CPT Codes In Dermatology: What They Are, Why They Matter, and How They Changed in 2025

CPT codes are the secret language of healthcare, bridging communication between your dermatology practice, regulatory agencies, and the payers covering your patients’ treatments.

Choosing the wrong code is like using the wrong word in a foreign language — at best, it causes hesitation, and at worst, disastrous misunderstandings. Trying to minimize what a provider does down to a 5-digit code is a challenge, but doing it right can drive revenue rather than block it.

Codes for Current Procedural Terminology – or CPT – are created and maintained by the American Medical Association and are used to classify medical procedures. They’re distinct from ICD-10 codes, which are maintained by the World Health Organization and used to classify diagnoses.

These standardized coding languages are intended to create transparency in healthcare reimbursement, to ensure dermatology providers are fairly compensated, and to protect the safety and privacy of patients.

Why Accurate CPT Coding Is Important to Dermatology Practices

Accurate coding is key to your clinic’s revenue cycle management. When your practice bills insurers using the right CPT codes, ICD-10 codes, modifiers, and supporting documentation, your claims can move smoothly through the adjudication process — a miss on any of these will lead to denials.

The industry benchmark for claims acceptance is 90% or higher, though few practices reach that. When your claims are filed with correct CPT codes, they’re more likely to be accepted and paid.

Insurers aren’t the only ones who care about CPT codes. Accurate coding is required to comply with myriad state and federal regulations, including rules related to patient privacy, fraud prevention, and data protection.

A pattern of careless coding can raise red flags resulting in an audit. A practice with a history of improperly coding procedures opens itself up to the risk of legal and financial penalties for noncompliance, recoup/refund requests, and even accusations of fraud.

Accurate coding can help you grow future revenues as well. CPT codes are a convenient shorthand for tracking local dermatology trends — what brings patients into your practice.

Identifying these trends can help you hire staff, allocate resources, and adjust marketing to grow your practice.

How CPT Codes Affect Dermatology Revenue

The revenue cycle begins with the services you provide — patient care. When a patient is seen in your practice, everything about the visit is documented in your EHR.

Medical coders review this record and assign appropriate CPT codes to each aspect of the visit — such as whether the patient was new or returning, the reason for the visit, and any treatments carried out or prescribed.

Coded information is translated into claims that are submitted to private insurers or government payers. Payers rely on these codes to determine whether to pay a claim, and whether to pay it in full or in part.

If the CPT codes used don’t line up with the services provided, or with the services the insurer judges the patient needs, the claim will be rejected. This is why reviewing billing and medical policies per payer can be so important.

The practice then has the option of revising and resubmitting the claim or of pursuing the patient for payment. Both options extend the delay between providing the service and being paid for it.

When a practice prioritizes accurate coding, the rate of claims denial drops and revenue flows into the business on a shorter and more predictable basis.

Modifiers Change the Meaning of CPT Codes

Modifiers are like mini codes that give CPT codes more context. They allow providers to include important details on a claim to ensure accurate reimbursement.

For example, when Modifier 59 is attached to a code, it tells the insurer that the service was distinct from other services performed the same day. Other modifiers indicate whether a patient is new or established, where on the patient’s body the treatment was administered, and how many times the treatment was administered in a single visit.

Modifiers can allow multiple CPT codes to pay together, when they otherwise may not be due to NCCI edits, global periods, and the like.

Staying Up to Date on Coding Changes

CPT codes are complex and regularly updated. It’s critical the medical coding specialists in your dermatology practice are certified and participate in ongoing training.

One recent change affecting dermatologists across the country is the rise in telemedicine. A 2023 report found more than 96% of dermatologists offer telehealth services.

Telemedicine is an excellent way for a practice to offer convenient service to patients and to increase patient volume. However, as far as medical coding is concerned, it adds a layer of complexity. Practices using teledermatology must be careful to use the correct codes to specify whether the visit was in-person, audio-only, or audiovisual.

Streamlining Medical Coding With Technology

There are more than 11,000 CPT codes, spanning every medical specialty. Specialty practices can streamline work for their coders by using specialty-specific practice management software. This can be crucial because a dermatology practice may need only focus on 10% or less of the total CPT codes available to all practitioners.

Nextech’s dermatology-specific EHR and practice management tools prioritize the codes most relevant to dermatology procedures, helping coders to quickly and accurately build claims.

Automated billing tools in practice management software also help validate claims before they’re sent out. Thanks to the integrated EHR, claim fields can be prepopulated, appropriate codes can be suggested, and compliance checks happen in real time.

Common CPT Codes in Dermatology

Note: The following list is intended to be representative only and should not be considered a comprehensive list of all common CPT codes in dermatology.

E/M Codes Are Important CPT Codes for Dermatologists

E/M codes are specific CPT codes referring to “evaluation and management.” Think “consult codes” loosely, but not the 9924X codes, as those are no longer payable. These play a key role in medical billing for dermatology, because evaluation and management are likely to play a role in nearly every interaction between patient and provider.

E/M codes are very specific. It’s important to choose the CPT code that best represents not only what service was provided, but whether it was provided to a new or returning patient and whether it was performed in a clinic, hospital, or other location.

There are different E/M codes depending on the level of service — that is, the level of examination, expertise, and medical decision making involved OR this can be determined on time. Keep in mind that the 2021 E/M coding changes made time-based coding less advantageous whereas it used to be MORE … because they simplified the MDM models. One’s bell curve will generally shift more toward level four visits these days than it used to. For convenience, the AMA has a great coding tool.

If the visit was primarily counseling or care coordination, and did not involve a measurable level of service, the code is determined by the length of time the provider spent with the patient.

2024 CPT Code Changes

In 2024, the AMA introduced 349 changes to CPT codes. Most were not related to dermatology, but some will definitely impact dermatology practices.

Here are the most relevant changes medical coders in dermatology should know about:

• Billing for prolonged services codes (99417 and 99418) now requires the service to go a full 15 minutes beyond the base time.
• New CPT codes in pathology address the digitization of glass slides. The new codes for digital slides are billed as add-ons to surgical path codes.
• Add-on code G2211 was introduced for specialists managing long-term, complex conditions to bill for outpatient visits.
  
  Be cautious when using this new code. It’s intended for the provider primarily responsible for coordinating care of the patient’s condition, such as their general practitioner.
  
  Not all E/M codes are eligible to be combined with G2211, and CMS has laid out specific rules for how it will reimburse this code.

What’s the Future for CPT Codes in Dermatology?

Medicine is an ever-evolving field, which is why coding will continue to evolve with it.

Of course, CPT codes will change as advancements in medicine introduce new treatments and as older, less effective treatments are replaced.

In our rapidly changing society, billing and reimbursement systems – and the codes that drive them – must also change to accommodate new ways of delivering medical care, such as telemedicine and value-based care models.

Reduce Coding Errors With Specialty-Specific Practice Management Software

Nextech’s integrated EHR and practice management software is specifically designed to meet the needs of dermatology practices.

In addition to prioritizing dermatology-relevant CPT codes, the EHR matches the specific way in which dermatologists work.

One-screen patient histories provide all the information a dermatologist needs. Smart stamping and photo management keep appointments running smoothly. Integrated tools for e-prescribing, patient engagement, marketing, billing, scheduling, and more let you scale your practice at your pace.

See what Nextech can do for you. Schedule a demo today.

Frequently Asked Questions

What Are CPT codes?

CPT codes are used to classify medical procedures. These codes create a standardized way for a healthcare practice to describe to regulators and insurers what happened at a patient visit, for purposes of compliance and payment.

CPT stands for Current Procedural Terminology. The codes are created and maintained by the American Medical Association.

What Are ICD codes?

ICD codes are used to classify medical diagnoses. These codes create a standardized way for a healthcare practice to describe to regulators and insurers how they diagnosed a patient’s condition.

ICD codes are created and managed by the World Health Organization. The current list of codes, ICD-10, stands for International Classification of Diseases, 10th Edition.

What Are E/M codes?

E/M codes are a specific subset of CPT codes. E/M stands for evaluation and management.

Procedures that qualify for E/M codes include services like office visits and preventive exams, as opposed to procedures used to treat a condition.

About the Author

John Gwin is the founder and CEO of The Auctus Group, Sensus Group and Porta; all service and technology companies in the revenue cycle management space. He has spoken with ADAM, FFAS, MAPS, ISPS, Edge and others. He also serves as an advisor in the RCM and RCM Tech spaces. Lastly, John is a Board Member for the HBMA Innovations Committee as well as President of BRAVE, a non-profit serving to educate and advocate for the breast cancer community.