Wiki General Dermatology questions

[swendlandt]

Hello,

I am looking for general feedback and knowledge in regards to dermatology services. Services would be provided via telehealth POS 10 but overall general information is also helpful.
Most NPs providing care
10-20min visits
A majority of the time some Rx is being prescribed. Some medications will require labs (spironolactone)
It will cover a broad range of conditions, but Acne and Cold Sores will probably be the most common.

Questions I have are as follows:

Any other flags you'd have for a derm program? It seems like acne is generally covered for E/M visits, but want to confirm.

I expect 90% of these to be Level 3 with 10% being Level 4 when labs and an RX are involved

Does the complexity level seem right?

Thank you everyone for your knowledge and feedback as I do not have experience in dermatology.

 

[TThivierge]

Hello,

I am looking for general feedback and knowledge in regards to dermatology services. Services would be provided via telehealth POS 10 but overall general information is also helpful.
Most NPs providing care
10-20min visits
A majority of the time some Rx is being prescribed. Some medications will require labs (spironolactone)
It will cover a broad range of conditions, but Acne and Cold Sores will probably be the most common.

Questions I have are as follows:

Any other flags you'd have for a derm program? It seems like acne is generally covered for E/M visits, but want to confirm.

I expect 90% of these to be Level 3 with 10% being Level 4 when labs and an RX are involved

Does the complexity level seem right?

Thank you everyone for your knowledge and feedback as I do not have experience in dermatology.

Hi Swendlant
If the lab results taken on skin bx it may change to something more such as: in situ , malignant, uncertain, carcinoma, Etc. We were always told to wait till got lab results return before coded this info. It is better to wait till results come back to code it with most details. I hope you are allowed to read the lab results. If not allowed code it D49.2 . Part of the medical coding is to use most details to ensure correct coding. But go by your protocol at your office. Also when do lab CPT coding for skin bx of lab codes range from CPT 88302 to 88305 which connect to type of skin imperfections if provider documented such as: skin tag, wart, cyst, lipoma, mass, nevus, pilar cyst, boil or mass on certain body areas. Here are the dx blocks to consider....... Lipoma D17 Boil L02 Skin lumps mass R22 Wart dx B07 or L82 Lesion L89 M.Nevi D22 Cyst L05 Skin changes R23.4 Unspecf Neoplasm skin bone D49.2 Benign Neoplasm per body area D21 to D25 per providers documentation.

Also do not forget to end the claim with Z dx. code describe encounter fit patient circumstances such as.......
Z12.83 Encounter malignant skin Z13.89 Encounter for unknown disorder Z87.2 History of skin disorder Z85.820 Personal History of malignant skin DO
Z86.018 Personal HO of benign neoplasm skin

I hope this data helps you
Lady T

 

[TThivierge]

Hi Again Swendlandt,
Here is a bit more on dermatology. If pt has lump to be drained use CPT 10021, 10004 no imaging guidance and CPT 10005-10012 FNA with imaging guidance. Also if lump neoplasms is cancerous vs non cancerous use proper CPT code Add modifier 59 if 2 lumps or cysts aspirated in differ areas on body, document site on body and describe it. Debridement are CPT 11042-11047 depends if skin tissue, bone, or muscle.
Other CPT codes for skin start in page 83 of the 2025 CPT manual. Lesions should be measured, skin tags noted and if cancer vs benign neoplasm and location on body. Use definitive dx code FIRST and Z dx codes last.
Use CPT 96912 or 96931 if photos taken of skin problems. IF this is a consult in office new or est. use that CPT code plus which doctor referred patient to dermatology practice.

Keep in mind non pressure vs pressure ulcers on skin L97 and L98 and depth mentioned, Insect bites S60.56 , Chigger biteB88, Blisters, dx S20, Boils L02, Nevus (moles) dx D22 Keloid scars L73.0 vs Skin Scar L90 Dry skin is Xerosis L85.3 just to name a few skin diagnosis. and if pt has skin conditions due to chronic condition I d add that too such as dx E11 or varicose veins or infections.

I hope this data helps you

Lady T