Notification



Notification Issue Date:



Claim Payment Policy


Title:Photography, Including Documentation and Record-Keeping Photography, Whole Body Integumentary Photography, Dermoscopy, and Dermatoscopy

Policy #:07.07.05b

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

PHOTOGRAPHY FOR DOCUMENTATION AND RECORD KEEPING PURPOSES

Photography conducted for documentation and record keeping purposes (including those requested by the Company for medical necessity review) is not considered a distinct service. It is considered an integral part of an evaluation and management (E & M) service or procedure. Therefore, this service is not eligible for separate reimbursement consideration.

WHOLE BODY INTEGUMENTARY PHOTOGRAPHY

Whole body integumentary photography, whole body photography, dermatoscopy, and dermoscopy are not considered distinct and eligible services. Therefore, these services are not eligible for separate reimbursement consideration when billed alone or in conjunction with other services.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to, the following: records from the health care professional's office, hospital records, nursing home records, home health agency records, records from therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

Imaging software is not regulated by the US Food and Drug Administration (FDA).

Description

Clinical photographs used for documentation/record-keeping purposes may be taken during a medical visit or procedure and stored in an individual's record. However, they do not serve a specific diagnostic-testing or decision-making purpose.

Total body photography is the process of taking a set of high-quality images of a patient’s body parts for skin lesion tracking, comparing, and progress monitoring. This procedure involves the use of devices such as the FotoFinder bodystudio ATBM system, an advanced imaging software and hardware photography station.

Whole-body photography and dermatoscopy (also known as dermoscopy, epiluminescence microscopy, skin surface microscopy, and incidence light microscopy) are noninvasive techniques performed in the office setting for the detection and monitoring of lesions.

Dermatoscopy uses a digital camera with specialized software and reflective light optics to capture the asymmetry, color, size, and borders of lesions. It may involve the application of immersion oil to the skin, which eliminates light reflection from the skin surface, thus causing the stratum corneum (dead and dying cells filled with mature keratin) to be transparent. Inspection of the images with a magnifying lens shows the subsurface structures of the epidermis and epidermal junction; a hand-held microscope or a dermoscope may be used for direct visualization.

Dermatoscopic structures thought to be useful in identifying melanoma include pseudopods (bulbous and often kinked projections found at the margins of a lesion that are directly connected to the pigmented network), radial streaming (fine serrated extensions at the edge of a lesion), pattern of the pigment network, and black dots (found near the edge of a lesion and correlating with free melanin or melanocytes in the stratum corneum). These features, in addition to the standard assessment of lesions according to asymmetry, borders, color, and diameter, have been organized into a procedure for diagnosing skin lesions. The high resolution of the images enables the clinician to get detailed information about a suspicious mole. Using this information, the moles can be scored on a risk scale. The digital images may also be compared with previous photographs to determine whether the growth is benign or malignant, or whether new moles have developed. With a digital imaging system, new lesions or lesions that have changed may appear to flash or pulsate when compared with the previous images.

A skin evaluation system may be marketed as melanomography or as a melanomagram. Melanomagrams may involve the use of devices such as the MoleMax II™ (Derma Medical Systems, San Diego, CA) and DermaGraphix™ (Canfield Imaging Systems, Fairfield, NJ).
References


Andreassi L, Perotti R, Rubegni P, et al. Digital dermoscopy analysis for the differentiation of atypical nevi and early melanoma: A new quantitative seminology. Arch Dermatol .1999;135(12):1459-1465.

Argenyi ZB. Dermoscopy (epiluminescence microscopy) of pigmented skin lesions. Current status and evolving trends. Dermatol Clin. 1997;15(1):79-95.

Argenziano G, Fabbrocini G, Carli P, et al. Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions. Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis. Arch Dermatol. 1998;134(12):1563-1570.

Ascierto PA, Palmieri G, Celentano E, et al. Sensitivity and specificity of epiluminescence microscopy: Evaluation on a sample of 2731 excised cutaneous pigmented lesions. Br J Dermatol. 2000;142(5):893-898.

Bahmer FA., Fritsc P, Kreusch J, et al. Terminology in surface microscopy. J Am Acad Dermatol. 1990;23(6 Pt 1):1159-1162.

Binder M, Puespoeck-Schwarz M, Steiner A, et al. Epiluminescence microscopy of small pigmented skin lesions: Short-term formal training improves the diagnostic performance of dermatologists. J Am Acad Dermatol. 1997;36(2 Pt 1):197-202.

Binder M, Schwarz M, Winkler A, et al. Epiluminescence microscopy. A useful tool for the diagnosis of pigmented skin lesions for formally trained dermatologists. Arch Dermatol. 1995;131(3):286-291.

Company Benefit Contracts

Cristofolini M, Zumiani G, Bauer P, et al. Dermatoscopy: Usefulness in the differential diagnosis of cutaneous pigmented lesions. Melanoma Res. 1994;4(6):391-394.

Jerant AF, Johnson JT, Sheridan CD, Caffrey TJ. Early detection and treatment of skin cancer. American Family Physician [serial online]. 2000;62(2): 357-387. Available at: https://www.aafp.org/afp/2000/0715/p357.html. Accessed May 29, 2018.

Kittler H, Pehamberger H, Wolff K, Binder M. Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: Patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol. 2000;43(3):467-476.

Nachbar F, Stolz W, Merkle T, et al. The ABCD rule of dermatoscopy. High prospective value in the diagnosis of doubtful melanocytic skin lesions. J Am Acad Dermatol. 1994;30(4):551-559.

Soyer HP, Smolle J, Leitinger G, Rieger E, Kerl H. Diagnostic reliability of dermoscopic criteria for detecting malignant melanoma. Dermatology. 1995;190(1):25-30.

Stanganelli I, Burroni M, Rafanelli S, Bucchi L. Intraobserver agreement in interpretation of digital epiluminescence microscopy. J Am Acad Dermatol. 1995;33(4):584-589.

Swartz, Mark H. Textbook of Physical Diagnosis: History and Examination. 7th ed. Philadelphia, PA. Elsevier Saunders; 2014.




Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

96904


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements



Policy History

Revisions from 07.07.05b:
07/30/2018This version of the policy will become effective 07/30/2018.

This policy is a combination of two policies:
  • Whole-body Integumentary Photography and Dermatoscopy
  • Photography Used for Documentation/Record-Keeping Purposes


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 07/30/2018
Version Issued Date: 07/30/2018
Version Reissued Date: N/A

Connect with Us        


2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.