Dermatology injection code utilization
In our ongoing effort to inform and educate, the AAD/A coding team continues to monitor the utilization of frequently reported services in dermatology through the Medicare Part B National Utilization Data. This article reviews and compares the Medicare Part B national utilization of dermatology-related injection codes for calendar years 2019 and 2020.
Code utilization articles like this one are designed to help dermatology practices compare their usage of common dermatology codes to the national average as part of their ongoing assessment of internal coding and reporting patterns. Dermatology practices can use the information provided in this article as a benchmarking tool to compare the practice’s reporting of injection codes to the national allowed charges for injections in the Medicare claims data.
In reviewing the data provided herein, it is important to note that 2020 claims data was impacted by the National COVID-19 Stay-At-Home Order issued on March 15, 2020, which resulted in a reduction of in-person procedures performed by dermatology practices.
Injections are reported based on the administration technique used to inject drugs or biologics to treat patient’s conditions. The most used techniques in a dermatology practice to administer medications are through intramuscular (CPT code 96372), followed by chemotherapy administration (CPT 96401– 96405).
In 2019, Medicare allowed almost $233 million for intramuscular, chemotherapy administration, and intralesional injection codes compared to 2020, when only $180 million in charges were allowed.
1. Therapeutic, intramuscular injection codes
CPT codes 96372 - Therapeutic, prophylactic, or diagnostic injections; subcutaneous or intramuscular are used to inject a therapeutic drug into the skin or muscle for therapeutic, prophylactic or diagnostic measures.
In CY 2019, Medicare allowed $154 million of all intramuscular injection allowed charges or 66.4% of intramuscular, chemotherapy administration and intralesional injection allowed charges. For the same period in 2020, Medicare allowed nearly $106 million of all intramuscular injection charges or 58.8% of intramuscular, chemotherapy administration, and intralesional injection allowed charges.
This indicates a decrease of $48 million or 31% in allowed charges between the two calendar years.
2. Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic
CPT codes 96401 – 96406 Chemotherapy administration; intralesional codes are used for administration for non-hormonal anti-neoplastic medication to lesions.
In CY 2019, $61.6 million of all chemotherapy administration injection charges were allowed by Medicare or 26.4% of all intramuscular, chemotherapy administration and intralesional injection allowed charges. For the same period in 2020, Medicare allowed $60.6 million of all chemotherapy administration injection charges or 33.6% of all intramuscular, chemotherapy administration, and intralesional injection allowed charges.
This indicates a minimal decrease of $1 million between the two calendar years.
3. Intralesional injection codes
CPT codes 11900 – 11901 Injection, intralesional are used to administer non-chemotherapy medication into the lesion.
In CY 2019, $16.7 million of all intralesional injection charges were allowed by Medicare or 7.2% of all intramuscular, chemotherapy administration and intralesional injection allowed charges. For the same period in 2020, Medicare allowed $13.8 million of all chemotherapy administration injection charges or 7.6% of all intramuscular, chemotherapy administration, and intralesional injection allowed charges.
This indicates a minimal decrease of $3 million between the two calendar years.
The table below demonstrates the Medicare allowed charges for dermatology-related injections in CYs 2019 and 2020.
Determining your billing frequency
To determine your billing frequency for a specific procedure or service, begin by accessing the Part B National Summary Data File to identify the national utilization for a specific code or a range of codes.
Once you have this data you can use the formula below to determine the Medicare national billing frequency ratio for a specific code set.
For example, the dermatology billing ratio for integumentary injection codes to the medicine injection codes can be calculated by dividing the total frequency for integumentary injection codes by the total frequency for graft codes.
2020 integumentary injections procedures ÷ 2020 medicine injections procedures = billing frequency ratio
$105,997,264 (intramuscular injections) ÷ $13,768,965 (intralesional injections) = approximately 7.69
Dermatology practices can use the information provided in the Medicare Part B National Utilization Data as a tool to determine the national benchmark and identify the practice’s coding utilization pattern. This information can then be used to determine if additional physician/non-physician clinician education is required to ensure that the coding and documentation support the practice’s utilization patterns.
Applying the data findings to your practice data findings
A discrepancy in your practice utilization patterns from those of the Medicare national benchmark does not necessarily indicate that these services are being reported incorrectly. The discrepancy could simply demonstrate that based on your patient population and geographic location, you may be performing more or less reconstructive skin surgeries than other dermatology practices. But knowing this can help your practice be prepared to defend any discrepancies if they catch the notice of an auditor.
Documentation must support the medical necessity and accurately describe the procedure or service performed. For guidance on appropriate elements of documentation for dermatology services, see the AADA’s Principles of Documentation for Dermatology, Sixth Edition as well as coding resources in the Practice Management Center.
