Accurate payments for dermatology services require correct coding

It’s important to provide the correct codes and pertinent details for dermatology services. This will ensure you receive appropriate and timely payment.

We realize that it sometimes can be a challenge to select the correct codes and related modifiers. We’ve found that the most common billing errors occur with modifier 25 and 59.

Modifier 25 is used with an evaluation and management code when a significant, separately identifiable E&M service by the same physician on the same day of another procedure or service.

Modifier 59 is used with a procedure code for a distinct service performed independently from other non-evaluation and management procedures on the same day. Documentation must support a different or separate session, procedure, surgery, site or organ system, incision, excision or lesion performed on the same day by the same physician.

Here are examples of how to apply these key modifiers to patient situations:

• During a yearly physical exam, the doctor discovers the patient has developed actinic keratosis. When documentation supports a separate and distinct evaluation — assessment and treatment of actinic keratosis — the evaluation and management service is separately payable. Modifier 25 should be applied to the appropriate evaluation and management code.
• A doctor examines a patient for a lesion and finds another distinct lesion present. The doctor treats both lesions. Modifier 59 may be applied to the code reporting treatment of the second lesion because it is considered a separate and distinct procedure.

If you have questions about coding for dermatology services, consult your provider manual on web-DENIS for documentation guidelines or contact your provider consultant.