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Wiki Total body scan exam

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andersont

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Yakima, WA
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Are there any screening codes for this exam? I have had patients say their insurance will pay 100% for a screening. We bill a level of service and dx codes for whatever the skin shows ie. rash, moles etc. When we bill this, it's paid usually at 80%. Insurance tells the patient we didn't code as a screening. Thanks
 
Your patients are probably confused. Certain screenings (such as mammograms) are provided without a co-payment by the insurer (and here in Florida, that's state law), but I am not aware of any payer or state that includes skin cancer screenings among these.

Although V76.43 is the correct code for skin screening for malignancies, we never use this as a primary diagnosis, because it is not payable by insurance. We do as you do; bill the diagnosis based on the findings and, if there are none, we use V10.83 or V10.82 (personal history of skin cancer), which are payable. I don't think we've come across a patient yet who didn't have one or the other (findings or history)!

I would explain to the patients that their insurance does not even cover skin cancer screenings, much less waive the co-pay, so if you billed it as a screening they would have to pay for the visit as a non-covered service.
 
If the patient presents for screening you are required to use the V code for the screeening as the first listed code, the findings are a secondary code to indicated an incidental finding. You cannot code for payment, you must code the visit as what it was, it is screening for preventive purposes. Also use the 33 modifier on the 99214 to indicate this was performed for preventive reasons. If the screening is covered the 33 will waive the copay.
 
The rules for modifier 33 state that it can only be used for "evidence-based services in accordance with a US Preventive Services Task Force [USPSTF] A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory)." (See http://www.ama-assn.org/resources/doc/cpt/new-cpt-modifier-for-preventive-services.pdf for an explanation and http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm for a list of included services.) Skin cancer screening is not included, so I do not believe that you could use modifier 33 for a skin check.

When you use the V-code as your primary diagnosis, are there any insurers who pay for the exam? Or do you collect from the patient as a non-covered service?
 
V code

For our Dermatologists some of the patients policies waive the copay for billing a V code as the primary diagnosis such as the V711 and V1083 and V1082. Most insurance companies websites will have a list of preventable diagnosis codes. Its per policy and just because lets say one blue cross does it doesnt mean the other will. We have billed these with 99213, 99212 etc and copays have been waived. I am in Michigan. In some cases we just have to explain to the patients that dont have this V code coverage waiver that there is not an established code like there is for lets say their primary care physician for a well visit. I wish the insurance companies would make a code for derms. Annual skin checks are just as important has an annual physical. :) Oh an I have never had a claim deny as a non covered service with a V code on it. The only time it has been denied is when a patient does not have office call coverage on their policy at all. Hope this helps.
 
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