Accurate billing is essential to the financial health of dermatology practices—but general billing services often fall short. This article explores how specialized dermatology billing support leads to fewer denials, faster reimbursement, and stronger revenue performance by addressing the unique coding and compliance challenges of the specialty.
* * *
In dermatology, accurate and efficient billing is critical to financial success. From excisions and biopsies to cosmetic treatments and pathology, dermatology practices rely on precise coding and timely reimbursements to maintain profitability and growth. That is why more dermatologists are turning to specialized, outsourced dermatology billing services to improve their claim accuracy, reduce denials, and ultimately maximize revenue.
Unlike general medical billing, dermatology billing requires in-depth knowledge of dermatologic procedures, diagnosis codes, and the nuances of payer requirements. The difference can mean thousands of dollars in lost revenue or denied claims when handled incorrectly.
Why General Billing Services Typically Fall Short
General medical billing services often provide a broad-stroke approach that fails to capture the complexity and specificity of dermatology. While these billing companies may understand the basics of CPT and ICD-10 coding, they may not be familiar with the intricacies of dermatologic procedures such as Mohs surgery, cryotherapy, or phototherapy. And this lack of knowledge can prove detrimental.
Dermatology practices deal with a wide range of codes that require detailed documentation and coding precision. For example, ICD-10 codes in dermatology include everything from L40.0 for psoriasis vulgaris to C44.91 for basal cell carcinoma of unspecified skin sites. These differences may seem minor but can significantly affect how a claim is processed. A general billing team may not catch these subtleties, leading to improper claim submission or underpayment. If these issues go undetected, a dermatology practice could risk significant financial consequences — including payer clawbacks or even allegations of fraud — if inaccurate billing results in overpayment or noncompliant reimbursement.
Moreover, dermatology procedures often involve multiple components that must be coded and billed separately. A lack of familiarity with the likes of global periods, modifier use, or documentation requirements can delay payment and trigger unnecessary audits. For example, billing for Mohs surgery is complex, requiring careful attention to tissue stages, mapping, and pathology. These are all elements that must be accurately represented in the claim or a practice may face denials or worse.
Common Dermatology Procedures and Billing Challenges
Dermatology procedures like excisions, biopsies, Mohs surgery, cryotherapy, laser treatments, patch testing, and photodynamic therapy each come with unique billing requirements. Some involve surgical elements, while others may include pathology review or additional follow-up services. Each requires accurate documentation and the correct CPT codes to avoid delays or denials.
Take skin biopsies and excisions, for instance. Depending on the location, size, and whether tissue is sent for pathology, different codes may apply. With patch testing, the interpretation and documentation must align with payer expectations. Even something seemingly routine like wart removal can result in complications if billed without the correct modifiers.
Navigating Evolving Dermatology Payer Rules
Dermatology billing is not static. Payer rules are frequently updated, and insurance companies are paying closer attention to compliance. Reimbursement policies for procedures like acne surgery or actinic keratosis destruction continue to change, and many payers now require specific documentation or prior authorization before approving claims.
Billing teams that are not well-versed in these policies risk falling behind. Staying current on local coverage determinations (LCDs), national coverage determination (NCDs), and preauthorization protocols is critical. It is not just about knowing the codes; it is about knowing how to defend them when reimbursement is questioned. Dermatology-focused billing teams bring this level of insight to every claim they handle.
Understanding ICD-10 in Dermatology Billing
Accurate diagnosis coding is essential to support medical necessity and ensure reimbursement. In dermatology, commonly used ICD-10 codes such as L72.0 for epidermal cysts, L82.1 for seborrheic keratosis, and D23.5 for benign skin neoplasms require careful interpretation of clinical notes. Missteps here can impact claims, especially when tied to procedures requiring detailed justification.
The diversity of skin conditions and the specificity required in diagnosis coding make ICD-10 a challenge for general billing services. Dermatology-specific billing expertise ensures that providers use the right codes, properly sequence diagnoses, and support claims with appropriate clinical documentation.
Dermatology Billing Services That Power Practice Growth
More dermatology practices are realizing that specialized billing support contributes directly to financial performance. Billing teams with true dermatology expertise help ensure that all services are accurately coded and billed, while supporting compliance with increasingly complex payer requirements. That level of specialization results in cleaner claims, fewer denials, and faster reimbursement.
Whether it is navigating bundled services, correctly applying modifiers, or ensuring timely claims submission, dermatology billing expertise makes a measurable difference for today’s practice. With growing competition, rising costs, and tighter margins, the ability to optimize billing is not optional — it is essential to long-term success and viability.
If your practice has experienced denials, underpayments, or delayed reimbursements, it may be time to assess whether your in-house personnel or outsourced billing partner has the dermatology-specific expertise needed to support your growth. Investing in a billing partner that truly understands your specialty and practice can drive long-term financial results and reduce stress on your administrative staff.
PGM: The Dermatology Billing Experts
PGM’s dermatology billing service is built on decades of experience supporting the unique financial needs of dermatology practices. With a deep understanding of procedure-specific coding, evolving payer rules, and dermatology-focused revenue cycle management, PGM helps practices reduce denials, accelerate reimbursement, and improve financial performance. Whether you are a solo provider or part of a large group, our team works as an extension of your practice to ensure accurate claims and maximize collections. To learn how PGM can support your dermatology practice, contact us today.