Are Dermatologists Avoiding Higher-Level Codes Due to Audit Fear?
Yes, many dermatologists are avoiding higher-level codes due to audit fear, which often leads to undercoding and significant revenue loss. While compliance concerns are valid, excessive caution in dermatology billing can result in missed reimbursement opportunities and long-term financial impact. The real issue is not coding at higher levels—it’s coding without proper documentation support. Why Are Dermatologists Concerned About Higher-Level Codes? Higher-level E/M codes and complex procedure codes typically trigger greater payer scrutiny. Common concerns include: Increased audit risk Documentation sufficiency Recoupment demands Compliance penalties Because audits can be costly and disruptive, some providers intentionally select lower-level codes to “stay safe.” However, this practice creates another problem— revenue leakage . What Is Undercoding and How Does It Affect Revenue? Undercoding occurs when a provider bills a lower-level code than what the documen...
