Dermatology Billing Services Down To The Centimeter.
Dermatology claims turn on small details: the biopsy technique, the excised diameter, the pathology result, the repair length. We bill from those details in your notes and ask your clinicians when one is missing.
- Visits, biopsies, excisions and Mohs
- Claims held for pathology when needed
- Keep your existing EHR
No real patient or claim data.
Your DermatologistMeasures before excision
Same Visit, Separate Services?
A procedure already includes the brief evaluation that led to it. A separate visit is billable with modifier 25 only when your dermatologist also evaluated a significant, separately identifiable problem, and documented it that way.
- Deciding to biopsy the lesion you came in for
- Consent and site preparation
- Routine post-procedure instructions
- Full-body skin check for a new concern
- Managing a separate condition, such as psoriasis
- Its own history, exam and decision-making in the note
Biopsy Codes Follow The Technique.
Since 2019, biopsy codes are chosen by how the tissue was removed. When several techniques are used in one visit, one primary code is reported for the highest-ranked technique, and the rest as add-ons.
| Technique | First lesion | Each additional | Rank | What the note must say |
|---|---|---|---|---|
| Incisional | 11106 | 11107 | 1 · highest | Full-thickness sample into subcutaneous tissue |
| Punch | 11104 | 11105 | 2 | Punch tool used, site, size |
| Tangential (shave, scoop) | 11102 | 11103 | 3 | Technique and site for each lesion |
Example: a punch biopsy and two tangential biopsies in one visit are reported as one punch primary plus tangential add-ons, not three primaries. Illustrative only; payer edits vary.
Excisions Wait For Pathology.
Benign and malignant excisions use different codes, so the final pathology decides the code. Billing before the result is a common reason for corrected claims.
- 1ExcisionExcised diameter measured before removal
- 2PathologySpecimen read; benign or malignant
- 3Code ChosenBenign or malignant excision code by size band
- 4Repair AddedIntermediate or complex repair billed separately
- 5Claim SentWith pathology on file
A simple closure is part of the excision. Intermediate (layered) and complex repairs are reported on their own.
Repairs of the same type in the same anatomic group are summed and reported as one total length, in centimeters.
Layered closure, undermining, debridement or retention sutures need to be in the note for the repair level billed.
Counting Lesions, Stages And Blocks.
Destruction Is Counted, Not Measured
Destruction of premalignant lesions such as actinic keratoses is reported by count:
The note needs the number of lesions treated.
Billed By Stage And Tissue Block
The Mohs surgeon acts as both surgeon and pathologist. Codes depend on the location, the number of stages and the number of tissue blocks in each stage.
- Head, neck, hands, feet and genitalia use different codes from trunk and extremities
- Additional stages and blocks beyond five per stage are add-ons
- Repairs after Mohs are billed separately, often by the same surgeon
Know Before The Procedure.
Insurers pay for treatment that is medically necessary, not cosmetic. The note and the patient conversation need to happen before the procedure, not after the denial.
Medically Necessary
Symptoms such as bleeding, pain, itching, inflammation or change are documented. The claim reflects that reason.
Uncertain Coverage
For Medicare patients, an Advance Beneficiary Notice before the service lets you bill the patient if Medicare denies. Commercial plans use their own waiver forms.
Cosmetic
No insurance claim. Collected under your practice's own cosmetic pricing and policies.
Medical Billing Or Full RCM?
Medical Billing
Your team keeps registration, eligibility and authorizations. We bill visits and procedures from your notes, hold excisions for pathology and follow every response. Coding can be added.
About Medical Billing Services →Full RCM
We also check eligibility, handle authorizations and code each visit and procedure, with credentialing included.
About Full RCM →In-house dermatopathology billing and cosmetic patient-pay services need their own scope review before we confirm them.
Questions Dermatology Practices Ask.
Please do not send patient photos or records through the website.
Do You Hold Excision Claims Until Pathology Comes Back?
Yes. Benign and malignant excisions use different codes, so we wait for the final report rather than guess and correct later.
How Do You Decide On Modifier 25?
From the note. If your dermatologist documented a separate evaluation for a different problem, we bill the visit with modifier 25. If not, the evaluation is part of the procedure.
Can You Bill Mohs And The Repair Together?
Yes. Mohs stages and blocks are billed from the Mohs report, and the repair is billed separately by type, anatomic group and total length.
What If A Patient Wants A Cosmetic Removal?
That is patient-pay and stays off the insurance claim. Where coverage is uncertain, an Advance Beneficiary Notice or waiver should be signed before the procedure.
Talk Through Your Dermatology Billing.
Tell us the services you bill, your payer mix and how pathology and procedure notes reach billing today. Please do not send patient photos or records through the website.
- Visits, biopsies, excisions and Mohs
- BAA signed before any patient-data access
- Medical Billing or Full RCM