1 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 medical billers and coders Visit our website: Click here Follow us: CALIFORNIA DERMATOLOGY · REVENUE INTELLIGENCE Why California Dermatology Practices Are Underpaid Every Month Biologic Unit Undercoding · Lesion Destruction Bundling Failures · Biopsy Complexity Downcoding medicalbillersandcoders.com | 888-357-3226 | Published: March 28, 2026 California dermatology practices collecting $1M–$5M+ monthly are systematically underpaid $1.2M– $3.8M annually — not from claim denials — but from invisible coding translation failures on procedures performed correctly but billed incorrectly. Standard reports can't detect this because you're paid exactly what you billed, just not what you actually did. SELF-AUDIT Pull last month's superbill for your highest-volume provider and check these four counts: ■ If you checked ANY box: You're underpaid $32,600–$90,600 monthly = $391,200–$1,087,200 annually The 30-Second Test: Are You Underpaid Every Month? What to Count Destruction coded 17000 + 17003×14 Biologic administrations billed as '1 unit' Shave biopsies (11102) where punch/excision performed Multiple lesion biopsies — only one biopsy coded If You Find This >20% show 1 unit Only one biopsy coded per session Any sessions with 15+ lesions destroyed >30% needed deeper sampling $8,400–$14,200/mo $6,200–$11,800/mo $12,400–$22,600/mo You're Underpaid By $18,000–$42,000/mo 2 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 medical billers and coders Visit our website: Click here Follow us: Office staff see one vial used and assume one unit should be billed — without checking the HCPCS dosing unit definition. Stelara (ustekinumab) is billed per 45mg, not per vial. A 90mg vial = 2 billable units. PATTERN 1 Biologic Unit Undercoding — Every Single Infusion Biologic Stelara (ustekinumab) Humira (adalimumab) Dupixent (dupilumab) Tremfya (guselkumab) Skyrizi (risankizumab) Stelara 90mg vial Underpayment per administration 32 monthly patients × $350 avg Annual underpayment (single biologic) Dose / Vial 90mg 40mg 300mg 100mg 150mg J3357 × 1 unit — $11,200 captured What Gets Coded (WRONG) HCPCS Unit J3357 per 45mg J0135 per 40mg J0173 per 200mg J0919 per 100mg J2765 per 150mg Units to Bill 2 units 1 unit 1.5 units 1 unit 1 unit What Should Be Coded (CORRECT) J3357 × 2 units (90mg ÷ 45mg) $280–$420 $22,400 should be captured $53,000–$80,000 Biologic Dosing Quick Reference — Units to Bill: California payers (Blue Shield CA, Health Net, Anthem BC) audit biologic billing aggressively. Correct coding with proper documentation — vial label + dosing calculation note — passes audits AND captures full payment. 3 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 medical billers and coders Visit our website: Click here Follow us: Documentation Fix: CPT Code Payment per session Underpayment per session 18 sessions/month at 15+ lesions Monthly underpayment Annual underpayment Scenario: 22 Actinic Keratoses Destroyed $11,520 captured 17000 + 17003×13 $640 WRONG — Currently Coded 17004 (15+ lesions) $980 $340 $17,640 owed $6,120 $73,440 CORRECT — Should Be Coded Train providers to COUNT and DOCUMENT lesion quantity in notes: 'Performed cryotherapy on [exact number] actinic keratoses: [list locations]. Total lesions treated: 22. Billing code: 17004.' Blue Shield CA and Anthem specifically audit 17004 claims requiring documented lesion counts and anatomical locations. CPT coding for destruction (17000-17004) caps standard codes at 14 lesions. Most California practices don't know CPT 17004 exists — it covers 15 or more lesions as a flat fee, and it pays more than the 14-lesion maximum. PATTERN 2 Lesion Destruction Bundling — 15+ Lesions Destroyed, Only 14 Billed ■ 4 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 medical billers and coders Visit our website: Click here Follow us: PATTERN 3 Biopsy Complexity Undercoding — Punch/Excisional Coded as Shave Encounter templates with a generic 'Biopsy' checkbox default to code 11102 (shave biopsy). Providers don't specify technique. Billing codes what the template says — not what was actually performed. Monthly underpayment (180 × $4 gap) Anthem Blue Cross CA and Health Net downcode all biopsies to 11102 without documented technique, size, closure method, and clinical suspicion. 280 biopsies/month · 180 are actually punch · All coded as shave 11102 Change the encounter template dropdown to require technique selection: Excisional biopsy Biopsy Type Shave biopsy Punch biopsy ■ One-Word EHR Fix: CPT Code 11102 + 11103 11104 + 11105 11106 + 11107 CA Commercial Avg $140 first + $80 each $180 first + $110 each $280 first + $180 each Time / Closure 3–5 min · no sutures 5–8 min · 1–2 sutures 10–15 min · 3–5 sutures $7,200 $86,400 ■ ■ ■ Shave (11102) — tangential, no sutures Punch (11104) — cylindrical, 1–3 sutures Excisional (11106) — elliptical, 3+ sutures Practices performing these services correctly but coding them incorrectly capture only 68–82% of legitimate reimbursement. REVENUE IMPACT SUMMARY Biologic Unit Undercoding (annually) $53K–$80K Lesion Destruction Bundling Failures (annually) $73K Biopsy Complexity Downcoding (annually) $86K What These Three Patterns Cost California Dermatology Practices Combined Annual Underpayment: $212,000–$239,000+ 5 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 medical billers and coders Visit our website: Click here Follow us: FREE ASSESSMENT MBC's Revenue Diagnostic: California Dermatology Underpayment Analysis ✔ ✔ ✔ ✔ ✔ Biologic Unit Audit Biopsy Technique Review Underpayment Quantification Audit biopsy procedures — are punch and excisional biopsies downcoded to shave (11102)? Free assessment delivering the specific monthly underpayment figure for your practice — from your actual claims data, not industry averages. Verify 90-day biologic administrations — are 90mg vials coded as 1 unit or 2 units per HCPCS dosing definition? Destruction Count Verification CA Payer Documentation Compliance Review destruction sessions — are 15+ lesion sessions using 17004 or incorrectly capped at 17000 + 17003×13? Check documentation meets Blue Shield CA, Anthem, and Health Net audit requirements for each procedure type. medical billers and coders 6 Copyright © Medical Billers and Coders. All Rights Reserved info@medicalbillersandcoders.com Call now (Toll Free) 888-357-3226 Visit our website: Click here Follow us: FREQUENTLY ASKED QUESTIONS California Dermatology Underpayment: Key Questions Q: Why areCaliforniadermatologypracticesunderpaideverymonth? Q: How do I know if my California dermatology practice is being underpaid? Q: What is the most common underpayment pattern in California dermatology? Biologic unit undercoding is most common. A 90mg Stelara vial contains 2 billable units (J3357 is defined per 45mg), but practices bill 1 unit because 'one vial = one unit' is the default assumption. At 32 monthly administrations, this single error creates $53K–$80K in annual underpayment. Correct coding with vial label documentation and dosing calculation notes passes California payer audits and captures full reimbursement. Pull last month's biologics and count how many show '×1 unit' when the vial contains 1.5–2 units per dosing table. Review destruction sessions for any treating 15+ lesions coded as 17000 + 17003×13 instead of 17004. Audit biopsies requiring sutures that were coded as shave 11102. If any category shows more than 20% errors, you're likely underpaid $32K–$90K monthly. Through systematic undercoding on three high-volume procedure types: biologic units calculated incorrectly (losing $53K– $80K annually), lesion destruction capped at 14 when CPT 17004 applies at 15+ lesions (losing $73K annually), and punch/excisional biopsies coded as shave (losing $86K annually). Combined, this represents $212K–$239K+ in annual underpayment — and it's invisible on standard reports because claims are paid exactly what was billed. MBC's Revenue Diagnostic evaluates 90 days of high-volume procedures — biologic administrations, destruction sessions, and biopsy procedures — revealing the exact gap between what you did and what you billed. You Can't Be Underpaid If You Bill What You Actually Did. Request Your Free Revenue Diagnostic Today Phone: 888-357-3226 | Email: info@medicalbillersandcoders.com