Maximize your dermatology practice revenue with specialized billing expertise. Our certified coders understand the complexities of skin procedures, cosmetic vs medical distinctions, and pathology coordination to optimize your reimbursements.
Proven Results
28% Average Revenue Increase
97% First-Pass Claim Rate
45% Reduction in Denials
12 Days Faster Payment Collection
Common Billing Challenges
Cosmetic vs Medical Coding
Distinguishing between cosmetic procedures (non-covered) and medically necessary dermatologic treatments requires precise documentation and coding.
Complex Procedure Coding
Dermatology involves numerous procedures with specific size, location, and technique modifiers that must be accurately applied.
Pathology Coordination
Managing billing for biopsies, excisions, and coordinating with pathology labs for proper claim submission.
Phototherapy Billing Complexity
UV phototherapy for psoriasis and other conditions requires tracking treatment units and frequency limitations.
Multiple Lesion Management
Billing for multiple lesion removals, destructions, or biopsies in a single visit requires complex coding and bundling knowledge.
Prior Authorization Delays
Biologic medications and certain procedures require extensive prior authorizations that delay patient care.
Our Solutions
Dermatology-Certified Coders
Our team includes certified coders with specialized training in dermatologic procedures and cosmetic vs medical coding distinctions.
Accurate CPT and ICD-10 coding for all skin procedures
Expertise in lesion measurement and site coding
Knowledge of cosmetic exclusion guidelines
Proper modifier application for multiple procedures
Documentation & Compliance
Comprehensive documentation review ensures medical necessity is clearly established for all procedures and treatments.
Medical necessity validation before submission
Photographic documentation guidance
Pathology report coordination
Audit-resistant claim submission
Revenue Optimization
Maximize reimbursements through proper coding of complex procedures, biopsies, and pathology coordination.
Capture all billable procedures per visit
Proper bundling and unbundling decisions
Reduced accounts receivable aging
Improved cash flow management
Prior Authorization Management
Dedicated team handles all prior authorizations for biologic medications and specialty procedures.
Faster approval for biologic therapies
Reduced administrative burden
Higher approval rates through proper documentation
Streamlined patient treatment initiation
Specialized Services
Medical Dermatology
Expert billing for acne, eczema, psoriasis, and other medical skin conditions with proper E/M coding.
Medical consultations
Chronic condition management
Phototherapy billing
Biologic infusions
Surgical Procedures
Specialized billing for biopsies, excisions, Mohs surgery, and skin cancer removal with accurate size coding.
Biopsy procedures
Excisions with repair
Mohs micrographic surgery
Flap and graft procedures
Cosmetic Procedures
Clear billing distinction for cosmetic treatments and proper patient financial responsibility communication.
Cosmetic procedure tracking
Patient payment processing
Medical crossover identification
Cash billing optimization
Pathology & Lab Billing
Comprehensive billing for in-office procedures with pathology coordination and proper specimen tracking.
Pathology coordination
Specimen tracking
Lab result integration
Professional fee billing
Common CPT Codes Reference
Key codes include 17000 (destruction of first premalignant lesion - actinic keratosis), 17003 (destruction of additional premalignant lesions 2-14), 11400-11406 (excision of benign lesion by size), 11600-11606 (excision of malignant lesion by size), 11102 (tangential biopsy), 11104 (punch biopsy), 11106 (incisional biopsy), 17311-17315 (Mohs micrographic surgery stages), 96920 (laser treatment for inflammatory skin disease), and 17340 (cryotherapy for skin lesions). Accurate size-based coding, lesion count documentation, and modifier usage are critical for dermatology reimbursement.
Expert Billing Insights
Lesion Excision Size-Based Coding Accuracy
Dermatology excision coding (11400-11406 for benign, 11600-11606 for malignant) requires precise measurement of the excised diameter including margins, not just the clinical lesion size, with code selection based on both size and anatomical location. Undercoding excision size is one of the most common revenue loss areas in dermatology, as the difference between a 1.0 cm and 1.1 cm excision can change reimbursement by 30-50%. Practices should implement standardized measurement protocols and ensure pathology reports confirm excision dimensions to support the billed code.
Measure and document the excised specimen diameter including margins, not just the visible lesion size
Use anatomical site groupings correctly: trunk/extremities, scalp/neck/hands/feet/genitalia, face/ears/eyelids/nose/lips
Cross-reference pathology reports with billed excision sizes to ensure consistency and audit defensibility
Train providers to document intermediate or complex repair separately when closure requires more than simple sutures
Mohs Micrographic Surgery Multi-Stage Billing
Mohs surgery billing uses 17311 for the first stage with up to 5 tissue blocks, 17312 for each additional stage, and 17313-17315 for additional blocks beyond 5 in any single stage. Each stage and block must be individually documented with frozen section interpretation, mapping, and margin assessment to support billing. Mohs reimbursement can exceed $1,500 per case with multiple stages, making accurate stage and block counting essential for revenue optimization while maintaining compliance.
Document each Mohs stage separately with tissue map, frozen section interpretation, and margin assessment
Bill 17312 for each additional stage after the first, with a separate operative note for each stage
Use 17313-17315 for tissue blocks exceeding 5 in any single stage, with documentation of each individual block
Bill the reconstruction/repair procedure separately using the appropriate repair code (12001-14302) after Mohs completion
E/M Services with Modifier 25 in Dermatology
Dermatology practices frequently perform E/M services on the same day as procedures, requiring modifier 25 to indicate a significant, separately identifiable evaluation and management service beyond the procedure decision. Payers increasingly audit modifier 25 usage in dermatology, requiring documentation that clearly separates the E/M component from the procedure-related assessment. Proper modifier 25 usage can increase per-visit revenue by 20-40%, but improper use can trigger audits, refund demands, and compliance penalties.
Document the E/M service with a distinct chief complaint, history, and medical decision making separate from the procedure indication
Avoid using modifier 25 when the E/M visit only confirms the decision to perform the already-planned procedure
Ensure E/M documentation addresses conditions or concerns beyond the specific lesion being treated or biopsied
Monitor modifier 25 utilization rates by provider and compare against specialty benchmarks to identify audit risk
Payer-Specific Billing Tips
Medicare (Traditional FFS)
Follow Local Coverage Determinations (LCDs) for premalignant lesion destruction, as LCDs specify documentation requirements for actinic keratosis treatment and photodynamic therapy coverage
Document lesion-specific diagnoses with ICD-10 codes that support medical necessity for each biopsy or excision, avoiding unspecified diagnosis codes
Comply with the two-midnight rule for Mohs surgery requiring extended observation, ensuring proper outpatient vs inpatient status determination
Bill global period services correctly for excisions with 10-day global periods, understanding that follow-up visits within 10 days are included
Medicare Advantage Plans
Verify prior authorization requirements for Mohs surgery, as many MA plans require pre-approval based on lesion type, size, and anatomical location
Obtain prior authorization for biologic medications (dupilumab, secukinumab) before initiating therapy, as MA plans have stricter step-therapy requirements than traditional Medicare
Appeal downcoded Mohs surgery claims with detailed operative notes documenting the medical necessity for each stage performed
Document HCC-qualifying diagnoses such as melanoma and other skin cancers during encounters to support accurate risk adjustment scoring
Commercial Payers
Verify cosmetic exclusion policies for each commercial payer, as coverage for lesion removal may depend on clinical documentation of functional impairment, pain, or premalignant features
Obtain pre-authorization for photodynamic therapy, biologic medications, and extensive Mohs surgery cases to prevent post-service claim denials
Document medical necessity for procedures that could be perceived as cosmetic, including photographs, symptom documentation, and prior treatment history
Bill cosmetic procedures as patient-responsibility with proper ABN or financial agreement, keeping cosmetic and medical claims on separate encounters
All Payer Best Practices
Track 10-day global periods for excisions and 0-day global periods for biopsies to avoid billing included follow-up services separately
Implement a lesion documentation template that captures size, location, clinical description, and medical necessity for every procedure
Maintain a modifier usage log tracking 25, 59, XE, and 76/77 utilization rates to identify patterns that could trigger payer audits
Coordinate pathology billing with dermatopathology labs to prevent duplicate billing and ensure proper professional/technical component separation
Client Testimonial
Medtransic's dermatology billing expertise has transformed our practice revenue.
Their understanding of cosmetic versus medical coding and pathology coordination
has increased our collections by 32% while significantly reducing claim denials.