Will any carriers pay for diagnosis Z12.83

thomas7331

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I don't know of any payers that cover skin cancer screening as a separate preventive service, and there isn't really a CPT or HCPCS code to represent this anyway.

My thoughts - a skin check would be inclusive to an annual preventive physical exam visit, which is covered by almost all payers now and that's where a skin cancer screening should take place. For a health patient with no symptoms, there really isn't any medical necessity to justify a separate visit to a specialist just to exam the skin if the patient's primary care provider didn't find anything of concern. On the other hand, if the patient has a history of skin problems that makes them higher risk and the physician has recommended periodic exams to check for a recurrence or new cancer, then it's no longer a screening but rather a follow-up or surveillance following previous treatment, which would support an E&M service.
 

JesseL

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I don't risk using that code. I tell the doctor to question what lesions on their body are they concerned with & produce a history for a E&M from there. Most of the time the chief complaint is the patient is worried about all the growths on their body and we bill a regular E&M.
 

CatchTheWind

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Thank you all for your answers!

Thomas, while your thoughts about skin check being part of the PCP's annual exam probably parallel that of CMS and the other payers, I do not agree with it from a clinical perspective. First, I don't believe that most PCPs perform a full skin exam during the annual examination. Second, even if they were to do so, they don't have the experience or expertise to do this effectively; they might end up doing unnecessary biopsies of lesions that an experienced dermatologist can tell at a glance are benign, and possibly fail to recognize signs of suspicion in other lesions. Skin exam is not something that can be done "by the book"; it takes an experienced and discerning eye that only a specialist should be expected to possess.

Sorry for the rant; after almost a decade of working with dermatologists, I guess I've gotten opinionated!
 

LBernat7

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Agree- and Aetna

Thank you all for your answers!

Thomas, while your thoughts about skin check being part of the PCP's annual exam probably parallel that of CMS and the other payers, I do not agree with it from a clinical perspective. First, I don't believe that most PCPs perform a full skin exam during the annual examination. Second, even if they were to do so, they don't have the experience or expertise to do this effectively; they might end up doing unnecessary biopsies of lesions that an experienced dermatologist can tell at a glance are benign, and possibly fail to recognize signs of suspicion in other lesions. Skin exam is not something that can be done "by the book"; it takes an experienced and discerning eye that only a specialist should be expected to possess.

Sorry for the rant; after almost a decade of working with dermatologists, I guess I've gotten opinionated!

I agree 100% and Aetna patient who work for certain employers will cover visit at 100% on a patient as Z12.83 primary DX if used as secondary they will assess a copay. We just sort of found this out down the pipeline of patients we see on a regular. Otherwise if you have a HX use that first then the Z12.83 we have had no issues otherwise. But never for a medicare Pt they will not pay the Z12.83
 

thomas7331

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Interesting discussion from everyone and good info. I just thought I'd add that the US Preventive Service Task Force (USPSTF) does not recommend skin cancer screening for asymptomatic adults at this time due to insufficient evidence to support the benefits, and this would make it hard to argue for medical necessity:

http://jamanetwork.com/journals/jama/fullarticle/2536643

From a strictly coding perspective, I would still maintain that this service is not appropriately billed with an E&M code because, if the patient truly is asymptomatic and/or has not been advised by a physician that this is necessary for a particular medical reason, there is no chief complaint or medical necessity to support the code choice.
 

ellzeycoding

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Great article link, Thomas.

I will also stress that just because a patient comes into the office and states that they have insurance that provides preventative screenings that you should bill this as a preventative screening. My advice, first, never let a patient tell you how or what to code. Even if they tell you that they called the insurance and a skin cancer screening would be covered, always verify the coverage and screening yourself from the insurance. Find the written policy and get the authorization in writing. Most of the time, the patient didn't say the right words to their insurance rep, or the rep mis-spoke. More often than not, preventative screenings for skin cancers are not covered benefits. Some do, but it is few!
 
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