Daniel M. Siegel, MD, is a clinical professor of dermatology at SUNY Downstate Health Sciences University, New York, and is the former president and honorary member of the American Academy of Dermatology (AAD).

Daniel M. Siegel, MD

Tips on Billing Issues in Dermatology Practices, With Daniel Siegel, MD

New rules related to billing were implemented in 2021 for determining service in outpatient interactions, and a new session presented at the 

The talk was presented at Maui Derm by Daniel M. Siegel, MD, clinical professor at SUNY Downstate Health Sciences University, and Mark Kaufman, MD, associate clinical professor in the Department of Dermatology at the Icahn School of Medicine at Mount Sinai. In a 

 with HCPLive, Siegel highlighted notable takeaways on this topic. This interview summary represents a continuation of his discussion with HCPLive.

“It's an ongoing battle, and the payers know this,” Siegel explained. “Friends from overseas will often wonder about pharma companies, the overseas companies. Somehow think that if you get in the US, you're golden…Think of the US as like the EU. Every state is a country.”

Throughout this segment of his Maui Derm interview, Siegel described reimbursement by payers as an ongoing and deliberately complex battle, describing the variation in insurance coverage and payment policies by state, by region, by insurer, and even individual plans within the same market. In a similar manner to the EU, Siegel notes insurance operates almost as though separate countries with their own rules are involved.

Such fragmentation, Siegel noted, allows payers to slow care delivery and reimbursement via administrative hurdles, including repeated phone escalations and prolonged prior authorization processes. These will commonly necessitate direct involvement by clinicians. Such tactics are embedded in the way payers manage costs and control utilization, he concluded.

“If you look at a disease like psoriasis, no one's going to argue that psoriasis is a chronic disease,” Siegel said. “But is it chronic and stable? Is it chronic and improving since the last encounter? Is it severe enough to possibly cause hospitalization?”

Pustular psoriasis, Siegel explained, can lead to cardiac failure in certain specific cases. But unless there is an ICD-10 code including acuity or comorbidities, as the diabetes codes do, then the wording in the column must be addressed. Concerning chronic diseases such as psoriasis or acne, Siegel highlighted the value of documenting whether patients have attained their treatment aims, as those who are not at their goal are, by definition, not stable and may qualify for a higher level of medical decision-making.

In this session, Siegel and Kaufman aimed their efforts at helping clinicians in dermatology navigate such challenges ethically and accurately, without leaving legitimate reimbursement unclaimed or taking any compliance violation risks. Siegel used surgical wound repair as a key example, describing the ways in which improper or templated documentation regarding complex repairs can potentially raise red flags for auditors.

Siegel additionally gave warnings to attendees, stressing the value of documentation reflecting what was actually done, as opposed to what is most advantageous for billing. Mechanisms for enforcement, Siegel noted, are more sophisticated than many comprehend.

To learn out more about this subject, view the full interview with Siegel posted above.

The quotes used in this interview summary were edited for clarity.

Siegel did not note any relevant disclosures.

Tassavor M, Shah A, Ungar J. Dermatology Resident Billing and the Impact of 2021 Evaluation and Management Coding Changes. Cureus. 2021 Jun 21;13(6):e15810. doi: 10.7759/cureus.15810. PMID: 34306877; PMCID: PMC8294024.

Siegel D, Kaufman M. How To Maximize Your Billing Effectiveness in the Era of Dwindling Reimbursements and ICD-10. Presented at the 2026 Maui Derm Hawaii Conference, January 25-29.

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Siegel addressed additional points presented in his Maui Derm 2026 session, 'How To Maximize Your Billing Effectiveness in the Era of Dwindling Reimbursements and ICD-10.'

Discussing Billing Challenges in Dermatology, With Daniel Siegel, MD

The effects of EMR, ICD-10, and coding changes on 

 were highlighted in a new talk presented at the 2026 Maui Derm Hawaii conference, held at the Grand Wailea Hotel in Maui from January 25 - 29.

The session was presented by Daniel M. Siegel, MD, clinical professor at SUNY Downstate Health Sciences University, and Mark Kaufman, MD, associate clinical professor in the Department of Dermatology at the Icahn School of Medicine at Mount Sinai. Siegel spoke in a new 

 interview on-site at Maui Derm about key takeaways from the talk, highlighting the process and procedures involved in ICD-10 billing.

“The biggest challenge, really, is getting paid, because payers often don't pay you, even if your documentation is well done,” Siegel explained. “...There was actually an effort in 2021 to simplify things..The effort began in about 2019, when there was a joint RUC, which stands for ‘resource-based relative value update committee,’ of the American Medical Association.”

Prior to 2021, the list of notes needed was described by Siegel as too much paperwork. While steps were taken to simplify evaluation and management (E/M) documentation beginning in 2021, insurers, and especially private payers, were described by Siegel as often failing to reimburse physicians correctly.

Such documentation shifts stemmed from a multiyear collaboration involving the American Medical Association, the CPT Editorial Panel, and the RUC. Siegel noted how, prior to these shifts, dermatologists were essentially incentivized to formulate lengthy, overly detailed notes by counting “bullet points” in reviews of systems, histories, and physical exams to excuse increased billing

Siegel later noted this practice commonly led to over-stuffed electronic medical record (EMR) notes, obscuring the clinical rationale for patient visits. Under the updated rules from 2021, clinicians did not require documentation of every possible exam element for straightforward conditions, such as well-controlled acne.

“The reality is that most acne is not the dramatic stuff you can see treated with an interesting combination of meds; it's fairly straightforward and handled well with topicals or oral tetracycline or other things,” Siegel said.

Although he notes this shift has diminished administrative burden and allowed for more practical documentation, Siegel added his belief in the system’s imperfection and inconsistency. He pointed out insurers have not uniformly adapted to these new documentation requirements, highlighting Medicare’s role in developing the updated guidelines and generally adherence to them. Many private insurers, Siegel explained, were not part of the process.

As a result of this, dermatologists may follow the current rules correctly and still see claims denied or downcoded. In such cases, Siegel expressed, the only response can often be time-consuming appeals. This disconnect between policy changes and payer behavior remains a major source of frustration and financial problems for dermatology practices

For any additional information on this topic, view the full interview with Siegel posted above.

The quotes contained in this interview were edited for clarity.

Siegel did not report any relevant disclosures.

In this interview, Siegel highlights key points presented in his Maui Derm 2026 talk, 'How To Maximize Your Billing Effectiveness in the Era of Dwindling Reimbursements and ICD-10.'

Daniel M. Siegel, MD

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