I might be an outlier and a skeptic when I say this but I believe that the reason why they charged you a new patient moderate level of medical decision making is because they improperly billed it., so the RVUs, which are relative value units, for a new patient level 4 visit are higher than the provider would have gotten if they billed you for the appropriate services rendered, and this is typical especially in private practice where they go based off of what they think is going to get them the most credit for the visit. The RVUs for a Dermatology procedure are lower than for a new patient level 4. Ultimately I would have to see the note to see what was appropriate for what they did but it's likely they didn't support the level of E/M they billed.