Dermatology billing services
Billing for medical and surgical dermatology, with biopsies, destructions, excisions and Mohs coded from the note and the pathology report.
Why dermatology billing takes specialty knowledge
Dermatology claims are full of counts and measurements. Biopsy codes depend on the technique used. Destruction codes depend on how many lesions were treated. Excision codes depend on whether the lesion was benign or malignant and on the excised diameter, including margins, which often cannot be coded until pathology comes back. Most procedures carry a 0 or 10-day global period, so an E/M on the same day needs modifier 25 and a clear separate reason.
SFA Solutions codes dermatology claims from the procedure note and the final pathology. We hold excision claims until the diagnosis is confirmed, count destroyed lesions correctly across 17000, 17003 and 17004, bill Mohs stages and repairs separately when allowed, and separate cosmetic services from covered ones before the claim is filed. Your providers keep seeing patients while our coders work through each lesion from the note and the path report.
Common codes we work with in dermatology
| Code | Description |
|---|---|
| 11102 | Tangential biopsy of skin, single lesion |
| 11104 | Punch biopsy of skin, single lesion |
| 17000 | Destruction of premalignant lesion, first lesion |
| 17003 | Destruction of premalignant lesions, 2 through 14, each |
| 17110 | Destruction of benign lesions other than skin tags, up to 14 lesions |
| 11642 | Excision of malignant lesion of face, ears, eyelids, nose or lips, excised diameter 1.1 to 2.0 cm |
| 17311 | Mohs surgery, head, neck, hands, feet, genitalia, first stage, up to 5 tissue blocks |
| 99213 | Established patient office visit, low medical decision making or 20+ minutes |
CPT is a registered trademark of the American Medical Association. Payer rules vary; we check each payer's current policy.
Where dermatology practices lose revenue
Biopsy codes by technique
Skin biopsies are coded by method: tangential (11102), punch (11104) or incisional (11106), each with an add-on code for additional lesions (11103, 11105, 11107). When different methods are used in the same session, the first lesion is reported with the highest-valued primary code and the others with add-ons. Biopsy and excision of the same lesion on the same day are not billed together.
Excisions wait for pathology
Excision codes 11400-11646 are split into benign and malignant and by excised diameter, measured as the lesion plus the narrowest margins. Since the benign or malignant choice depends on the pathology report, coding before results arrive leads to corrected claims. Intermediate and complex repairs are billed separately from the excision.
Destruction counts
Premalignant lesions such as actinic keratoses are billed with 17000 for the first lesion and 17003 for each of lesions 2 through 14. When 15 or more are treated, 17004 is billed alone, without 17000 or 17003. Benign lesions like warts use 17110 for up to 14 lesions and 17111 for 15 or more.
Mohs surgery and modifier 25
Mohs codes 17311-17315 require the same physician to act as surgeon and pathologist, and are billed by location and number of stages. A same-day E/M is payable only when the visit addresses a problem beyond the decision to perform the planned procedure, with modifier 25. Cosmetic removals of benign lesions that cause no symptoms are not covered and should be billed to the patient.
What else affects dermatology revenue
A/R challenges in dermatology
Holding excision claims for pathology protects coding accuracy, but it also means the A/R clock should be watched from the date the path report arrives. Dermatology also carries patient balances that age quickly: cosmetic services that should be paid at the visit, high deductibles on procedure-heavy visits, and lesion removals a plan considered cosmetic. Biologic treatments add authorization renewals, and a lapsed approval can stop payment on follow-up injections or visits.
Credentialing considerations
Dermatologists enroll under taxonomy 207N00000X, with separate subspecialty taxonomies for Mohs micrographic surgery and dermatopathology that some plans check. An in-office lab, even for a KOH prep, needs the right CLIA certificate before lab codes are billed, and a dermatopathology lab needs its own CLIA certificate and payer enrollment. NPs and PAs who do skin checks or procedures need their own enrollment with each plan before they can bill under their own NPI.
Payer considerations
Many Medicare contractors have a local coverage policy for removing benign skin lesions such as seborrheic keratoses, and removal is covered only when the note shows a qualifying reason like bleeding, irritation or suspicion of malignancy. Commercial plans have similar cosmetic exclusions. Biologics for psoriasis and atopic dermatitis are usually covered through the pharmacy benefit with step therapy, while in-office injections billed under the medical benefit need their own authorization. We check which benefit applies before the first dose.
Dermatology coding details that affect payment
ICD-10 considerations
Skin cancer codes are specific to type and site, such as C44.311 for basal cell carcinoma of the skin of the nose and C44.321 for squamous cell carcinoma of the skin of the nose, while melanoma codes in C43 add laterality for the limbs. Before pathology returns, a lesion is usually coded by its presenting sign or with D49.2 (neoplasm of unspecified behavior of bone, soft tissue and skin), and D48.5 is reserved for lesions the pathologist reports as uncertain behavior. Seborrheic keratosis has separate codes for inflamed (L82.0) and other (L82.1), which matters for coverage of removals. Actinic keratosis (L57.0) supports destruction codes 17000 to 17004, and biologic claims need a specific psoriasis or atopic dermatitis code such as L40.0.
Modifiers to watch
| XS or 59 | Used when separate lesions at different anatomic sites are treated with procedures that NCCI would otherwise bundle, such as a biopsy and a destruction. |
|---|---|
| 58 | Added when a planned re-excision for positive margins is done during the global period of the original excision. |
| 79 | Applied when an unrelated lesion is treated during the 10-day global of an earlier excision or destruction. |
| GA | Used when a Medicare patient signs an ABN before removal of a benign lesion that may not meet the coverage criteria. |
| 25 | Placed on the E/M when a full skin exam or management of another condition is documented on the same day as a minor procedure. |
Global periods
Biopsies (11102 to 11107) and Mohs surgery carry 0-day globals, while destructions such as 17000 and excisions 11400 to 11646 carry 10-day globals. Adjacent tissue transfers in the 14000 series carry 90-day globals, so routine follow-up visits after a flap are not billed separately.
Medicare considerations
Medicare does not cover routine full-body skin cancer screening without signs or symptoms, so those visits need an ABN or should be discussed with the patient in advance. Many MACs publish policies on Mohs surgery that limit its use to certain tumor types and locations and expect stage-by-stage documentation. Incident-to billing for NPs and PAs applies only to follow-up of an established physician plan of care, so new problems seen by an NP are billed under the NP's own NPI.
Dermatology billing KPIs to track
- Days from pathology result to claim. Excision claims held for pathology need to go out quickly once the report arrives, or the hold turns into aging A/R.
- Modifier 25 denial rate. E/M with same-day procedures is the most audited dermatology combination, so rising denials signal documentation gaps.
- Cosmetic collection at time of service. Cosmetic services are the patient's responsibility, and balances left for statements are harder to collect.
- Corrected claim rate on excisions. A high rate shows excisions are being coded before pathology or with incorrect excised diameters.
Dermatology billing audit checklist
- Confirm excision size is coded from the excised diameter including margins, not the lesion size alone.
- Check that benign versus malignant excision codes match the final pathology report.
- Verify destruction claims use 17004 alone when 15 or more premalignant lesions are treated.
- Review seborrheic keratosis removals for a documented qualifying symptom or a signed ABN.
- Confirm Mohs claims document the number of stages and tissue blocks for each site.
- Check that CLIA certificate level supports any in-office lab tests billed.
How SFA runs dermatology billing
We set up a workflow to hold excision claims until final pathology is received.
Coders assign biopsy, destruction, excision, repair and Mohs codes from the note and pathology report.
Modifier 25, 59 and XS are applied only where documentation supports a separate service, then claims are filed.
Denials are appealed and cosmetic balances are billed to patients with clear statements.
The services that matter most for dermatology
Medical Coding
Biopsy methods, lesion counts and excision sizes have to be coded exactly from the note and pathology.
Learn moreDenial Management
Modifier 25 and bundling denials are common in dermatology and often reversible with proper documentation.
Learn moreEligibility Verification & Prior Authorization
Biologic therapies and some procedures need prior authorization before the patient is treated.
Learn moreWhat practices typically see with SFA
Averages and selected client results. Your free audit shows where your own numbers stand today.
Target for the claims we manage, not a measured average.
Highest improvement seen in selected client results.
Largest drop in A/R days seen in selected client results.
Targeted for submission within 24 hours after final review.
From primary care and nurse practitioners to surgery and imaging.
We work inside the system your practice already uses.
Results vary by practice, specialty, payer mix, claim volume, billing history, documentation and other factors. Performance figures represent average or selected client results and are not guarantees of future performance. The 95% figure is a clean-claim target, not a measured cohort. The client-results page does not include a measurement period, starting collections, or practice size.
Dermatology billing questions
Can I bill an E/M visit with a skin biopsy?
Yes, when the visit includes significant, separately identifiable work beyond evaluating the lesion you biopsied, such as managing other conditions. Append modifier 25 and document the additional work separately.
How do I bill destruction of 20 actinic keratoses?
Bill 17004 once for 15 or more lesions. Do not report 17000 or 17003 with it.
Why wait for pathology before billing an excision?
Excision codes differ for benign and malignant lesions, and the diagnosis code depends on the pathology result. Billing early often means submitting a corrected claim later.
Are seborrheic keratosis removals covered?
Only when there is a documented medical reason, such as bleeding, inflammation or irritation. Removal for appearance alone is cosmetic and is the patient's responsibility.
Can Mohs and the repair be billed together?
Yes. The repair is reported separately from Mohs, using the appropriate repair, flap or graft code for what was done after the final stage.
See what your dermatology billing is missing
Send us a few details and an RCM specialist who knows dermatology will review where claims are denied, underpaid or left unbilled.
- A clear walkthrough of what we find
- Reply typically within one business day
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