Discussing Billing Challenges in Dermatology, With Daniel Siegel, MD

The effects of EMR, ICD-10, and coding changes on dermatology practice 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 - 29.1

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 HCPLive 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.

References

1. 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.