2017 dermatology coding/billing update · this 2017 dermatology coding update newsletter is being...

2017 Dermatology Coding Update - 1

Copyright 2016, Ellzey Coding Solutions, Inc. ( www.ellzeycodingsolutions.com or 1-855-326-3464)

CPT copyright 2015, American Medical Association. All rights reserved.

2017 Dermatology Coding/Billing Update

By Karl M. Ellzey, President Ellzey Coding Solutions, Inc.

This 2017 dermatology coding update newsletter is being provided to you free-of-charge as a service to the dermatology community from Ellzey Coding Solutions.

For additional dermatology coding, billing, compliance, and practice management products and services, please visit our website at www.ellzeycodingsolutions.com or call 1-855-326-3464.

Contents 2017 CPT Changes ................................................................................................... 1

New Place of Service Code ....................................................................................... 3

New Telehealth Modifier ............................................................................................ 3

Reminder: JW Modifier in Effect January 1, 2017 ...................................................... 3

Correct Coding Initiative Version 23.0 Effective January 2017 .................................. 4

2017 Medicare Physician Fee Schedule .................................................................... 6

Modifier 25 Audits on the rise!.................................................................................... 6

2017 Medicare Part B and Part A Deductible and Coinsurance ................................ 7

Mandatory Reporting of 10 and 90-day Global Period Postoperative Care ............... 7

2016/2017 ICD-10 Changes ...................................................................................... 9

2016 vs 2017 Fee Schedule Comparison ................................................................ 11

2017 CPT Changes For 2017, the CPT procedure changes affecting dermatology are minimal and will not affect most practices. Shown below are the new, deleted, and revised codes as listed per CPT 2017 that may affect some dermatology practices. Overall, there were 700+ changes to CPT for 2017. New CPT codes 36473 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging

guidance and monitoring, percutaneous, mechanochemical; first vein treated 36474 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging

guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure)

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Revised CPT codes 36476 second and subsequent veins(s) treated in a single extremity, each through separate

access sites (List separately in addition to code for primary procedure) 36479 second and subsequent veins(s) treated in a single extremity, each through separate

access sites (List separately in addition to code for primary procedure) 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without

anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session

Deleted CPT codes 11752 Excision of nail and nail matrix, partial or complete (e.g., ingrown or deformed nail),

for permanent removal; with amputation of tuft of distal phalanx 93965 Noninvasive physiologic studies of extremity veins, complete bilateral study (e.g.,

Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography)

J0760 Colchicine injection (Note: Drug removed from FDA approval list)

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New Place of Service Code For January 2017, a new Place of Service (POS) code is available:

POS code: 02 Name: Telehealth

Description: The location where health services and health related services are provided or received, through a telecommunication system.

New Telehealth Modifier ( for synchronous 2-way telehealth services) CPT officially has a telehealth modifier. CMS will continue to recognize telehealth modifiers GT and GQ.

95 Synchronous Telemedicine Services Rendered Via a Real-Time Interactive Audio and

Video Telecommunications System

See Appendix P of 2017 CPT for a list of codes that may be billed with modifier 95

Reminder: JW Modifier in Effect January 1, 2017 Use of modifier JW for discarded or unused portions of single-use vial drugs will be required starting January 1, 2017.

JW Drug amount discarded/not administered to any patient

Check with commercial carriers to see if they recognize modifier JW.

Modifier JW is for single-use drug vials where the amount administered is less than the total units in the vial and the remainder is unused/discarded.

Example: CPT J0585 (Botulinum Toxin A - Botox) is in a 100 unit single- use vial. This code is billed per unit administered. A patient is given 65 units from a 100 unit single-use vial. You bill:

Do not use for J-codes that include “up to” a certain number of units. (e.g., J3301 is billed per 10mg, and you administer only 5mg, you bill J3301 x 1 unit which includes 5mg given plus 5mg of the unused drug)

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf




Correct Coding Initiative Version 23.0 Effective Ja nuary 2017 Version 23.0 of the Correct Coding Initiative (CCI) goes into effect January 2017. Every three months, CMS publishes a new list of the pairs of codes they consider bundled together and not payable separately. The exception is when these procedures or services are performed on unrelated sites or lesions. The biller adds modifier 59/XS to the claim to override the payment and get the claim paid. The trick is to know which dermatology codes need modifier 59/XS and which ones do not. January adds 404 changes to the current CCI listing for dermatology. This is comprised of 258 new code bundles and 146 deleted code bundles. CMS (and most commercials) are still allowing use of modifier 59 or the ‘X’ modifiers that were introduced in 2015. XS would be the most common ‘X’ modifier used in dermatology. For an article on the proper use of ‘X’ modifiers, please visit the ECS website: http://www.ellzeycodingsolutions.com/kb_results.asp ?all=Y Ellzey Coding Solutions can provide dermatologists and staff with a filtered comprehensive listing of the CCI bundles only affecting dermatology CPT codes. Our listing is available in PDF and printed format and provides an additional 34 pages of instructions on the proper use of modifiers 25/57, and 59(XS).

Correct Coding Initiative for Dermatology

Our dermatology-specific listing consists of over 55,100+ code bundles based on 831 possible CPT/HCPCS code used by dermatologists. We also list the new and deleted code pair changes for the previous year. 800 pages available in printed format or electronic PDF format. Current edition and annual subscriptions available.

For more information visit: www.ellzeycodingsolutions.com/cci

http://www.ellzeycodingsolutions.com/kb_results.asp?all=Y

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The Correct Coding Initiative is part of our DermCoder online coding tool’s QuickCheck feature. You can quickly check the placement of eight different modifiers on up to 10 CPT codes with a single click. (Modifiers 24, 25, 51, 57, 59 (XS), 76, 79, and 91) QuickCheck also alerts you to coding errors and will provide a Quick-Link to the Medicare Local Coverage Determination Policy (LCD) for your state’s Medicare carrier.

Sign up for a 30-day FREE Trial of DermCoder… Over 1,900 dermatologists, billers, and coders use DermCoder for fast and accurate dermatology coding and billing information.

Our online dermatology coding software helps you navigate through the maze of information resources (CPT, ICD-10, Modifiers, Fees, postop days, coding and billing news, LCDs, etc.) and shows you only what you need to know, in a concise and user-friendly format.

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2017 Medicare Physician Fee Schedule On November 14, 2016, CMS officially released the 2017 Medicare Physician Fee Schedule. These fee schedules are available on your carrier’s website. 2017 Medicare fee schedules can also be viewed in DermCoder. DermCoder also has the ability to generate a second fee schedule based on a multiple of the Medicare fee schedule. For example, some practices create a fee schedule that is 150% or 200% of the Medicare allowable. DermCoder users can easily calculate and export those fees for you for importing into your EMR or PM system. For 2017, the Conversion Factor (CF) will be $35.8887. For comparison, the 2016 CF was $35.8043. In addition to the Conversion Factor, geographic adjustment factors have been recalculated for each payment locality. Lastly, the relative value units have been adjusted for many services. Overall, the fee schedule changes for dermatology will be neutral, with an overall average net effect of about 0% for most providers. Here are a few of the significant findings…

• CPT 99211 (Nurse visits) will see an increase of about 2% • Technical components for 88304/88305 will see a decrease of -14.3% and -13.3%

respectively. • Large intermediate repair codes of the face, ears, eyelids, nose, lips (CPT

12056/12057) will see a decrease of -9.92% and -3.21% respectively. • Excision of a nail matrix (CPT 11750) will see a decrease of -14.87% • Avulsion of the nail plate , first (CPT code 11730) will see an increase of 6.32% while

the avulsion of nail plate, add-on (CPT 11732) will see a decrease of -10.67% • Dermabrasion, superficial, other than face (CPT 15783), will see an increase of about

2.81% Modifier 25 Audits on the Rise! The Office of Inspector General (OIG) and many commercial carriers are continuing to audit all providers on inappropriate modifier 25 usage. The incorrect use of modifier 25 is one of the most common errors we see when auditing dermatology encounters. It is also one of the most commonly misunderstood E/M modifiers. Long gone are the days of automatically billing an E/M visit with any type of surgical visit by adding modifier 25. If a high percentage of your encounters have E/M visits billed, even for new patients, take notice. For a comprehensive article on modifier 25 and its correct usage , visit the Ellzey Coding Solutions website… https://www.ellzeycodingsolutions.com/kb_results.as p?ID=2 To access other articles visit… www.ellzeycodingsolutions.com and click the Coding Articles link on the bottom left of the main page!

https://www.ellzeycodingsolutions.com/kb_results.asp?ID=2





2017 Medicare Part B and Part A Deductible and Coin surance 2017 Part B - Supplementary medical insurance (SMI) Under Part B of the Medicare supplementary medical insurance (SMI) program, enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay), which are set by statute.

Deductible: $183 a year Coinsurance: 20 percent

2017 Part A - Hospital insurance

Deductible: $1,316.00 Coinsurance: • $0 a day for days 1-60 • $329 a day for 61st-90th day • $658 a day for 91st-150th day (lifetime reserve days) • $164.50 a day for 21st-100th day (skilled nursing facility coinsurance)

Mandatory Reporting of 10 and 90-day Global Period Postoperative Care Services for Large Group Practices in Select States Starting July 1, 2017, CMS will require providers that perform postoperative care for certain services with 10 and 90-day global periods to report all instances where postop care is delivered. Global postoperative care typically consists of the following types of activities:

• Review vitals, laboratory or pathology results, imaging, and progress notes. • Take interim patient history and evaluate post-operative progress. • Assess bowel function. • Conduct patient examination with a specific focus on incisions and wounds, post-

surgical pain, complications, fluid and diet intake. • Manage medications (for example, wean pain medications). • Remove stitches, sutures, and staples. • Change dressings. • Counsel patient and family in person or via phone. • Write progress notes, post-operative orders, prescriptions, and discharge summary. • Contact/coordinate care with referring physician or other clinical staff. • Complete forms or other paperwork.




However, this rule will only affect providers in groups of 10 or more providers in the following states only:

• Florida • Kentucky • Louisiana • Nevada • New Jersey

• North Dakota • Ohio • Oregon • Rhode Island

CMS has stated that only certain services with 10 and 90-day postop periods will require this reporting. The codes that qualify for reporting will need to have been provided by more than 100 providers nationally and are furnished either 10,000 or more times annually or have more than $10 million in annual allowed charges. CMS states that they will release the list of codes on or after January 1, 2017.

Although reporting will be mandatory for this limited group of providers (in certain states) starting July 1st, earlier voluntary reporting is encouraged. Solo practitioners and providers in smaller groups are also encouraged to voluntarily report, but there is no mandate.

Reporting will be accomplished using CPT code 99024. Previously CMS recommended a few different G-codes, but settled on the existing CPT code 99024 in the final ruling published in the Federal Register on November 15, 2016. 99024 Postoperative follow-up visit, normally included in the surgical package, to indicate

that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure

This code is billed once per postoperative visit, regardless of the activities performed or time spent, and is a non-reimbursable code. Since it is used for reporting purposes only, it should be billed at $0.01 as to not reject out of billing software, claim-scrubbers, or clearinghouses.

This code is not to be used for postoperative complications that are not included in the global surgical package. This typically includes complications such as wound dehiscence, infection or abscess, hematoma I&D, repair of bleeders, etc. Providers can continue to bill for these services using modifier 24 (E/M visits) and modifier 79 for postop complication surgical services. More articles on our website!

We have even more articles on the Ellzey Coding Solutions website. To access these articles visit… www.ellzeycodingsolutions.com and click the Coding Articles link on the bottom left of the main page!

• D48.5 vs D49.2 (Unspecified or Uncertain)? • Dermatology Preventive Visit/Screening Caution • Modifier 25 and Dermatology • Myths and Facts about Unspecified ICD-10 codes • Repeat surgical procedures when your carrier doesn’t like modifier 76





2016/2017 ICD-10 Changes (Reminder) There has been an ICD-9/ICD-10 code freeze in place since 2011. On October 1, 2016, the following additions/deletions/revisions went into effect for dermatology ICD-10 codes. Summary (all codes/all specialties):

• 1,943 New codes • 422 Revised from codes • 422 Revised to codes • 305 deleted

New ICD-10 codes for October 1, 2016 potentially af fecting dermatologists D47.Z2 Castleman disease D89.40 Mast cell activation, unspecified D89.41 Monoclonal mast cell activation syndrome D89.42 Idiopathic mast cell activation syndrome D89.43 Secondary mast cell activation D89.49 Other mast cell activation disorder F42.4 Excoriation (skin-picking) disorder L03.213 Periorbital cellulitis L76.31 Postprocedural hematoma of skin and subcutaneous tissue following a

dermatologic procedure L76.32 Postprocedural hematoma of skin and subcutaneous tissue following other

procedure L98.7 Excessive and redundant skin and subcutaneous tissue M21.611 Bunion of right foot M21.612 Bunion of left foot M21.619 Bunion of unspecified foot M21.621 Bunionette of right foot M21.622 Bunionette of left foot M21.629 Bunionette of unspecified foot N50.8.1 Right testicular pain N50.812 Left testicular pain N50.819 Testicular pain, unspecified N50.82 Scrotal pain N61.0 Mastitis without abscess N61.1 Abscess of the breast and nipple N90.60 Unspecified hypertrophy of vulva N90.69 Other specified hypertrophy of vulva W26.2XXA Contact with edge of stiff paper, initial encounter W26.2XXD Contact with edge of stiff paper, subsequent encounter W26.2XXS Contact with edge of stiff paper, sequela W26.8XXA Contact with other sharp object(s), not elsewhere classified, initial encounter W26.8XXD Contact with other sharp object(s), not elsewhere classified, subsequent encount. W26.8XXS Contact with other sharp object(s), not elsewhere classified, sequela




W26.9XXA Contact with unspecified sharp object(s), initial encounter W26.9XXD Contact with unspecified sharp object(s), subsequent encounter W26.9XXS Contact with unspecified sharp object(s), sequela Z05.71 Observation and evaluation of newborn for suspected skin and subcutaneous

tissue condition ruled out Z51.6 Encounter for desensitization to allergens Revised ICD-10 codes for October 1, 2016 potentiall y affecting dermatologists L762.1 Revise from Postprocedural hemorrhage and hematoma of skin and

subcutaneous tissue following a dermatologic procedure L762.1 Revise to Postprocedural hemorrhage of skin and subcutaneous tissue following

a dermatologic procedure L762.2 Revise from Postprocedural hemorrhage and hematoma of skin and

subcutaneous tissue following other procedure L762.2 Revise to Postprocedural hemorrhage of skin and subcutaneous tissue following

other procedure Deleted ICD-10 codes for October 1, 2016 potentiall y affecting dermatologists N61 Inflammatory disorders of breast N50.8 Other specified disorders of male genital organs N90.6 Hypertrophy of vulva W45.1XXA Paper entering through skin, initial encounter W45.1XXD Paper entering through skin, subsequent encounter W45.1XXS Paper entering through skin, sequela W45.2XXA Lid of can entering through skin, initial encounter W45.2XXD Lid of can entering through skin, subsequent encounter W45.2XXS Lid of can entering through skin, sequela

Over 100,000+ ICD-10 synonyms added to DermCoder’s ICD-10 search

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• “basosquamous cell carcinoma” • “skin tags” • “digital mucous cyst”

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2016 vs 2017 Fee Schedule Comparison (National Average Fee Schedule) The following is a list of common or frequently-performed services in dermatology.

CODE MOD Description 2016 2017 $

change %

change

11042

DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< $118.15 $118.43 $0.28 0.24%

11056

PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 $58.72 $59.22 $0.50 0.85%

11100

BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION $104.55 $105.15 $0.60 0.57%

11101

BIOPSY SKIN SUBQ&/MUCOUS MEMBRANE EA ADDL LESN $33.30 $33.38 $0.08 0.24%

11642

EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM $275.69 $277.06 $1.37 0.50%

11720 DEBRIDEMENT NAIL ANY METHOD 1-5 $32.58 $32.66 $0.08 0.25%

11721 DEBRIDEMENT NAIL ANY METHOD 6/> $45.47 $45.58 $0.11 0.24%

12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM $307.20 $309.00 $1.80 0.59%

12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM $292.88 $294.65 $1.77 0.60%

12052

REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM $298.25 $299.67 $1.42 0.48%

13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM $339.07 $340.94 $1.87 0.55%

13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM $401.37 $403.39 $2.02 0.50%

13120

REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM $354.82 $356.73 $1.91 0.54%

13121

REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM $433.23 $435.33 $2.10 0.48%

13131

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM $390.62 $392.98 $2.36 0.60%

13132

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM $483.36 $485.57 $2.21 0.46%

13151

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM $428.22 $430.66 $2.44 0.57%

13152

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM $514.87 $516.80 $1.93 0.37%

14060

ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< $790.92 $794.22 $3.30 0.42%





change %

change

15260

FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/< $1,031.16 $1,036.11 $4.95 0.48%

17000

DESTRUCTION PREMALIGNANT LESION 1ST $67.67 $67.83 $0.16 0.24%

17003

DESTRUCTION PREMALIGNANT LESION 2-14 EA $5.73 $5.74 $0.01 0.17%

17004

DESTRUCTION PREMALIGNANT LESION 15/> $152.17 $152.89 $0.72 0.47%

17110 DESTRUCTION BENIGN LESIONS UP TO 14 $112.07 $112.69 $0.62 0.55%

17111 DESTRUCTION BENIGN LESIONS 15/> $132.83 $133.86 $1.03 0.78%

17311

MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS $670.26 $674.35 $4.09 0.61%

17312

MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE $393.85 $396.21 $2.36 0.60%

17313

MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS $626.58 $630.21 $3.63 0.58%

17314

MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE $377.74 $380.06 $2.32 0.61%

17315

MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE $80.92 $81.83 $0.91 1.12%

88304 26 LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $11.82 $12.20 $0.38 3.21%

88304 TC LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $34.37 $29.43 -$4.94 -14.37%

88304 LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $46.19 $41.63 -$4.56 -9.87%

88305 26 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $39.74 $39.84 $0.10 0.25%

88305 TC LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $34.37 $29.79 -$4.58 -13.33%

88305

LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $74.11 $69.62 -$4.49 -6.06%

96372

THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM $25.42 $25.84 $0.42 1.65%

96567

PDT XTRNL APPL LIGHT DSTR LES SKN BY ACTIVJ RX $136.41 $137.09 $0.68 0.50%

96900 ACTINOTHERAPY ULTRAVIOLET LIGHT $20.77 $21.17 $0.40 1.93%

99201 OFFICE OUTPATIENT NEW 10 MINUTES $44.04 $44.50 $0.46 1.04%





change %

change



99211 OFFICE OUTPATIENT VISIT 5 MINUTES $20.05 $20.46 $0.41 2.04%




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