Clinical Tips: Billing for Clinical Keratoacanthomas

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Charge for C&D Code, Not Biopsy

For patients who present with clinical keratoacanthomas (off the face and scalp), you can often go ahead and do curettage and desiccation (C&D) immediately following your biopsy. Hold your note till you get the path back to charge. If your diagnosis was correct, charge for the appropriate size C&D code for malignant destruction, which pays more than the shave biopsy code. Do not charge for the biopsy if you are charging for the C&D.

Debbie Adams Hauser MHS, PA-C
Winston Salem, NC

The Language Around Hyaluronidase

If there is a bit too much swelling/product, I usually tell the patient that I can reduce “the swelling” with a minor injection. Often, I do not mention I am using hyaluronidase to dissolve some of their filler because some folks might feel bad they are wasting the filler that was previously injected.

Benjamin Barankin, MD
Toronto, ON, Canada

Fun Clinical Correlation

Many professional truck drivers have an isolated 1- to 2-cm, round, red psoriasiform plaque on the lateral aspect of the left knee. It represents a chronic dermatitis due to friction on the skin as the knee rubs against the driver’s side door during the long driving routes. If you see this, ask the patient if they are a professional truck driver. You will make an impressive clinical diagnosis.

Wayne Fujita, MD
Aiea, HI

No IF, Try Honey!

If you are seeing a patient requiring a skin biopsy for immuno-fluorescence (IF) and you do not happen to have Michel’s solution for whatever reason, you can place the specimen in one of the urine containers with an orange cap and cover with sufficient honey as a fixative. It will preserve the antigens for at least 10 days (at least as validated in our lab by myself). So, time to run to the grocery store and get honey in one of the plastic squeeze bottles for the office.

Esiahas Amdemichael, MD
Kitchener, ON, Canada