Dermatology Medical Billing Services - Compare Quotes From Vetted Providers

Lesion-based documentation drives everything

• Record the diagnosis for each lesion, exact anatomic site, laterality, and count.
• Measure excisions by the clinical lesion diameter plus intended margins. Capture final defect size when repairs are performed.

Biopsies vs removals

• Distinguish diagnostic biopsy from therapeutic removal.
• Use the correct biopsy family for tangential, punch, or incisional techniques and add the appropriate add-on codes for additional lesions when performed.
• Shave removals are not biopsies. Code them by anatomic area and size.

Destruction coding is diagnosis and count dependent

• Premalignant lesions such as actinic keratoses are billed per lesion using the correct base and add-on structure for volume.
• Benign destruction uses different codes and has thresholds for 1 to 14 vs 15 or more lesions.
• Document method used, such as cryotherapy, electrodessication, or chemical, and link to each specific diagnosis.

Excision and repair pairing

• Benign and malignant excisions are selected by anatomic location and excised diameter. Malignant has its own code family.
• Simple, intermediate, and complex repairs are separately reportable when criteria are met. Do not report a simple repair when it is included with another service per policy.
• For layered closures, document depth, length by site, and any undermining to support intermediate or complex levels.

Mohs micrographic surgery specifics

• Choose codes based on anatomic site and number of stages and tissue blocks.
• The operative note must map each stage and block to margins taken and clearance achieved.
• Do not separately bill pathology on the same specimen when included in Mohs per coding rules.

Pathology linkage and split billing

• Each biopsy, excision, or Mohs stage must link to the corresponding pathology result.
• When dermatopathology is performed by a different entity, split billing with professional and technical component modifiers may apply per contract and POS.

Phototherapy and patch testing

• Phototherapy services require documentation of modality, exposure time or energy, treatment area, and treatment plan.
• Patch testing needs a clear list of allergens, application date, reading date, and results for each site.

Biologics, injectables, and Rx management

• Specialty drugs may require prior authorization and specific HCPCS codes with units by mg or mL. Track wastage where payer rules require a modifier or separate line.
• Link drug administration to diagnosis and maintain lot numbers and strength in the chart.

Modifiers that matter

• 25 for a significant and separately identifiable E/M on the same day as a minor procedure. The note must show distinct history, exam, and medical decision making beyond the procedure.
• 59 or appropriate X modifiers to denote distinct procedures on different lesions or anatomic sites when edits bundle services.
• 51 for multiple procedures when applicable per payer rules.
• 57 when the E/M results in the decision for a major surgery.
• 58, 78, 79 for staged, related return to the OR, or unrelated procedures during the global period.
• Use laterality and digit or toe modifiers when required by payer policy.

Place of service and global periods

• POS affects payment and component billing. Office, ASC, and hospital outpatient settings follow different rules.
• Know the global period for each procedure. Most minor dermatology procedures have 0 or 10 days, while larger excisions and complex repairs may differ. This impacts use of postoperative modifiers and E/M coverage.

Keeping billing in-house can work well when you have a stable team, predictable volume, and the capacity to hire, train, and cover vacations or turnover. You retain tight control over workflows but you also carry the risk and cost of staffing, QA, software, and performance management.

Outsourcing shifts those burdens to a specialized team that brings SLAs, denial management, and scalable capacity. It’s often a fit when claim volume is growing, denials are creeping up, or leadership wants to redeploy staff to patient-facing work without sacrificing cash flow.