Dermatology Coding Alert

Published on Sat Aug 08, 2009 PDF

Question: My physician sees a patient for a skin cancer screening. Should I use the preventive medicine service codes?

Florida Subscriber

Answer: Since most insurances do not recognize preventive skin cancer screenings, using CPT 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity ...) or 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity ...) with V76.43 (Special screening for malignant neoplasms; skin) would be more appropriate than using preventive medicine service codes (99381-99397). Patients also have no general out-of-pocket expenses.

CPT states, "If an abnormality/ies is encountered or a pre-existing problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate office/outpatient code 99201-99215 should also be reported."

Much better: If the patient has no history of skin cancer, look for other V codes that would be more suitable, like V13.3 (Personal history of disease of skin and subcutaneous tissue). Otherwise, you risk it getting rejected by payers.