Dermatology billing requires mastery of lesion coding, Mohs surgery component billing, cosmetic vs. medical distinction, and the highest E/M complexity level decisions.
Common Billing Challenges
These are the six billing failure points we see most often — and the ones our team resolves systematically from day one.
Excision, shave removal, and destruction codes are selected based on lesion size, body location, and method — each with a different reimbursement. Mismatch between the operative note and claim code is the top audit trigger.
Mohs is billed by stage and tissue block — 17311 for first stage, 17312 for each additional stage, plus 17315 for each additional block. Incomplete component billing loses significant revenue per case.
Lesion removal for cosmetic reasons is non-covered; for medical reasons (skin cancer, functional impairment) it is covered. Documentation must clearly support medical necessity to prevent blanket cosmetic denials.
When multiple lesions are treated in the same session, modifier 51 and the correct multiple procedure reduction rules apply. Incorrect application results in either denials or overpayment recovery demands.
Dermatology practices billing their own pathology need correct 88305/88304 coding for excised specimens — with documentation supporting the number of specimens processed.
Injectable biologics (Dupixent, Tremfya, Skyrizi) require J-codes or HCPCS C-codes with the correct units, prior auth, and buy-and-bill vs. specialty pharmacy pathway documentation.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in that specialty.
| CPT Code | Description | Common Issue |
|---|---|---|
| 11646 | Excision malignant lesion, face >4cm | Size/method match to operative note |
| 17311 | Mohs, 1st stage | Stage + block count in op note |
| 17004 | Destruction, 15+ benign lesions | Medical necessity documentation |
| 11305 | Shave removal, trunk, 0.6-1.0cm | Modifier 51 + reduction rules |
| 99214 | E/M, established, moderate complexity | Specimen count documentation |
| 96372 | Therapeutic injection, SC/IM | Auth + J-code + buy-and-bill |
Why RCMAXIS
We are not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to your field — not a generic CPC only.
Significantly above the 10.8% industry denial rate for your specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.