Skin procedures are among the most complicated services that family physicians have to code. Many who otherwise do their own coding prefer to delegate this job to someone else. But even if someone else is doing your coding, you have to know the rules, use the correct terminology and pay attention to detail to ensure that your documentation leads your coding staff to the correct code.
In my experience, the most effective strategies are familiarizing yourself with the most common pitfalls in skin coding and using an encounter form designed to help you document skin procedures correctly. In a recent review of coding at local practices representing about 75 physicians, I noticed a number of coding mistakes that appeared repeatedly, including the following:.
Incorrectly documenting the details of the procedure, such as the size or location of the lesion, the number of lesions, the length of the laceration, the type of skin closure, whether debridement was performed or the size of margins excised. Submitting one code when two or more codes should be used, such as when two or more biopsies are performed, when two to 14 plantar warts or keratoses are treated, when more than 15 skin tags are removed, and when deep layering or undermining is used to close an excision.
Using the wrong codes. For example, it is incorrect to use flat wart codes and for plantar wart treatment, or to use biopsy codes when the lesion is completely excised. Using incorrect terminology to describe what you did, such as biopsy when what you really did was shave.
Medicare does not cover cosmetic surgery. Medicare reimburses skin tag, seborrheic keratosis, wart and flat wart removal only if they are bleeding, painful, very pruritic, inflamed or possibly malignant. Treatment of molluscum and pre-malignant lesions such as actinic keratosis are covered.
