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FINANCIAL CONSIDERATIONS IN DERMATOLOGIC SURGERY

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SUMMARY

  • The goal of complete and accurate coding is to clearly define to a payer what was performed during a given patient care interaction.

  • Each procedural charge submitted to a payer must be correlated with a valid diagnostic code.

image Beginner Pearls

  • Determine the excision code size by adding the maximum lesion diameter to that of the summed narrowest bilateral excision margins.

  • If a patient evaluation leads to a 90-day global procedure done on the same day, then the evaluation and management service is separately billable with modifier .57 appended.

image Expert Pearls

  • Immunohistochemical stain coding is defined as per specimen, and not per block of tissue.

  • Redundant tissue removal (standing cones or dog ears) does not elevate an otherwise linear closure procedure to the level of a flap, though it may turn an otherwise intermediate into a complex linear repair.

  • When a defect or a portion of a defect is repaired with a Burow’s graft generated from a linear excision and closure adjoining the defect, only the skin graft procedure is billable, as the graft code includes the excision and direct closure of the donor defect. Mohs surgery is still billable separately, though it may be subject to the multiple procedure reduction rule.

image Don’t Forget!

  • When more than one repair of the same type (simple, intermediate, or complex) is done within one anatomical area, sum the lengths of the repairs and bill for one closure, as directed by the site and sum of the of the repair lengths. If repairs of the same type are done in different anatomical code group areas, then bill each one individually.

  • A Z-plasty generated from the edge of a flap to promote the flap’s mobility does not constitute an additional separate flap.

image Pitfalls and Cautions

  • Avoid using “unspecified” (NOS—Not Otherwise Specified) diagnostic codes, highlighted in yellow in the ICD-10 manual, as this indicates that the medical record lacked sufficient information for a more precise code selection. Some insurers may deny claims with “unspecified” codes.

  • Excisions of epidermal inclusion and pilar cysts that extend into the subcutaneous space should be coded with the integumentary excision codes, as these entities are of skin, and not subcutaneous, origin.

image Patient Education Points

  • It is worth explaining to patients that physicians will bill insurance companies as a courtesy to them, but that ultimately it is the patient’s responsibility to cover the cost of any procedures performed.

  • Explaining that the surgeon is bound by the terms of a contract with the insurer helps the patient understand that the surgeon is indeed their ally.

INTRODUCTION

Surgical dermatology encompasses a variety of both therapeutic and cosmetic procedures. An appreciation of the techniques needed to optimally document the patient record and convey what was done into the billing system and, ultimately, to the payer, ...

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