Account: @unlimapps (1M followers)
Positioning: Enea Gjoka, MD — Dermatology Resident & CTO of Max AI
Date: February 2026
- Modifier 25 misuse/omission — The #1 audit trigger in derm. Every time you do a biopsy + E/M on the same visit, you need modifier 25 on the E/M. Practices that skip it leave $30-80 per visit on the table. Practices that overuse it get audited. Either way, you lose.
- Lesion removal coding errors — CPT 11200 covers removal of 1-14 skin tags as ONE unit. Practices billing it per-lesion get denied and flagged. Excision coding (11600-11646 malignant vs 11400-11446 benign) frequently mixed up based on path results.
- Failure to document medical necessity — Especially for procedures in the cosmetic/medical gray area. Missing lesion size, growth rate, symptoms = denied claims. One California practice lost $25K/year from this alone.
- Diagnosis code mismatch — Wrong ICD-10 paired with the procedure = automatic denial. Phototherapy billed with contact dermatitis instead of atopic dermatitis → 20% claim denial rate.
- NCCI edit violations — Billing CPT 17000 (premalignant destruction) + 17110 (benign destruction) same day without modifier 59 = bundled and denied.
- E/M undercoding — Dermatologists routinely bill 99213 when 99214 is supported. Fear of audits leads to systematic underbilling. Average loss: $20-40/visit × 20 visits/day = $400-800/day.
- Biologic prior auth failures — Dupixent, Humira, Cosentyx, Skyrizi all require extensive step therapy documentation. Incomplete PAs = delayed treatment + lost revenue for buy-and-bill practices.
- Mohs surgery coding complexity — Multi-stage, multi-block coding with repair codes layered on top. Repair code selection (intermediate vs complex closure, flap vs graft) frequently miscoded.
- Outdated CPT codes — New codes added/retired annually. ICD-10 L66.1 (lichen planopilaris) became non-billable Oct 2024 — practices still using it get auto-denied.
- Prior auth creep — Procedures previously auto-approved now require documentation. Derm ranks top 5 specialties for claim denials due to coding errors.
- "This coding mistake costs your practice $100K/year" — Specific, quantified revenue loss from common errors. Physicians respond to money.
- Modifier 25 deep dives — The most controversial modifier in all of medicine. Endless debate = endless engagement.
- "I reviewed 100 derm claims. Here's what I found." — Data-driven threads with specific error rates and dollar amounts.
- Prior auth horror stories + workarounds — Every physician has rage about prior auth. Channel it into useful content.
- Cosmetic vs medical billing gray areas — Lesion removal, chemical peels, laser treatments. Where's the line? Everyone has opinions.
- E/M level selection in derm — "When is a derm visit a 99214 vs 99213?" with specific documentation triggers.
- Buy-and-bill biologics breakdown — Revenue math for in-office Dupixent/Skyrizi administration vs specialty pharmacy.
- Mohs coding walkthroughs — Step-by-step for multi-stage procedures with repairs.
- "Your biller is leaving money on the table" — Common underbilling patterns.
- Insurance reimbursement trend data — Rate cuts, fee schedule changes, payer comparison.
- ICD-10 code updates — Annual code changes that catch practices off guard.
- NCCI edit cheat sheets — Common bundling traps in derm.
- Biopsy billing optimization — When to bill 11102 vs 11104, add-on codes.
- Telehealth billing in derm — Modifiers, place of service codes, documentation.
- Denied claim appeal templates — Actionable, saveable content.
| Format | Engagement | Shareability | Notes |
|---|---|---|---|
| Single punchy tweet with a specific dollar amount | ⭐⭐⭐⭐⭐ | ⭐⭐⭐⭐⭐ | "Modifier 25 errors cost the average derm practice $50K/year" |
| Thread breakdowns (3-7 tweets) | ⭐⭐⭐⭐⭐ | ⭐⭐⭐⭐ | Complex billing scenario walkthroughs |
| "Did you know" quick tips | ⭐⭐⭐⭐ | ⭐⭐⭐⭐⭐ | Highly saveable, great for bookmarks |
| Before/after claim examples | ⭐⭐⭐⭐ | ⭐⭐⭐⭐ | "This claim was denied. Here's the fix." |
| Screenshot of an EOB with commentary | ⭐⭐⭐⭐⭐ | ⭐⭐⭐ | Raw, authentic, relatable |
| Polls | ⭐⭐⭐⭐ | ⭐⭐⭐ | "Do you bill an E/M with every biopsy?" |
| Infographic-style images | ⭐⭐⭐ | ⭐⭐⭐⭐⭐ | Decision trees for modifier selection |
- 5-7 tweets/week (not all billing — mix in resident life, practice management, AI in medicine)
- 1 thread/week (deep dive on a billing topic)
- 2-3 quick tips/week (single tweet, high save rate)
- 1 engagement post/week (poll, question, hot take)
Almost nobody from the physician side. This is the gap.
Current landscape:
- Billing companies (DermatologyBilling.com, Auctus Group, MedLife MBS) — Post blog content, generic tips. Corporate tone. Zero personality.
- AAPC/AHIMA coding educators — Teach coding broadly, not derm-specific. Not physicians.
- Dr. Marty Makary (@MartyMakary) — Talks billing transparency at a policy level, not practice-level coding.
- Medical billing TikTokers — Exist, but focus on "become a medical coder" career content, not specialty-specific optimization.
- Derm Twitter — Active community (@DermTwitter), but focuses on clinical cases, not billing. Nobody bridges clinical derm + billing expertise.
- No physician is creating derm-specific billing/coding content on Twitter/X
- No one combines clinical authority (MD) + technical billing knowledge + AI/tech credibility
- No one is making billing content that's actually entertaining or punchy
- The billing companies posting content sound like textbooks — zero relatability
- Practice managers/billers WANT this content but can't find it from a credible physician source
Enea is literally the only person who is simultaneously:
- A dermatology resident (clinical credibility)
- CTO of an AI medical billing company (technical authority)
- Has a 1M follower account (distribution)
This is an uncontested niche.
Free billing tips on Twitter
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Build authority as THE derm billing expert
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Practices realize they have these exact problems
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"We built Max AI to solve this automatically"
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Demo requests / inbound leads
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Awareness (Twitter content) → Every tweet about a billing mistake is an implicit pitch for Max AI. "If you're still catching these manually, there's a better way."
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Lead generation → Threads that end with "We analyzed 10,000 derm claims with AI. Here's what we found." (Data nobody else has.)
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Authority building → When the AAD or derm conferences need a speaker on AI + billing, Enea is the obvious choice.
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Direct conversion → "I got tired of watching practices lose money on these mistakes. So we built Max AI to catch them in real-time." (Founder story > sales pitch)
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Referral engine → Practice managers share these tweets with their doctors. Doctors share with their billing staff. Everyone in the practice sees Max AI.
- Average derm practice: 3-5 providers, $2-5M revenue
- Billing optimization software: $500-2,000/mo per practice
- TAM: ~18,000 dermatology practices in the US
- Converting even 1% through organic content = 180 practices = $1-4M ARR
- Content cost: essentially free (Enea's time)
- CAC via content: ~$0 vs $5,000-10,000 per practice via traditional sales
1.
Dermatology ranks in the top 5 specialties for claim denials due to coding errors.
Most of these are completely avoidable. Let me walk you through the ones I see every week in clinic.
2.
If you're billing 99213 for every derm visit, you're probably leaving $200-400/day on the table.
A 15-minute visit where you review path results, assess 2 lesions, and adjust a biologic regimen is a 99214. Document it. Bill it.
3.
A practice in Florida billed CPT 11200 ten times for removing 10 skin tags.
11200 covers removal of UP TO 14 skin tags as a single unit.
That error alone triggered a denial and cost them $8K over 6 months.
4.
The modifier 25 paradox in derm:
Don't use it → you're leaving money on the table Overuse it → you're an audit target
The rule is simple: Was the E/M a separately identifiable service from the procedure? If yes, modifier 25. If you walked in just to do the biopsy, no.
5.
Your biller is probably not billing add-on codes for biopsies.
First biopsy: 11102 Each additional: +11103
If you took 4 biopsies and only billed 11102 once, you left ~$300 on the table. Multiply that by every biopsy day.
6.
Prior auth for Dupixent update:
UHC now wants documentation of failure on TWO topical agents before approval.
So your moderate-severe AD patient who's been suffering for months needs to "fail" triamcinolone cream first. For documentation purposes.
This is healthcare in 2026.
7.
I spend more time on prior authorizations than I do on some of my procedures.
A 15-minute shave biopsy requires zero paperwork. A biologic that could change a patient's life requires 45 minutes of forms.
Something is broken.
8.
Pro tip for biologic PAs: Document the EXACT percentage of BSA involvement AND the specific topicals that "failed" with dates.
Vague documentation = denied. "Failed triamcinolone 0.1% cream BID x 4 weeks (Jan 3 - Jan 31, 2026)" = approved.
9.
Mohs coding is where practices either make or lose serious money.
Stage 1, 1 block: 17311 Stage 2, 1 block: +17312 Each additional block in any stage: +17312
The repair is separate. An adjacent tissue transfer after Mohs on the nose can add $800+ to the claim. Don't forget it.
10.
The cosmetic vs medical billing line in derm:
Mole removal for "cosmetic reasons" → patient pays Mole removal because it's "changing" → potentially billable Mole removal because it's "atypical on dermoscopy" → definitely billable
Your documentation determines which bucket it falls in.
11.
NCCI edit trap that catches derm practices every week:
You destroyed 3 actinic keratoses (17000 + 17003x2) AND a verruca (17110) same visit.
Without modifier 59 on the 17110, the payer bundles it and you get paid for AKs only.
That's $100+ gone per visit.
12.
Excision coding in derm — the part everyone gets wrong:
The code is based on EXCISED diameter (lesion + margins), not the lesion size alone.
A 0.5cm melanoma excised with 1cm margins = 2.5cm excised diameter = 11606, not 11602.
That's a ~$400 difference.
13.
I'm a derm resident and CTO of an AI medical billing company.
The thing nobody talks about: most billing errors aren't because billers are bad at their jobs. It's because the system is impossibly complex and humans can't track 10,000+ coding rules in real-time.
AI can.
14.
We analyzed thousands of derm claims with AI.
The average practice has a 12-18% denial rate. The top 3 denial reasons are all preventable coding errors.
The practices that get this right collect 15-20% more than those that don't.
15.
Hot take: In 5 years, no dermatology practice will submit a claim without AI reviewing it first.
The coding rules change annually. The modifiers are a minefield. The payer-specific requirements are impossible to memorize.
This isn't a "nice to have." It's going to be standard of care for billing.
16.
Derm billing cheat sheet — modifiers you need to know:
25 — Separate E/M + procedure same day 59 — Distinct procedural service (different site) 76 — Repeat procedure, same physician 77 — Repeat procedure, different physician XE — Separate encounter XS — Separate structure
Save this.
17.
If your practice still uses ICD-10 code L66.1 for lichen planopilaris, every claim is getting auto-denied.
It became non-billable October 2024. Replaced by more specific codes.
Check your superbill templates. Outdated codes = silent revenue loss.
18.
Quick math on buy-and-bill biologics in derm:
Purchase cost: ~$X per dose Reimbursement: ASP + 6% (Medicare) or negotiated rate (commercial) Admin fee: 96372
If the spread is positive, you're generating revenue AND improving patient access. If it's negative, you're losing money on every injection.
Know your numbers.
19.
Poll for derm Twitter:
What's the biggest billing headache in your practice?
A) Prior authorizations B) Modifier confusion C) Underpayments / fee schedule cuts D) Denied claims from documentation issues
20.
Unpopular opinion: Most dermatologists should spend 1 hour learning billing and coding for every 10 hours of clinical training.
You can be the best diagnostician in the world, but if your claims are getting denied, your practice is bleeding money.
Nobody teaches this in residency. That's a problem I'm trying to fix.
| Week | Monday | Wednesday | Friday |
|---|---|---|---|
| 1 | Tweet #1 (hook/intro) | Tweet #4 (Mod 25 thread) | Tweet #19 (poll) |
| 2 | Tweet #2 (E/M levels) | Tweet #9 (Mohs thread) | Tweet #6 (prior auth) |
| 3 | Tweet #13 (AI + billing intro) | Tweet #12 (excision coding) | Tweet #16 (cheat sheet) |
| 4 | Tweet #20 (hot take) | Tweet #10 (cosmetic vs medical) | Tweet #14 (AI data) |
Sprinkle tweets 3, 5, 7, 8, 11, 15, 17, 18 as quick tips between the scheduled posts.
- The niche is completely uncontested — No physician creates derm billing content on Twitter
- Lead with money — Quantified revenue loss gets attention
- Sound like a doctor, not a consultant — First-person, clinic experience, real frustrations
- Every billing pain point is an implicit Max AI pitch — Don't sell. Educate. The product sells itself.
- 1M existing followers = instant distribution — Most niche accounts would kill for this starting point
- Bridge clinical + business — That's the unique value prop nobody else can claim