Dermatology Coding Alert: Master Your Derm ASC Coding

Numerous changes affecting ASCs every year are enough to confuse you. Still, few aspects of ASC reimbursement continue to be the same. Read further to know how the ASC rules affect you and what dermatology codes you should choose in such a case. These expert tips will surely take you a step ahead in perfecting your dermatology medical billing and coding.

1. ASC-allowed services: Know where to find them. CMS has a very specific list of codes payable for ASCs, but if you don't know how to access the list, you could be losing your reimbursement.

You can download the most recent ASC-allowable codes from the CMS website. It includes both the current quarter as well as previous quarters in case you're battling older claims.

2. 'Same-day global' rule. Each procedure the ASC bills takes a "same-day" global period as the ASC is only reporting facility fees and not physician work services. This is applicable to the coder working for the ASC and not the physician who performed the service.

In case the physician returned the patient to the ASC the day after the initial surgery, the ASC coder is supposed to report the suitable control-of-bleeding code with no modifier. On the other hand, the surgeon's coder would report the bleeding-control code with modifier 78 appended because the physician's services follow the standard global rule.

The ASC coder should go by the "same-day" global rule, but the physician's coder should follow standard global period rules from the fee schedule.

3. You Can Avoid modifier SG. In the past, the ASC coder had to list modifier SG (ASC facility service) as the first modifier on the claim in case he billed Medicare for any service performed in the ASC. However, that all changed with the CMS Transmittal 1410, which stated that the SG modifier is no longer applicable for Medicare services for services on or after January 1, 2008.

4. Discontinued surgery modifiers may differ. ASC coders may sometimes use modifier 52 (Reduced services) but would not use modifier 53 (Discontinued procedure). Instead, insurers generally want ASC coders to call on modifiers 73 (Discontinued outpatient hospital/ASC procedure before administration of anesthesia) or 74 (Discontinued outpatient hospital/ASC procedure after the administration of anesthesia), as appropriate.

When the physician gets back to the ASC with the patient to perform the aborted procedure at a later date or time, the ASC will get full reimbursement for the completed procedure.

5. Keep in contact with the surgeon's coder. You could lose your reimbursements when the physician and the ASC report separate codes for the same procedure. Remember, the physician and ASC should report the same codes for each surgery, any coding differences should be fixed before the claim is submitted.

Want to get more tips like these to master dermatology medical billing and coding? Click here to read the entire article and to get access to our monthly Dermatology Coding Alert: Your practical adviser for ethically optimizing dermatology medical billing and coding , payment, and efficiency for dermatology practices

Vitiligo Treatment : Know Whether to Apply 96900 or 96910

Avoid misrepresenting phototherapy services and know what dermatology codes apply

You need to examine your dermatologist's documentation to define what type of light, wavelength, and materials he used while providing phototherapy treatment to vitiligo /dychromia patients. Read this article to know what dermatology codes you should choose in such a case and how to overcome both E/M and multiequipment correct coding initiative (CCI) challenges.

In case you are charging for an office visit on the same day as phototherapy, the reimbursement might depend on the fact whether your physician's documentation includes a different diagnosis code. Experts maintain that the payers might reimburse at times if the doctor examines the patient for a different problem, hence with a different diagnosis code.

For patients having vitiligo (709.01), your dermatologist might use narrow band UVB phototherapy. The phototherapy is administered for two to three times per week for several months until the patient attains repigmentation of the skin. For this procedure, you need to pinpoint what types of phototherapy, UVA or UVB, the physician used as well as the varying wavelengths.

In case your dermatologist used tar or or petrolatum with the light treatment, you should code 96910 (Photochemotherapy; tar and ultraviolet B [Goeckerman treatment] or petrolatum and ultraviolet B). Through this procedure, the dermatologist runs ultraviolet B light, with dosages cautiously increased as the treatment develops, resulting in longer times spent under the light source.

You should report 96900 (Actinotherapy [ultraviolet light]) in case the patient applies the treatment herself.

Note: You should always check with your payer for their rules.

In case, your dermatolist prescribed psolarens combined with ultraviolet A (UVA) light therapy, you should use 96912 (Photochemotherapy; psoralens and ultraviolet A [PUVA]). If your dermatologist doesn't use tars, petrolatum or psolarens with the light treatment, the code that remains is 96900.

The difference: UVA phototherapy is generally given with a lightsensitizing tablet named psoralen (PUVA therapy). Occasionally a light-sensitizing cream or lotion having psoralen is used in localized skin areas (for instance feet [topical PUVA]). On the other hand, UVB phototherapy uses the sunburning part of the UV spectrum.

Don't take risks: If you code either 96910 or 96912 when your dermatologist uses merely a light source in the treatment or the patient applies a topical agent, you could be accused of misrepresentation of service. It could be a fraudulent claim under the Federal False Claims Act.

Want to get more tips like these to master dermatology medical billing and coding? Click here to read the entire article and to get access to our monthly Dermatology Coding Alert: Your practical adviser for ethically optimizing dermatology medical billing and coding, payment, and efficiency for dermatology practices