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History of Skin CA MDM

SUEV

Guru
Local Chapter Officer
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202
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I'm new to dermatology and have found that many coders suggest using the E/M codes 9921x-9920x for full body skin exams. If a patient has a history of skin ca and nothing is found, I'm coming up with straightforward MDM. Is that correct? If the pt is new, would you consider this a new problem, no workup (3pts) or a self-limited, minor problem (1 pt) since it's only a history. In the table of risk, if nothing's found would you consider this straightforward (self-limited, minor) or would some consider this low (stable chronic)? I would consider these self-limited, minor since nothing's found but wanted to double-check.
Also, if the patient presents with no history and just wants a full body exam and nothing's found, would these be coded as unlisted codes and the patient billed directly? Do we have to submit these charges to the insurance company first?
Thank you,
Sue
 

dtricia

Guru
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198
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History of skin CA exams

There are also diagnosis codes for Following up (V67)which are for surveillance following chemo or other treatment. I would not consider such an exam 'only a history or a minor problem' if it was a melanoma. This is an important follow-up for the patient, something they will have to do going forward for the rest of their life. Stable chronic would seem more appropriate if nothing found.
Tricia D.
 

CatchTheWind

True Blue
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589
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To Question #1: We have also struggled with the question of whether history of skin cancer gives us a straightforward or low MDM. My conclusion is that the "problem points" are going to be straightforward (resolved problem), and the "risk level" is low. But that's just my subjective take on it; I don't believe there is any definitive answer.

To Question #2: See: https://www.aapc.com/memberarea/forums/showthread.php?t=74176&highlight=history If the codes you use are never covered by the insurer, you do not have to send the claim first, and can collect from the patient without an ABN.
 

Gadomski1

New
Messages
1
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Dermatology Full Skin Exams

We are also billing out E & M codes. Are there any guidelines as to how many we can do a year since we are using E & M. I was told Full Skin Exams are once a year but allot of our patients want them every six months. Is it based on Diagnosis??

Thanks
 

CatchTheWind

True Blue
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589
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Because this is a "medically necessary" (not preventive) visit, there is no limit. (This is assuming you are billing with a "history of skin cancer" diagnosis, and not using the patient's annual wellness exam.)
 
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