Category: Dermatology

Billing for Incisional Biopsies
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Billing for Incisional Biopsies

December 5, 2019 Question: How do we code for 2 separate incisional biopsies – one on the back and another on the patient’s lower lip? Do we use 11106 and 11107 or 11106 and 40490? Do we need any modifiers to make sure the claim is paid? Answer: If all are incisional biopsies (not tangential...

Definition of Simple versus Complicated
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Definition of Simple versus Complicated

November 14, 2019 Question: What is the definition of simple vs complicated for the I&D codes 10060 versus 10061? Answer: While CPT doesn’t define the difference between “simple” and “complicated”, it is the accepted practice that a simple I&D 10060 is just that. An incision (not just a puncture) is performed, and the abscess is...

New Patient, or Not?
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New Patient, or Not?

October 31, 2019 Question: If I see a new patient in consultation for a suspicious skin lesion and release them to their primary care provider and they come back to see my partner for eczema one year later on their own, can she report the encounter as a new patient visit?   We are the same...

Excision versus Biopsy
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Excision versus Biopsy

October 3, 2019 Question: Does this code description require a scalpel? If you do a punch excision – margins are clear. Can that be billed as excision ? Does excision require a scalpel? A patient got a bill and she is a nurse and claims it should be a punch biopsy.    Answer: The excision codes...

Waiting on Pathology?
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Waiting on Pathology?

September 19, 2019 Question: Do you have to await the pathology report in order to assign the diagnosis of benign or malignant for a lesion; when reporting destruction codes 17000-17111 or any lesion removal codes? Answer: There are multiple answers to your question depending on which piece is addressed. I will try to address them...

Incident-To Billing
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Incident-To Billing

September 5, 2019 Question: Our physicians have instructed us to bill under a physician’s NPI number for all Advanced Practitioners (PA’s and NPs) for all patients for Medicare as we follow incident-to billing. We have been submitting claims for all new and established patient visits regardless of whether there is a physician in the office....

Mohs Staging
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Mohs Staging

August 8, 2019 Question: My physician performed Mohs surgery on a patient with a basal cell carcinoma on his cheek. He took the first stage with 6 tissue blocks, but does cancer is still evident in the margins based on the mappings. A second stage is removed with 4 tissue blocks. The second stage shows...

Lesion Excision and Repair
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Lesion Excision and Repair

July 25, 2019 Question: I saw a patient for an excision of a squamous cell carcinoma on his chest. The size is 4.2 cm diameter. I know I report 11606 for the lesion excision but I also did an intermediate repair with a layered closure and the side is 6.5cm. Can I bill for the...

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