Dermatology Billing Services

Dermatology revenue is built visit by visit from stacked procedures: a biopsy, an excision, a destruction, sometimes a wound repair, and an evaluation and management service on top, all in a single appointment. Each of those code families has its own size, site, and technique rules, and the diagnosis on the claim decides whether a payer treats a lesion removal as medically necessary or cosmetic. In this specialty, the coding decision determines payment as much as the clinical decision does.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for dermatology practices, built around lesion documentation, procedure stacking rules, and the medical necessity case for every removal.

Dermatology billing challenges

Four code families carry most dermatology revenue: biopsy (11102 to 11107), excision (11400 to 11646), destruction (17000 to 17286), and Mohs micrographic surgery (17311 to 17315). Biopsy and excision are not interchangeable: a biopsy removes a tissue sample for diagnosis, while an excision removes the entire lesion, and coding one as the other produces incorrect payment and compliance exposure. Excision codes are size dependent, so documentation must capture the lesion diameter, the surgical margins applied, and the final excised diameter. Missing any of the three measurements is a leading cause of excision denials. Destruction codes work differently again, with add-on codes capturing additional lesions rather than full standalone codes.
Modifiers decide whether stacked procedures pay. Modifier 25 supports a significant, separately identifiable evaluation and management service on the same day as a procedure, and the note must stand on its own as an evaluation and management service once the procedure documentation is removed. Modifier 59 and the X modifiers mark a distinct lesion or session when procedures that would normally bundle were genuinely separate, and modifier 51 marks multiple procedures in the same session. Laterality modifiers RT and LT identify the side treated, which matters for bilateral lesion work. Modifier 58 covers a staged or related procedure during a postoperative period, common in Mohs and complex closures, while modifier 79 covers an unrelated procedure during a postoperative period.
Medical necessity versus cosmetic classification is the other major denial path. The ICD-10 specificity on the claim decides how the payer views the removal, and vague diagnosis coding invites reclassification as cosmetic and denial. Mohs surgery has its own strict rule: a single physician must act as both surgeon and pathologist, examining the excised tissue immediately to determine clear margins. If either responsibility is delegated to another clinician who bills separately, the surgeon should report an excision or biopsy code instead of a Mohs code, and the pathology examination inside a Mohs case is an inclusive component that is not reported separately.

What MedPlus RCM handles for dermatology practices

• End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
• Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
• Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
• Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
• A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
• Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
  We serve dermatology practices nationwide, including general dermatology, Mohs surgery practices, and cosmetic and medical dermatology clinics, across skin cancer care, inflammatory skin disease, and procedural dermatology.

Results dermatology practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Can a biopsy and an excision be coded interchangeably?
No. A biopsy samples tissue for diagnosis and an excision removes the whole lesion. Each has its own code family, and using the wrong one causes incorrect payment and compliance risk.
What documentation does an excision claim need?
Lesion diameter, surgical margins, and final excised diameter. All three measurements should be in the record, since missing any of them is a common denial cause.
When does modifier 25 apply in dermatology?
When a significant, separately identifiable evaluation and management service is performed on the same day as a procedure. The note must support an evaluation and management service that could stand alone without the procedure documentation.
What makes a lesion removal medically necessary rather than cosmetic?
The diagnosis and its specificity. A well documented medical indication with a specific ICD-10 code supports payment, while vague diagnosis coding invites cosmetic reclassification and denial.
Can Mohs surgery and pathology be billed separately?
No. In Mohs surgery, one physician acts as both surgeon and pathologist, and the pathology examination of the specimen is included in the Mohs code, not reported separately.

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