Dealing with sebs

[Hoser]

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How do you all approach the "can you just freeze this off?" non-inflamed SK? I don't want to freeze things that aren't inflamed for Medicare reasons but then I would feel like a jerk telling an 80 year-old with an ugly SK on their face who drove 2 hours for their appointment "nope, sorry." Blah.

Oh, and after looking through the threads of people who are seeing 40+ patients a day, I'm impressed and feel pretty darn inefficient!

 

[asmallchild]

How do you all approach the "can you just freeze this off?" non-inflamed SK? I don't want to freeze things that aren't inflamed for Medicare reasons but then I would feel like a jerk telling an 80 year-old with an ugly SK on their face who drove 2 hours for their appointment "nope, sorry." Blah.

Oh, and after looking through the threads of people who are seeing 40+ patients a day, I'm impressed and feel pretty darn inefficient!

It depends how many. If it's one, I'll usually do it and just no charge.

If they want 30 on their back sprayed off, we offer cosmetic pricing for removal.

It gets rejected so often now (even with documented inflammation) that our biller recommends only offering it as a cosmetic service.

 

[Balderdash]

How do you all approach the "can you just freeze this off?" non-inflamed SK? I don't want to freeze things that aren't inflamed for Medicare reasons but then I would feel like a jerk telling an 80 year-old with an ugly SK on their face who drove 2 hours for their appointment "nope, sorry." Blah.

Oh, and after looking through the threads of people who are seeing 40+ patients a day, I'm impressed and feel pretty darn inefficient!

Tell them to wait until Aclaris's drug gets approved next year

 

[Decicco]

Also keep in mind that there are other options than freezing to treat these. My preference especially with a cosmetic patient is to numb the lesion and then use light electrocautery and curretage. Has less risk of dyspigmentation because only the lesion is treated (vs freezing which is less precise and affects surrounding tissue).

 

[MOHS_01]

I've never been a fan of freezing them. If I'm doing it for cosmetic reasons, I always electrodessicate and rub them off. If they just annoy the person - and it's not in a cosmetically sensitive area - I'll freeze them and send them on their way. Liquid nitrogen is cheap, time is not... from a business perspective, I lose more money taking the time to explain why it is not covered than I do just freezing the damn things.... then say that insurance would not cover it but I will do a few for free... if they have many, I give some line about risk for infection with so many open sores and go from there.


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[Hoser]

I like doing a light EDC as well; destroying is a better term than freezing in many cases. I am also fine destroying a few for someone but was told that NOT billing medicare could be seen as fraud, since you are supposedly getting a leg-up on the competition by providing a free service. I don't know if that is accurate and no searching I've done has substantiated that claim. Just curious what others' thoughts were with that in mind.