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 2026 Maui Derm Hawaii conference addressed this topic in depth.1,2

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 new interview 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.

References

1. 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.

2. 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.