Medical Billing Challenges Faced by Dermatologists

It’s not rocket science to prove that dermatology is one of the most complex medical specialties as it is a multi-faceted specialization. For example, dermatological procedures can range from simplistic cosmetic surgeries to more complicated skin grafting that must be reflected in the medical billing. Therefore, this is what makes medical billing a complicated process for dermatological practice. Moreover, dermatologists usually handle more patients than physicians in other specialties. Hence, to address the large volume of the patient, the medical billing and coding should be as accurate as possible so that you receive proper reimbursement.

This article will get more insight into dermatological medical billing and coding challenges faced by dermatologists and how you can streamline your dermatological billing processes to make them more efficient and quicker.

Different coding systems

Coding systems are essential for both the physicians and the insurance payers as they indicate the procedure performed based on which the reimbursement is provided. Usually, the insurance providers use the ICD (The International Classification of Diseases) and the CPT (Current Procedural Terminology) codes for dermatological billing and coding.

Health Insurance Portability and Accountability Act (HIPAA) sets ICD-10-CM as the standard transaction code for diagnostic purposes. Moreover, this transaction code is used for tracking the numerous health care statistics/ disease burden, mortality statistics, quality outcomes, and billing. ICD-10 diagnosis codes are more detailed and usually begin with an alpha character with typically 3 to 7 characters in length.

All inpatient and outpatient procedures and services in medical practice are indicated with the CPT codes. In fact, many of these codes are used by the in-house dermatological practices for billing purposes such as skin biopsies, Mohs surgery, and excision. Also, there are Evaluation and Management (E/M) codes within the CPT coding system used for the billing of an inpatient or an office visit appropriately.

Documentation Challenges

All types of medical billing documentation must be completely accurate as they can also be considered a legal document justifying the services rendered to the patients or the reasons for such services and alike. Such medical documentations also serve the purpose of evidence in front of the honorable court of law. Moreover, it is an essential source for accurate reimbursement for the procedures performed.

However, there are numerous modifiers to be used in the medical documentation of dermatological practices. But, 59 modifier is the most used code as the other related modifiers are not well understood. Therefore, many dermatological physicians have faced multiple issues with the medical documentation and the use of modifiers in the E/M and dermatology procedures.

Outdated patient records

Many dermatologists are often unable to fetch the latest insurance information from their patients. However, the administrative medical billing team usually gets in touch with the correct insurance payer to avoid any kind of claim denials. Therefore, it is essential to take some time out to check all the insurance information before providing any kind of dermatological services. This will save your months of unpaid claims time.

Dermatology Medical Billing Compliance

Lack of proper billing knowledge can lead to the overuse of modifiers 25 and 59. On the one hand, 25 modifiers are defined as “significant, separately identifiable evaluation and management (E/M) service on the same day of the procedure or other service by the same physician.” In contrast, modifier 59 is defined as a District Procedural Service (DPS). Under certain situations, it may be required to indicate that a service or procedure was independent and distinct from other non- evaluation and management (E/M) services performed on the same day.

As per an article in Dermatology Times, approximately 60% of E/M services performed by dermatologists are submitted with modifier 25. Of the remaining services, around 25% are coded as “for the rest of medicine.” Therefore, it indicates that any amendment in the modifier 25 payment policy will directly impact dermatology practices more than any other specialties.


With the stringent compliance standards to uphold and recent billing changes, Medical Billing Challenges Faced by Dermatologists can save a lot of time and effort. However, for realizing your true revenue earning potential, you must first prioritize a responsible and achievable plan for the financial strategies of your practice. One such feasible plan is to outsource your dermatology medical billing to 24/7 Medical Billing Services. By outsourcing the dermatology medical billing, you can expect the most efficient and accurate bill processing from the experts that know their jobs very well. In addition, our dermatology billing services can give you the expertise that your practice needs to grow and thrive in this medical landscape.

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