Specialties
Medical billing for dermatology
Dermatology combines visits, procedures and pathology, often on the same day, and many claims can’t be coded correctly until the pathology report comes back.
What makes dermatology billing hard
- Biopsies are coded by technique, such as tangential, punch or incisional, and by the number of lesions.
- Excisions are coded by size, including margins, and by whether the lesion is benign or malignant. That depends on pathology, so billing before the report arrives is a guess.
- Destruction of lesions such as actinic keratoses is counted by number, and the count changes the code.
- Mohs surgery, where the surgeon also acts as pathologist, is billed by stages and tissue blocks.
- Same-day visits and procedures. A separately identifiable visit on the day of a procedure needs modifier 25 and documentation to support it.
- Cosmetic or medical. Payers exclude cosmetic services, and patients need to agree to self-pay before the service, not after the denial.
How we work it
Excision claims are held until pathology confirms the diagnosis, then coded by size and type. Coders check lesion counts and procedure details against the note, and services that are likely to be cosmetic are flagged so the patient’s agreement is in place before treatment.
Common questions
Should we wait for pathology before billing an excision?
Yes. Excision codes depend on whether the lesion is benign or malignant, and only the pathology report confirms that. Billing early often means a corrected claim later.
How do you handle cosmetic services?
They’re identified before the visit where possible, so the patient agrees to pay directly. Submitting them to insurance and waiting for the denial delays payment and frustrates the patient.
Start with the free audit
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