Dermatologists evaluate and manage a range of skin conditions during evaluation and management (E/M) office visits, which may also include biopsy and lesion treatment procedures. A procedure code for biopsy or lesion treatment identifies that a specific service was performed in the office visit but does not, by itself, describe the full range of medical conditions evaluated and managed during the visit. The American Academy of Dermatology Association commissioned Milliman to examine diagnosis patterns on Medicare fee-for-service (FFS) billing-group days of E/M visits where a procedure was provided for the same beneficiary, on the same date, billed by the same provider group—involving three common dermatologic procedures that often accompany dermatology E/M visits.
Using calendar-year 2024 Medicare FFS claims from the 5% Limited Data Set (LDS), extrapolated to a national FFS basis, this report addresses two related questions: (1) among Current Procedural Terminology (CPT) 11102 (skin biopsy) billing-group days, what share of the biopsies are for a cancer-related diagnostic purpose; and (2) beyond the specific diagnosis for which billed procedures were performed, what other diagnoses are commonly reported on billing-group days containing CPT 11102, 17000 (destruction premalignant lesions; first lesion), or 17110 (destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions).
The claims analyzed were limited to billing-group days that included both a modifier 25 office or other outpatient E/M service and a same-day procedure with a 0-, 10-, or 90-day global period based on a prior Milliman analysis.
Key findings:
- Skin biopsies billed under CPT 11102 are frequently provided for cancer-related diagnostic purposes.
- Billing-group days containing CPT 11102, 17000, or 17110 include an average of approximately 4.5 to 5 other unique diagnosis codes beyond the line-level diagnoses reported for procedures.
- Z-codes were less frequent but common, with approximately 0.9 to 1.1 unique codes per billing-group day, compared with an average of 3.5 to 4.1 for non-Z-code diagnoses.
- Among billing-group days reporting at least one Z-code, approximately 78% to 87% included a Z-code specifically related to skin cancer assessment.
- Other reported diagnoses often included skin conditions and skin cancer history.
This report was commissioned by the American Academy of Dermatology Association.