Diagnosis inconsistent with the procedure
Billing a malignant excision before pathology, or a benign code when pathology shows cancer, causes mismatches.
How we prevent it: We hold excision claims until pathology is final and code from the report.
DERMATOLOGY BILLING
Dermatology Billing Services
Dermatology claims depend on correct lesion sizing, excision and repair coding, and proper use of modifiers for multiple procedures on the same day.
No upfront feesHIPAA-compliantSpecialty-trained coders
$0
Upfront or setup fees
0
Revenue cycle steps managed end to end
0
Specialties and lab types we bill for
0
Of your data and systems stay yours
OVERVIEW
Dermatology billing done right
Dermatology claims depend on correct lesion sizing, location and pathology. Excisions are coded by the lesion diameter plus margins, benign or malignant status comes from the pathology report, and repairs are coded by length, complexity and anatomic group.
Biopsy codes depend on technique, destruction codes on the number and type of lesions, and Mohs surgery on location and stages. Payers also separate medically necessary procedures from cosmetic ones.
We hold excision claims for final pathology, code from your procedure notes and measurements, sum repairs correctly and apply modifier 25 only when a visit is separately documented.
Also see our medical coding, denial management, eligibility verification and revenue cycle management services.
CODING
Common dermatology CPT & HCPCS codes we bill
Dermatology coding is driven by lesion type, size, location and technique.
| Code | Description | What we watch for |
|---|---|---|
| 11102 | Tangential biopsy of skin, single lesion | Use 11103 for each additional lesion; punch and incisional biopsies have their own codes. |
| 11104 | Punch biopsy of skin, single lesion | When different biopsy types are done, report the highest-ranking first. |
| 17000 | Destruction of premalignant lesion, first lesion | Add 17003 for lesions 2–14; use 17004 alone for 15 or more. |
| 17110 | Destruction of benign lesions such as warts, up to 14 lesions | Use 17111 for 15 or more lesions. |
| 11402 | Excision of benign lesion, trunk, arms or legs, excised diameter 1.1–2.0 cm | Diameter includes the narrowest margins; simple closure is included. |
| 11602 | Excision of malignant lesion, trunk, arms or legs, excised diameter 1.1–2.0 cm | Code after pathology confirms malignancy. |
| 17311 | Mohs surgery, head, neck, hands, feet or genitalia, first stage, up to 5 blocks | Add 17312 for each additional stage; Mohs is exempt from multiple procedure reduction. |
| 13132 | Complex repair, forehead, cheeks, chin, mouth, neck, hands or feet, 2.6–7.5 cm | Repairs in the same anatomic group and complexity are added together. |
| 12032 | Intermediate repair, scalp, trunk or extremities, 2.6–7.5 cm | Layered closure must be documented. |
| 96920 | Excimer laser treatment for psoriasis, total area less than 250 sq cm | Payers require documented failure of topical therapy. |
Code descriptions are summarized. CPT® is a registered trademark of the American Medical Association. Coverage and payment rules vary by payer and change every year; we code to the current code set and your payers’ policies.
Modifiers that matter in dermatology billing
25
Significant, separate E/MFor a visit that goes beyond the evaluation of the lesion being treated.
59 / XS
Separate structureFor procedures on separate lesions or sites that NCCI pairs together.
79
Unrelated procedure in the global periodFor a new lesion treated during a prior excision’s global period.
58
Staged or related procedureFor planned re-excision when margins are positive.
DENIALS
Why dermatology claims get denied
The denial reasons we see most often in dermatology billing, with the claim adjustment reason code (CARC) payers usually attach, and what we do so they don't happen again.
E/M or biopsy bundled
A visit or biopsy on the same lesion as an excision is bundled.
How we prevent it: We apply NCCI edits and report 25 or XS only when the documentation supports it.
Cosmetic service not covered
Removing asymptomatic seborrheic keratoses or skin tags is often non-covered.
How we prevent it: We document symptoms that make removal medically necessary and collect waivers for cosmetic services.
Mohs appropriateness not met
Payers apply Mohs appropriate use criteria by tumor type, size and location.
How we prevent it: We confirm the lesion meets criteria before Mohs is billed.
Documentation requested
Payers often request notes, measurements and pathology before paying Mohs, flap and complex repair claims.
How we prevent it: We send the procedure note, measurements and pathology report with the first response so payment is not held up.
HOW WE WORK
How we run your dermatology revenue cycle
From the first eligibility check to the final patient payment, one dedicated team handles every step and reports back to you.
01
Eligibility and authorization
We verify coverage, benefits, copays and deductibles before the visit. For dermatology, that includes separating cosmetic from covered services before the visit.
02
Charge capture and coding
Our coders review documentation and assign CPT, HCPCS and ICD-10-CM codes to the highest supported specificity. Excisions are coded from measurements and the final pathology report.
03
Claim scrubbing and submission
Every claim is checked against NCCI edits, payer policies and modifier rules before it goes out electronically, so it is paid on the first pass.
04
Payment posting and reconciliation
We post ERAs and EOBs, compare payments to your contracted rates and flag underpayments for appeal.
05
Denial management and A/R follow-up
Every denial is worked: corrected, appealed or escalated, with root causes fed back to the front end. Bundling and pathology denials are corrected and appealed with notes and path reports.
06
Reporting and patient billing
You get clear monthly reports on collections, denials and A/R aging, and patients get easy-to-read statements and answers to billing questions.
COMPLIANCE
Dermatology payer rules we track for you
Rules that change how dermatology claims must be coded, documented and submitted.
Excision size: the excised diameter is the largest lesion diameter plus the narrowest margins on each side.
Repair grouping: repairs of the same complexity in the same anatomic group are summed into one code.
Biopsy hierarchy: when different biopsy types are done, the highest-ranked type is primary.
Mohs: Mohs surgery is exempt from the multiple procedure reduction, and repairs are billed separately.
FAQ
Dermatology billing questions
Do you wait for pathology before coding excisions?
Yes. Excision codes depend on whether the lesion is benign or malignant, so we code from the final pathology report.
Do you bill Mohs surgery?
Yes. We code Mohs stages and blocks, repairs and flaps, and check Mohs appropriate use criteria.
How do you handle cosmetic procedures?
We separate cosmetic services from covered ones, collect patient payment up front and use waivers where needed.
How much do your dermatology billing services cost?
We charge just 2.25%–2.75% of what we actually collect for you, with no upfront or setup fees. Your exact rate within that range depends on claim volume and the services you need, and we confirm it after a free review of your current billing.
Do we have to change our EHR or practice management system?
No. We work inside the systems you already use, and your data stays yours. We set up secure access, learn your workflows and start working claims without disrupting your front desk.
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