Dermatology coding depends on measurements taken at the time of the procedure. Lesion size and count determine the code, and if the note records neither, the claim goes out on a guess.
Bundling is the other frequent trigger. A biopsy performed at the same session as an excision is often included in the excision, and billing both without justification produces a denial that looks like an error even when the work was separate.
What trips dermatology claims up
- Lesion counts and sizes taken from the note, since the code depends on both
- Biopsy billed separately only where it wasn't bundled into the excision
- Benign and malignant destruction coded from the pathology result
- Cosmetic versus medically necessary separated before the claim goes out
What we check before a claim goes out
- Lesion counts and sizes taken from the operative note
- Biopsy billed separately only where not bundled into the excision
- Benign versus malignant coded from the pathology result