THE BOTTOM LINE
Most dermatology denials are decided before the claim ever goes out. Usually before the patient leaves the room.
Three things drive the pattern: whether the diagnosis on the claim supports coverage, whether the E/M note stands on its own apart from the procedure note, and whether the procedure codes you billed together are allowed to be billed together. Get those three right at the point of documentation and the back end mostly takes care of itself.
This guide walks the visit in the order it actually happens, from the front desk to the remittance advice.
What the full playbook covers
Solo subscribers read the full playbook. Here is what it contains.
- Definitions and frequently used terms
- Start with the diagnosis, because everything else hangs on it
- Picking the procedure code
- The E/M question: modifier 25
- When you bill more than one procedure: NCCI
- In-office pathology: TC and 26
- Reading the remittance: what these CARCs actually mean
- The skin cancer screening trap
- Documentation practices that prevent the denial
- Frequently asked questions
- How we work on this at ROI
- Something not working the way you expect?
- Sources