How do you handle billing for full skin check in pts without skin cancer history?

CatchTheWind

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My understanding is that most carriers will not pay for a ROUTINE (ie: annual) full skin check unless the patient has history of skin cancer. So I am wondering how your offices handle these visits. Do you provide them at no charge?... Bill the patient?... Expect that the provider will find at least one problem and use that as the diagnosis?...
 

thomas7331

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I don't think a history of skin cancer is required by payers, but it's true that they often won't cover a skin exam that's simply a screening, i.e. there is no complaint. I heard this discussed at length in a derm conference a number of years back. The recommendation was that if a patient comes in for a 'skin check', the provider or staff doing the intake should interview the patient to determine more specifically what concerns that might have about their skin, because it's rare that an adult will have perfect and unblemished skin yet still feel the need to have a dermatologist do a full body skin check. Typically there are lesions that the patient or PCP feel are concerning and need a trained eye to diagnose. Even if those turn out to be benign, it's still considered medically necessary to evaluate those, and that warrants billing the skin check as an E&M service. But if the patient truly has nothing of concern on their skin, then it really is a screening that really could be handled as part of their preventive annual PCP physical and billed as such, and if they insist on a specialist exam for their 'peace of mind' we would typically advise the providers to let the patient know in advance that this may not be covered under their preventive care benefits and could end up being self pay.
 
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Full skin check resulting in procedure

In this situation, if the full skin check results in the provider removing a lesion, would the exam bundle into the procedure, or does it warrant a separate code?


For example, the progress note contains the following, and cryo was performed on the plaque noted:
General Examination:
CONSTITUTIONAL: Well nourished and well developed in no acute distress. Affect is normal and appropriate.
SKIN: Total body skin examination was performed including palpation and inspection of scalp, face, neck, chest, abdomen, back, buttocks, right and left upper extremities and right and left lower extremities including the hands, feet, nails notable for: fair skin with few light brown scaly plaques of even pigmentation and shape. scaly gray plaque noted on left popliteal fossa. No lesions noted suspicious for malignancy
 
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