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Skin Check w/o signs/symptoms or hx

  1. #1
    Question Skin Check w/o signs/symptoms or hx
    Medical Coding Books
    Hi All,

    I have a small group of Dermatologist here that I'm trying to get on the same page. All of them have separate practices outside and have different opinions on what is correct.

    In our system our PCPs "refer" out for almost everything (even LNO2). In certain circumstances our PCPs are sending elderly patients to the Derms for a "Full Skin Check" even if the patient has NO signs/symptoms or any personal or family history. It just seems like it's automatic for them.

    My question is this: to me it seems like this is an unreasonable and unnecessary service so should not be billable unless the patient requests the service and knowingly signs an ABN, correct?

    They've been billing this as a high level consult with the V76.43 (Screening Skin cancer). Obviously this is being denied. I know that is definitely wrong, but I just want to make sure I'm not off base in telling them it is not medically necessary.

    Thank you for any information or how your practice handles these same scenarios.

    Adam Hermance, CPC
    Last edited by ahermance; 01-23-2009 at 07:49 AM. Reason: forgot a piece of important info

  2. Default Audit
    Hi Adam ~

    Have you audited the E/M level for compliance? If there are no signs or symptoms - how are they achieving their comprehensive history? Also, what are they basing their MDM on? For my docs, if they just have liver and sun spots - no suspicous lesions - this does not rise above a LOW MDM with 2 or more self-limited/minor problems for a level 3 MDM. (I'm assuming when you state high level visit you are meaning a 99244?)

    The next question is - refer vs consult. If PCP isnt asking for advise or opinion on specifice problems its just a new patient. Sending patients to derm for a full skin eval is a transfer of care.

    We also have a form we fax to outside providers that specifically state consult or transfer of care and what advise they are seeking.

    Kelly, CPC

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