An Overview of Coding and Billing With AI Skin Check Tools
Panelists discuss billing and coding procedures for skin scanning devices, focusing on the use of unlisted Current Procedural Terminology (CPT) 99 codes with proper documentation and modifiers, the importance of clear communication with billing teams, available educational resources to aid primary care settings, and operational considerations including scope-of-practice variations for device use among clinical staff.
This segment focuses on the billing and coding procedures when using a skin scanning device in clinical practice, especially when utilizing unlisted CPT codes, commonly known as 99 codes. Since the device does not yet have a specific American Medical Association code, providers report the unlisted code alongside documentation of the FDA clearance number to clarify the service performed. When multiple lesions are scanned, multiple units of the unlisted code are reported accordingly. If the device is used as an adjunct to an evaluation and management (E/M) visit, the appropriate E/M code is reported with modifier 25, and the unlisted code is appended with modifier 59 to indicate a distinct procedural service. Comprehensive documentation, including lesion size, color, location, and any changes, is critical to justify medical necessity and support billing.
To assist providers, special billing guides, hotline support, and educational materials are available to ensure accurate coding, particularly for primary care settings that may be less experienced with newer medical technologies. The emphasis is on enabling clinicians to integrate this technology seamlessly while adhering to payer requirements. Proper documentation and clear communication with billing staff help minimize confusion and ensure claims are processed correctly. Providers are encouraged to share these resources with their coding teams to improve workflow and reimbursement outcomes.
During the question-and-answer portion, common clinical concerns were addressed. For pediatric patients with specific skin lesions, such as sebaceous nevi or large hairy melanocytic nevi, referral to a pediatric dermatologist or surgeon for evaluation is recommended, with decisions tailored to the patient’s needs and family preferences. Regarding device operation, while they were initially intended for use by physicians, there is movement toward allowing trained nurse practitioners, physician assistants, or medical assistants to perform scans under appropriate supervision. However, state regulations vary significantly, so providers must be aware of local rules governing the scope of practice. Overall, the session provided practical guidance aimed at improving patient care and clinical workflow.
