Question Can Full body skin exam be billed and paid?

Metroderm

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I need help on preventive care code. We normally do the full body exam and bill as office visit, but some patients are complaining that there should be no copay and no deductible because it should be preventive care. Patient doesn't have any symptoms, but just wanted have skin exam. How do you bill? Can it be preventive care and bill with 99395? How can I handle this visit as regular visit 99213? or 99395?
 

Orthocoderpgu

True Blue
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If you don't have a chief complaint, then 99212-99215 are not supported. If the patient is coming in and only having their skin examined, code 99395 would not be supported either as you have to have an "age appropriate" History, exam and counseling. The extent of the physical exam should be based on the patient's general health. Do they look younger than stated age or older than stated age? As I see it your only performing part of the code, not everything that should be done to support the code.
 

Metroderm

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If you don't have a chief complaint, then 99212-99215 are not supported. If the patient is coming in and only having their skin examined, code 99395 would not be supported either as you have to have an "age appropriate" History, exam and counseling. The extent of the physical exam should be based on the patient's general health. Do they look younger than stated age or older than stated age? As I see it your only performing part of the code, not everything that should be done to support the code.
Patient is 46 years old and has no suspicious lesion nor any complaint. We billed as visit and applied to the deductible. Patient called and complaint that we are using the wrong code. She didn't have to pay anything if we used a preventive care code. I'm just checking if there is any other option that I've missed.
 

thomas7331

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There is no specific code for a preventive skin exam/skin cancer screening, so I think the best option would be to use an unlisted code for this. If the patient's insurance plan offers this as a benefit, they may have some guidance for you as to how they wish it to be billed, but in my experience, it's usually not a covered service. The USPSTF has not recommended skin cancer screening as an effective preventive service, and most payers follow their guidance as far as what services should or should not be covered.

The problem with billing a routine physical exam code, in addition to the fact that it's not really an accurate code, is that the patient likely is only allowed one of those per year, and if you bill it for the skin cancer screening and it gets paid, then the patient will not be able to get another routine visit from their primary care doctor until the following year.
 

Metroderm

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Thank you for all these resource and information. I have to explain patient. Thank you.
 
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