Arizona sun keeps the medical side of dermatology busy year round, and geography decides who absorbs it. Phoenix, Scottsdale, Mesa, Chandler, and Gilbert hold most of the state's dermatology capacity, Tucson anchors the south, and an office in Flagstaff, Yuma, Prescott, or Sierra Vista is often the only one for a long stretch of highway. A patient who drove ninety minutes for a biopsy will not be back next week so someone can chase a diagnosis code that came back wrong.
What makes that expensive is where staff attention goes. In Scottsdale, Gilbert, and north Phoenix, aesthetics tends to fill the best hours on the calendar and pays at the counter before the patient reaches the parking lot, so whoever runs the front desk gets immediate feedback on it. Payer edits, coding questions, and appeals on the covered work get handled in whatever time is left over, usually late in the day and usually by whoever is least busy.
Our answer is to give the covered work its own staff rather than the remainder of somebody's afternoon. Dermatology coders read the note, decide whether a same-day E/M holds up next to an elective treatment, and settle the patient's share of the non-covered portion before the visit ends instead of after a statement goes out. We have been doing that work since 2017, now for 200+ practices and 1,246+ providers, in whichever system your office already runs.