Updates on coding in dermatology.

Correct coding is an important component of effective dermatology practice management. Over the past several years there have been updates to many commonly used codes within dermatology. This review highlights many of these updates, such as: the skin biopsy codes have been subdivided to reflect the different biopsy techniques. The definition of complex linear repairs has been updated and clarified. Outpatient and inpatient evaluation and management visits have new coding guidelines to determine level of care. Dermatopathology consultation codes have been updated and category III codes related to digital pathology have been created. Understanding the details and nuances of each of these categories of codes is vital to ensuring appropriate coding is performed.

Expanding and Strengthening Your Referral Network.

Dermatology referral utilization is increasing, with 15% of dermatology-related visits by primary care resulting in a dermatology referral. Given this, both strengthening an expanding a referral is a key component of a successful dermatology practice. In particular, effective communication is essential for efficient patient-oriented coordinated care. Written and/or verbal communication can help build a strong communication network and, in some instances, can be applied toward Merit-based Incentive Payment System (MIPS) reporting and billing for coding families that incorporate the coordination of care. Reaching out directly to referring clinics has also been shown to increase the quantity of referrals. This can include providing clinics with patient handouts on your clinic, education on what information is prioritized within the referral, and educating staff on how to complete their referrals effectively and efficiently. Social media can play an important role in referrals, especially for patients looking for cosmetic care. There are many different platforms, and these can serve as a marketing tool for physicians looking to bring in new patients.

Coding the "Spot Check": Part 2.

The updated outpatient evaluation and management (E/M) coding paradigm went into effect in January 2021, with the coding level being based on time or medical decision making (MDM). In part 2 of this series, we describe how to best code an encounter that includes a "spot check" with other concerns.

Coding the "Spot Check": Part 1.

The updated outpatient evaluation and management (E/M) coding paradigm went into effect in January 2021, with level of visit being based on time or medical decision making (MDM). This article discusses how to effectively utilize this coding structure to correctly document for the "spot check," a common encounter within dermatology.

How to Effectively Utilize Consultation Codes: 2023 Updates.

Consultation codes can be utilized by dermatologists in both the inpatient and outpatient setting. Updates to the inpatient and outpatient consultation code families went into effect January 1, 2023. Similar to the outpatient evaluation and management (E/M) codes, level of service is now determined solely based on either time on the date of the encounter or medical decision-making. Additionally, interprofessional consultation codes are time-based codes that can be utilized when assisting in the diagnosis and/or management of a patient without face-to-face contact.

Poison Ivy Dermatitis Treatment Patterns and Utilization: A Retrospective Claims-based Analysis.

INTRODUCTION: Poison ivy (toxicodendron) dermatitis (TD) resulting from contact with poison ivy, oak, or sumac is a common form of allergic contact dermatitis that impacts millions of people in the United State every year and results in an estimated 43,000 emergency department (ED) visits annually. Our objective in this study was to evaluate whether healthcare utilization outcomes are impacted by prescription practices of systemic corticosteroids. METHODS: We used a health claims database from 2017-2018 of those treated for TD. Descriptive statistics and logistics regression models were used to characterize trends. RESULTS: We included in this analysis 115,885 claims from 108,111 unique individuals (93.29%) with 7,774 (6.71%) return claims within 28 days. Of the return claims, 470 (6.05%) were to the ED. Emergency clinicians offered no oral corticosteroid prescription 5.27% (n = 3,194) of the time; 3276 (86.26%) prescriptions were for a duration of 1-13 days, 410 (10.80%) were for 14-20 days, and 112 (2.95%) were for >21 days. Further, we found that shorter duration oral corticosteroids (odds ratio [OR] 1.30; 95% confidence interval 1.17-1.44; P <0.001) and initial treatment for TD at the ED compared to primary care clinicians (OR 0.87 [0.80, 0.96]; P <0.001) and other non-dermatologists (OR 0.89 [0.80, 0.98]; P = 0.01) places patients at an increased risk for return visits with healthcare clinicians when controlling for drug group, duration of treatment, and initial treatment location. CONCLUSION: Despite recommendations to treat TD with oral steroids for at least 14 days, most emergency clinicians offered this treatment for shorter durations and was associated with return visits. Emergency clinicians should consider treatment of two to three weeks when providing systemic steroid coverage when there are no limiting contraindications, especially as patients who present to the ED may do so with more severe disease. Additional education may be needed on appropriate treatment pathways for TD to reduce healthcare utilization associated with undertreatment.

The Final Rule for 2022: What's New and How Changes in the Medicare Physician Fee Schedule and Quality Payment Program Affect Dermatologists.

The Centers for Medicare & Medicaid Services (CMS) 2022 final rule, which went into effect on January 1, 2022, contains updates affecting the practice of dermatology. This article reviews many of the changes to the Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) and their impact on clinical practice.

Establishing Consensus on the Treatment of Toxicodendron Dermatitis.

BACKGROUND: Toxicodendron dermatitis (TD) is a common form of allergic contact dermatitis that affects millions of Americans every year. Studies have shown that although there are general recommendations for the treatment of TD, there are no treatment algorithms for clinicians to follow when patients present with TD. OBJECTIVE: The objective of this study was to achieve consensus on the treatment of TD to create practical guidelines for physicians who treat TD. METHODS: Data were collected from March 2020 to April 2021. This study included semistructured focus groups and a Delphi Study with dermatologists to achieve consensus. RESULTS: A total of 51 dermatologists were included in the Delphi. Final agreement with proposed severity criteria ranged from 90.9% to 100.0%. Primary indicators of disease severity were body surface area, presence and severity of pruritus, and anatomic locations of eruptions with 77.4% agreement. Final agreement for the treatment algorithm was over the threshold majority agreement at 67.6%. CONCLUSIONS: Literature guiding the treatment of TD is scarce. The use of the Delphi method and focus groups can help expand dermatological resources both within dermatology and to other specialties that may need to treat skin conditions.

Associations of Internalized Skin Bias With Age, Adverse Psychopathology, and Health-Related Quality of Life Among Patients With Hidradenitis Suppurativa: A Cross-sectional Analysis.

Importance: Hidradenitis suppurativa (HS) is a chronic autoinflammatory disease that is highly associated with affective disorders such as depression and anxiety. Recent studies have shown that patients with HS may also endorse high levels of internalized skin bias (ISB). This redirection of skin disease-related social stigma toward oneself may also play an important role in the associations between adverse psychopathology (eg, depression, anxiety) and health-related quality of life (HRQOL). Objectives: To evaluate the associations of ISB with other core outcomes in HS and to determine if ISB may mediate the associations between adverse psychopathological outcomes and impaired HRQOL. Design, Setting, and Participants: A cross-sectional study of adult patients with HS recruited from 1 academic medical center as well as through virtual social and recruitment networks. Eligible participants completed an online survey comprised of 4 survey instruments along with demographic and disease history information from April 1, 2021, to July 15, 2021. Main Outcomes and Measures: Measures included the Internalized Skin Bias Questionnaire (ISBQ), Burns Anxiety Inventory, the Beck Depression Inventory-II, the Hidradenitis Suppurativa Quality of Life (HiSQOL) instrument, along with demographic and disease history information. The primary outcome was HRQOL as measured by the HiSQOL. Data were analyzed in July through August 2021. Results: The survey was completed by 230 of 279 patients (82.4%; mean [SD] age, 39.2 [11.2] years; 209 [90.9%] identified as female, 203 [88.7%] as not Hispanic, 178 [77.7%] as White). Depression and anxiety were shown to be a substantial burden in this sample, with 56.5% of participants' scores qualifying for moderate or greater anxiety and 45.7% moderate or greater depression. The mean (SD) HRQOL scores were moderately high at 34.5 (16.7), indicating strong levels of impairment. There was a moderate correlation between ISBQ score and depression (r = 0.67); and fair correlations with HRQOL (r = 0.52) and anxiety (r = 0.56). Therefore, ISB appears to positively mediate the associations between depression and anxiety (estimated proportions of total effect that were mediated, 38.7% and 24.9%, respectively) and HRQOL. After controlling for age, disease severity, and disease duration, both ISB and anxiety were positive predictors of impaired HRQOL. Conclusions and Relevance: This cross-sectional study found that ISB was associated with adverse psychopathology and impaired HRQOL in patients with HS. Furthermore, ISB appears to mediate the associations of depression and anxiety with HRQOL. Future studies are needed to design interventions targeted at addressing adverse psychopathology associated with ISB and improving HRQOL and well-being for patients with HS.

Characterizing demographics and cost of care for dyshidrotic eczema.

BACKGROUND: Dyshidrotic eczema (DE) is a common form of eczema affecting the hands, feet, or both areas. To date, there has been little research examining demographics and cost burden associated with this disease. OBJECTIVE: This study seeks to characterize the demographics of patients affected and the direct costs of care associated with DE. METHODS: This is a retrospective analysis utilizing insurance claim information from IBM MarketScan. Pertinent data including demographic information, healthcare provider type, medications prescribed, and average cost of care were identified using the ICD 10 code L30.1 for DE for the year 2018. RESULTS: In 2018, 34 932 patients filed claims for DE, with 61% female and an average age of 37 years at first diagnosis. DE was mostly seen in employees from the service industry and the manufacturing of durable goods. The total annual direct cost was US $11 738 985. Average annual costs, however, did vary based on type of treating healthcare provider, level of care, and medications prescribed. CONCLUSIONS: Patients with DE can face an economic burden due to their disease and providers should aim to recognize this disease and its treatments to minimize healthcare costs for patients and improve quality of life.

Efficacy of pediatric dermatology Extension for Community Healthcare Outcomes (ECHO) sessions on augmenting primary care providers' confidence and abilities.

Due to the shortage of pediatric dermatologists and the abundance of skin disorders presenting in childhood, general pediatricians shoulder the management of many pediatric dermatologic disorders and would benefit from additional dermatology-specific training. To address this educational gap, general pediatricians were enrolled in a pediatric dermatology-specific Project Extension for Community Healthcare Outcomes (ECHO) program and surveyed to assess the efficacy of the program in increasing providers' ability and confidence in managing pediatric dermatologic conditions. Providers unanimously reported increased confidence and abilities in assessment and management of pediatric dermatologic conditions. Pediatric dermatology Project ECHO demonstrated high efficacy in improving general practitioners' comfort and knowledge on dermatology-specific topics and may be used as an education model for enhancing primary care providers' knowledge and management of common disorders.