destroy a growth, but you billed for a less complicated procedure, such as electrodesiccation.
You’re also undercoding if you treat multiple malignant growths, but you bill for only one. The right way to do it would be to bill for each growth separately, since each requires a distinct procedure.
This is why it’s so important to be exact in your coding, because by undercoding, you won’t be paid back for the real value of the services you provided. Your practice will bleed cash as a result.
We can’t stress this enough—if you’re performing dermatology billing, you must thoroughly understand the right CPT and ICD-10 codes. For your practice to receive the maximum reimbursement it deserves, you must accurately code all your claims, because insurance companies will be ascertaining that all the procedures you’re billing for are medically necessary, and don’t fall under the category of cosmetic dermatology.
At Medusind, we’re coding experts when it comes to dermatology billing. We make it our job to keep up to date on the latest coding changes and requirements, so that when we process your claims, your practice gets the maximum funding possible.
