Most payers will not cover cosmetic scar revisions, so you should make sure the dermatologist establishes medical necessity for the procedure.
In many cases, patients with function-impeding scars present with scars around their eyes or mouth. For example, a patient with a basal cell carcinoma on the lip may have the dermatologist remove the carcinoma. The scar that forms as a result of that excision impedes the patient’s speech and eating, and therefore the dermatologist decides that the removal is medically necessary.
The dermatologist removes the scar, which is two centimeters long. You should report the procedure based on the location of the carcinoma that the dermatologist removed and the size of the excision. Measure each excision at the widest diameter, including any margins. So you would report 11442 (Excision, other benign lesion including margins, except skin tag [unless listed elsewhere], face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm), coding experts say.
In the situation above, the scar revision is cosmetic but the revision is part of the aftercare process.
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It’s that time of the year. Check out the latest Dermatology guidelines to make sure your dermatology practice is up to date.
The Office Inspector General (OIG) is hard at work, issuing a flurry of new testimony and decisions to guide healthcare practices. Here’s a look at a few of the decisions that may affect your dermatology practice.
Bottom line: You don't have time to weed through the never-ending onslaught of information about dermatology coding and coverage, so let us do it for you.
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