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    Wiki 99072

    According to DermCoder, "BCBS has recently stated they will not be reimbursing for this code." (They do not state which BCBS they are referring to, so I am guessing Florida, since that's where DermCoder is located.) DermCoder also says that you can use this code with E/M or procedures, and...
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    Wiki Incident to requirements

    To clarify what I believe Orthocoderpgu is saying, it is perfectly fine for a PA to see a new patient and bill with the PA as the rendering/billing provider. It is only when billing "incident to" (with the doctor as the provider) that the PA needs to be following the doctor's plan.
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    Wiki New ICD-10 codes starting October 1

    I just heard that there are new ICD-10 codes as of October 1. Do any of these apply to dermatology?
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    Wiki billing and E/M with a procedure

    applegateml is correct. You would not bill another E/M.
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    Wiki MIPS payments from Medicare Advantage plans

    Do we get MIPS payments from Medicare Advantage plans?
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    Wiki mips

    You have to report MIPS for all patients, regardless of insurance.
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    Wiki Out-of-Network provider

    Sharon, your practice is breaking the law. You are required by HIPAA to agree to any patient request not to bill their insurance (even on a one-time basis). This has been addressed in numerous threads; scroll around and you will see them.
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    Wiki 10060

    Be aware though that some payers won't pay for 10060 or 10061 if the diagnosis is "cyst." These codes are only for abscesses. (For those that won't pay it for cyst, we use 10140, which is drainage of "fluid collection."
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    Wiki Acne table of risk category

    I would call it a stable chronic illness, but that's just my opinion.
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    Wiki esthetician to do Acne Surgery 10040 bill to insurance?

    If she is doing it for cosmetic purposes, then the diagnosis is "cosmetic" and insurance won't cover it. If it was ordered by a doctor for treatment of the acne, then the diagnosis is "acne" and it can be covered.
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    Wiki incident to when there is a new diagnosis

    A patient sees the PA for follow-up on a the doctor's diagnosis and plan, but during the visit the PA diagnoses a new, unrelated condition. My understanding is that the visit cannot be billed incident to, but the doctors are giving me a hard time, stating that what matters is the condition the...
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    Wiki What Designates an "Active Involvement" in Plan of Care?

    There is nothing specific that I am aware of, only that services have to be provided by the doctor on a frequent enough basis to demonstrate his continuing active participation in the patient’s care.
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    Wiki If chemical peel is done on more than one body area, do you bill for two?

    If chemical peel 15792 is done on more than one body area, do you bill the code twice, or does one code cover the entire body?
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    Wiki Mohs

    If it is on the same lesion, you cannot bill. If it is on a different lesion, you can.
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    Wiki Supervision requirements for mid-level provider

    I cannot find clear information about Medicare "incident to" supervision requirements for telehealth visits. If the doctor is in the office, but the mid-level is working from home (or vice-versa, or they are both working from their own homes) does this mean we cannot bill incident to?
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    Wiki billing for phone "visit"

    Use the codes as follows (during the COVID-19 emergency only): G2012: brief telephone check-in (established only) 99441: telephone visit 5-10 min (new or established) 99442: telephone visit 11-20 min (new or established) 99443: telephone visit 21+ min (new or established) G2010: brief...
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    Wiki Telehealth 3-31-20

    Telephone-only visits are now billed as 99441-99443. Interactive audio-video visits (ie: Skype, Facetime) are billed as 99201-99205 and 99211-99215.
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    Wiki telephone only calls

    Medicare will temporarily pay for telephone-only visits that are more detailed than virtual check-ins. Use these codes: 99441: 5-10 min 99442: 11-20 min 99443: 21+ min I do not know what the difference is between 99441 and G2012.
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    Wiki 99211 vs 96372

    jbland, that is not correct - you can bill a 96372 without a J code (ie: when the patient brings their own medicine).
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    Wiki Telehealth services vs OV and modifiers

    See https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
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    Wiki Consent for telehealth

    It can be verbal. But you do have to document that you received it.
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    Wiki Derm TeleMed - Need immediate Help

    Note that in the blue and white chart at the bottom of the page that JesseL linked, there is a typo: 99431 is supposed to be 99421.
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    Wiki billing for phone "visit"

    The rules about patient having to call from a health-care facility rather than their own home have been waived due to the crisis.
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    Wiki Laser treatment for Vitiligo

    Send the claim as usual. You will get a denial or a letter requesting records. (Unless it is a carrier that accepts paper claims, in which case you can just send a paper claim with the records attached.) By the way, I just learned that some Medicare MACs will allow it. (Ours in Florida does...
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    Wiki When the secondary pays more than the Medicare allowed amount

    If a patient has Medicare plus a commercial insurance and Medicare is primary, Medicare pays 80% of the allowed amount, and then the secondary pays MORE than the remaining 20% (perhaps because their fee schedule is higher than Medicare's). Can you keep the difference, or do you have to refund...
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    Wiki 96401 vs 96372

    96401 is for chemotherapy injections. Humira, Dupixent and Stelara are not chemotherapy, so you have to use 96372.
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    Wiki Complex closure changes

    Are you sure the surgeon took a 1 cm margin on every side? That sounds really large. If so, it looks like you'll have to bill for intermediate. The way he will get "credit for the work performed" is that he will be billing for a larger wound than he would otherwise have done.
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    Wiki HELP PLEASE Excision code

    You code by the length, which is 0.07, so it's 11440. Are you sure those zeros belong in there? It sounds awfully small. (If it's actually 0.7 x 0.4 x 0.1, then the code would be 11441.)
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    Wiki E/M Level Elements - Derm example

    You need to exclude the elements related to the biopsy and just count what's left.
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    Wiki Global billing

    No, commercial insurance does not allow this! If a visit is within a global period, you can't bill insurance or the patient (unless the visit is for an unrelated problem). They are cheating their patients.
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    Wiki Humana denying claims for "no referral" even though we attached it

    We have indeed had better success getting claims paid when we ensure that the PCP uses the correct TOS (type of service): "medical" for CPT codes starting with 9, and "surgical" for codes starting with other numbers.
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    Wiki Deterioration of support at Allscripts

    We used to think Allscripts support department was very responsive and their reps were very knowledgeable. Now response times are spotty, all the old reps seems to be gone, and they are filled with new people who only halfway know what they are talking about. Is anyone else having the same...
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    Wiki Allscripts

    We have Allscripts Pro PM. Their reporting capabilities are very limited. We often have to make up our own reports using "Report Builder." I assume you have logged a case with support asking them where the information for each report comes from. If not, my suggestion would be to do that...
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    Wiki Medical assistant seeing the patient

    I have several questions regarding visits at which the patient sees only a medical assistant (for something that is allowed to be performed by auxiliary personnel, such injection or suture removal): 1. Does a licensed provider have to be present in the office? 2. Does a licensed provider have...
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    Wiki HIPAA VIOLATION?

    It's not difficult to verify that the person is at a legitimate medical practice. Just Google the practice, call them, and verify the address or fax number that the original caller gave you!
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    Wiki Premade Template Guidelines

    This is from First Coast Service Options (the MAC for Florida) at https://medicare.fcso.com/Publications_A/2006/138374.pdf : “Documentation is considered cloned when each entry in the medical record for a beneficiary is worded exactly like or similar to the previous entries. Cloning also occurs...
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    Wiki Multiple Claims in 1 Day

    If the payer requires modifier 51 when you have multiple surgeries, you should include that modifier. If they don't, their software should be able to catch this and reduce one of the payments. I don't think you have any responsibility to "alert" them, as long as you've used modifier 51 if they...
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    Wiki Diagnoses from pathology requisition

    It would seem to me that if the referring provider is giving you a diagnosis on the requisition, why would you need anything more?
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    Wiki Not Billing Insurance but accepted patient copay

    This may be a question for a lawyer. Apart from the legalities, I do see an ethical issue: Whenever a patient pays a co-pay, his insurance credits that toward his annual out-of-pocket maximum. By not filing the claim, the provider is cheating the patient out of the chance to meet his OOP.
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    Wiki Chemical peel for AKs: 17004 or 15788 series?

    Does anybody know?
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    Wiki Chemical peel for AKs: 17004 or 15788 series?

    Would you code a chemical peel for AKs as 17004 or with a code from the 15788-15793 series?
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    Wiki Who is the provider when an MA gives an injection?

    If an MA gives an injection (96372), since the MA has no NPI, do you put the doctor as the rendering physician (ie: field 24J)?
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    Wiki Medicare Advantage plans: Does 2nd appeal go to CMS's Independent Review Board?

    Medicare states "If a Medicare Advantage (Part C) health plan makes an adverse reconsideration decision (upholds its initial adverse organization determination), the plan must automatically submit the case file and its decision for review by the Part C Independent Review Entity (IRE)." We have...
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    Wiki What to charge for Candida Injection?

    The only time we billed for Candida injection, which was two years ago, we billed $228.06 for the J3490. This must have been based on our cost, although I can't remember for sure. Be aware that it may not be covered!!!
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    Wiki DermCoder software issue

    We have had the same issue. I don't know if you are all aware, but the owner (Karl Ellzey - Inga's son) passed away in early January. I believe his wife now running it, and she is probably struggling. I don't know what the future will bring - I hope she can get a handle on it or bring in...
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    Wiki Xtract and Excimar Laser treatment

    You cannot use 96910 for Excimer Laser. When using excimer for vitiligo, you have to use either 96920/21/22 or 96999, depending on the carrier.
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    Wiki Is pathology needed for biopsies?

    If you want to be technically correct, use D49.2. As Debra pointed out, D48.5 means that the pathologist has examined the tissue and has determined that there is something uncertain or atypical, while D49.2 means that the clinician doesn't know what it is.
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    Wiki clarification of 10140 vs 10060

    I never got any responses. We use 10140 whenever it's a cyst rather than an abscess, because that does seem to satisfy the CPT description better. But I've never gotten any definitive confirmation that this is correct.
  49. C

    Wiki Frozen section and BX on different site of Mohs

    As long as it's a separate site, it is billable. Be prepared for a denial, which you will have to appeal with records showing that this was a different lesion from the one treated with Mohs.
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    Wiki Multiple Claims in 1 Day

    Which "biopsy" are you talking about? If you mean the examination of the tissue being removed during the Mohs procedure, this is not billable. It is part of the Mohs. As for the Mohs and the closure by two different doctors, you can bill them on separate claims. Mohs and closure...
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