Review key points of the dermatology prior authorization (PA) process

Define strategies to anticipate the challenges of submitting and appealing dermatology PAs   

Effectively communicate with payers and patients to better align their goals

Discuss expert approaches to collaborate with dermatology office staff throughout the PA request and appeals workflow

2024 Virtual Grand Rounds Session 11: September 18, 2024 - Overcoming Obstacles: Optimizing Efficacy and Promoting Success in Dermatology Prior Authorizations

Coding

Office Practice & Coding Tips You May Not Be Aware Of

It is essential to understand billing and coding to run a successful practice, and Mark Kauffman, MD delivered a rigorous session to get us up to speed on coding strategies and the current fiscal physician landscape. He informed us of the dramatic decrease in physician reimbursement throughout the 2000s. While lobbying, legislation, and larger bureaucratic changes are required to truly fight inflation’s impact on physician salary, there are some small steps to take in your practice right now.&nbsp; He warned us to be aware of E/M leveling as payers begin to lump diagnoses into specific complexity levels robbing clinicians of the ability to make appropriate claims. These leveled claims should be appealed if necessary. Perhaps one of the most actionable tips Dr. Kauffman gave us is that suture removals can now be billed to capture clinic supplies required for these minor procedures. Explicitly, 15853 should be used for removing sutures or staples, whereas 15854 should be used for sutures and staples. However, both of these codes are for 0-global day procedures or can be used when outside of a global period when an E/M service is performed in the office setting, such as reviewing pathology results. They can never be reported during a global period of any procedure. A few notable changes to the 2024 Current Procedural Terminology book: 96920-96922 for the treatment of psoriasis with excimer laser now requires both a specific diagnosis and specific laser for billing.&nbsp; Dr. Kauffman ended this session by reminding us to use the entire fee schedule including facility fees or J codes when a drug requires an infusion or injection. In practices with multiple subtypes of dermatologists, such as pediatric, procedural, and dermatopathologic, each physician can bill and be paid without regard to their membership in the same group. Important dermatologic taxonomies are as follows: Dermatology 207N00000X, Mohs Surgery 207ND0101X, Clinical and Lab Derm Immunology 207NI0002X, Pediatric Dermatology 207NP0225X, Procedural Derm 20NSO135X, and Dermatopathology 207ND0900X.&nbsp;

Coding Condition Center

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2024 Virtual Grand Rounds Session 11: September 18, 2024 - Overcoming Obstacles: Optimizing Efficacy and Promoting Success in Dermatology Prior Authorizations