Urology Coding and Reimbursement Podcast: Recent Episodes
Mark Painter, Scott Painter and Dr. Ray Painter
The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life. Your cohosts, Mark, Scott and Dr. Ray Painter discuss urology coding and share best practices for the urology office. We will answer submitted urology coding questions so that you can learn the concepts and apply in your practice. Learn the best practices: urology coding, revenue cycle management, scheduling, collections, patient information collection, pre-authorization, prior approval, charge capture, office communications, claim entry review, appeals, audits and billing, that we have tested and proven so you can adapt and incorporate.
August 7, 2026
In this episode, Scott, Mark, and Dr. Ray Painter answer three reimbursement questions involving common—but increasingly scrutinized—coding situations. First, they discuss when a urologist can separately bill the professional component of a radiologic service such as retrograde urography on the same day as an E/M service, including the documentation requirements and potential conflict when radiology also bills for the interpretation. Next, they examine a ureteroscopy denial caused by an inconsistent diagnosis code and explain how to properly distinguish kidney and ureteral stones with and without hydronephrosis. Finally, they tackle another modifier 25 denial and explain why simply citing NCCI rules in an appeal may not be enough—the documentation must clearly demonstrate the significant, separately identifiable E/M service that supports the modifier.
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The Thriving Urology Practice Facebook group.
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July 31, 2026
In this episode, Scott, Mark, and Dr. Ray Painter answer three detailed listener questions. First, they discuss whether an E/M service can be billed when a urologist evaluates a patient on the hospital floor and then decides to take the patient to the operating room for stone treatment or stent placement. Next, they examine payer denials involving laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy and whether all listed lymph node groups must be removed to support code 55869. Finally, they explain how to report bladder stone removal performed through the same laparoscopic incision as a simple prostatectomy—and why the surgical approach may require an unlisted bladder procedure code.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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The Thriving Urology Practice Facebook group.
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July 24, 2026
In this episode, Scott, Mark, and Dr. Ray Painter examine a major shift in Medicare’s approach to coding UTI PCR testing. The discussion explains why reimbursement may now depend on the number of testing kits, methodologies, or procedures used—not simply the number of organisms reported—and what practices should review with their laboratory partners. The team also addresses denials, RAC and UPIC audits, corrected claims, potential commercial payer takebacks, and the continuing uncertainty in MolDX states. They then review the proposed 2027 RVU changes affecting urology, including a significant increase for in-office bulking agent injections, potential reductions for urodynamics, and additional changes to prostate biopsy codes.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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The Thriving Urology Practice Facebook group.
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July 17, 2026
In this episode, Scott and Mark Painter provide their initial analysis of CMS's proposed 2027 Medicare Physician Fee Schedule and highlight the changes most likely to impact urology practices. The discussion covers the proposed conversion factor reduction, a significant new proposal to apply the multiple procedure payment reduction to E/M services billed with modifier 25, changes to G2211, updates to practice expense methodology, prostate biopsy coding revisions, telehealth proposals, and a substantial reimbursement increase for bulking agent injections. The team also shares practical insight into what these proposals could mean for physician compensation, practice operations, and future commercial payer policies. The key takeaway: while the rule is still only proposed, now is the time for urology practices to understand the changes, submit meaningful comments, and begin planning for what could be a very different reimbursement landscape in 2027.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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The Thriving Urology Practice Facebook group.
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July 10, 2026
In this episode, Scott, Mark, and Dr. Ray Painter break down CMS’s latest updates to facility reimbursement for kidney stone procedures, including the revised C9761 code, the new C8014 code, and the payment implications for hospitals and ambulatory surgery centers. The discussion explains how suction-integrated ureteroscopes and suction-enabled access sheaths are now reimbursed, why physicians should understand facility payment even though their professional fee does not change, and how these updates may influence conversations with hospitals and ASCs about adopting new technology. The team also reviews the proposed 2027 payment changes and emphasizes the importance of aligning clinical decision-making with facility economics to expand patient access to innovative stone treatment technologies.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
June 26, 2026
In this episode, Scott, Mark, and Dr. Ray Painter continue their discussion on buy-and-bill drugs, using ZUSDURI® as a case study to explore the clinical, operational, and reimbursement challenges facing urology practices. The conversation covers prior authorizations, payer eligibility checks, documentation requirements, medical record reviews, RAC audits, and strategies for successfully introducing new drug therapies into a practice. The team also discusses the importance of standardized protocols, staff training, monitoring reimbursement, and leveraging technology to reduce financial risk. The key takeaway: successful buy-and-bill programs depend on more than getting paid—they require the right processes to ensure practices get paid, keep the payment, and continue delivering innovative therapies to patients.
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For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
June 19, 2026
In this episode, Scott, Mark, and Dr. Ray Painter tackle three challenging reimbursement scenarios submitted by listeners: Medicare denials for category III code 0816T, handling patient payments when claims are denied for timely filing or missing prior authorizations, and the ongoing complexities of billing urodynamics studies in a group practice setting. The discussion explores why “unprocessable” claims often require deeper investigation, how payer contracts influence whether patient payments must be refunded, and the pros and cons of global versus split billing for urodynamics services. The key takeaway: many reimbursement problems are not coding issues at all—they are workflow, contract, and claim-processing issues that require practices to understand both the rules and the business side of medicine.
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For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
June 12, 2026
In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose discuss the growing wave of payer scrutiny impacting urology practices, including automatic E/M downcoding, stealth denials, medical record requests, takebacks, and RAC-style reviews. Drawing on real-world experiences from hundreds of recently identified downcoded claims, the team shares practical strategies for detecting reimbursement issues before appeal deadlines expire, prioritizing revenue cycle resources, and building processes to monitor payer behavior more effectively. The discussion emphasizes the importance of strong clinical documentation, payer audits, contract monitoring, and team-wide coordination. The key takeaway: clean claims are no longer enough—practices must actively monitor, audit, appeal, and defend their reimbursement to avoid losing revenue.
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For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
June 5, 2026
In this episode, Scott, Mark, and Dr. Ray Painter provide an important update on the evolving C9761 reimbursement landscape, including CMS’s decision to revise the code description and introduce a new HCPCS code for suction-enabled ureteral access sheaths. The discussion explores what these changes could mean for ASCs, HOPDs, and physicians involved in stone management. The team also answers listener questions about billing intraoperative consultations versus procedures and addresses payer denials related to place-of-service restrictions when procedures are performed in the office setting. The key takeaway: understanding documentation requirements, reimbursement rules, and site-of-service limitations is essential as coding and payment policies continue to evolve.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
May 22, 2026
In this episode, Scott, Mark, and Dr. Ray Painter revisit ureteral stent removal and replacement coding after listener feedback highlighted the need for additional clarification on when cystoscopic codes versus fluoroscopic exchange codes apply. The discussion then shifts to emerging RAC audits targeting prostate artery embolization (PAE) claims involving CPT codes 37242 and 37243, emphasizing the importance of detailed documentation and medical necessity support. The episode wraps with a deep dive into Medicare’s medically unlikely edit (MUE) for add-on code 55715 for additional prostate biopsy lesions—exploring why the edit conflicts with CPT guidance, how practices should report multiple lesions, and why appeals may be necessary to receive proper reimbursement.
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For Urologist
For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
May 15, 2026
In this special live episode from the AUA Annual Meeting in Washington, D.C., Scott, Mark, and Ray Painter share highlights from the AUA Innovation Nexus program, where emerging companies, investors, and industry leaders are working to bring new urology technologies to market . The discussion focuses on the growing importance of reimbursement strategy early in product development, the operational and financial realities practices must consider before adopting new technology, and why collaboration between innovators, physicians, and practice teams is critical for success. The episode also explores how efficiency, workflow, and return on investment increasingly drive whether promising technologies ultimately make it into everyday urology practice.
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For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
May 8, 2026
In this episode, Scott, Mark, and Dr. Ray Painter discuss the growing wave of innovation in urology and why reimbursement strategy must be part of the conversation from day one. Ahead of the AUA Innovation Nexus meeting in Washington, D.C., the team explores how new technologies move from concept to clinical adoption—and the reimbursement hurdles that can slow that process down. The discussion covers coding, coverage, payer adoption, workflow planning, AI-driven practice tools, and the importance of building a realistic business plan before introducing new technology into a practice. The key takeaway: exciting technology alone is not enough—successful adoption requires clinical value, operational readiness, and a clear reimbursement strategy.
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For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
May 1, 2026
In this episode, Scott, Mark, and Dr. Ray Painter break down key differences between ureteral stent removal and replacement codes—50385, 50387, and 50688—highlighting how anatomy, access (internal vs. external), and the requirement for radiologic supervision drive proper code selection. They also tackle a growing issue with ICD-10 coding for bladder cancer, where the correct use of “history of” codes during BCG maintenance therapy is leading to unexpected payer denials. The discussion explores when to follow strict coding guidelines versus when payer-specific rules may require strategic adjustments. The takeaway: understanding both the technical details of coding and the realities of payer behavior is essential to avoiding denials and protecting revenue.
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PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
April 24, 2026
In this episode, Scott, Mark, and Dr. Ray Painter break down the latest guidance on HCPCS code C9761 and the growing confusion around what qualifies for payment under this new technology APC. They walk through key interpretations from the AHA, AMA, and MACs, highlighting the critical distinction between steerable ureteral catheters, scopes, and access sheaths—and why that difference can determine whether a case is paid or denied. The discussion emphasizes the importance of precise physician documentation, understanding device labeling, and verifying payer-specific policies before billing. The takeaway: while new technology offers higher reimbursement potential, it also introduces real risk—making clarity, compliance, and payer alignment essential.
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For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
April 17, 2026
In this episode, Scott, Mark, and Dr. John Lin tackle a deceptively simple question: does it make sense to perform more complex procedures—like Optilume and other minimally invasive treatments—in the office setting? The discussion breaks down the three critical pillars every practice must evaluate—clinical fit, financial viability, and operational execution—while highlighting key factors such as reimbursement, equipment costs, anesthesia logistics, staffing, and workflow efficiency. They also explore opportunity cost, geographic variability, and how in-office procedures can improve both patient experience and physician productivity when done right. The takeaway: success requires a fully developed plan—because bringing procedures in-house is never just a simple yes or no decision.
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For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
April 10, 2026
In this episode, Scott and Mark Painter break down the rapidly evolving and increasingly uncertain landscape surrounding UTI PCR testing, following heightened scrutiny from the OIG and a surge in payer denials—particularly for CPT code 87798. They discuss confusion around MUE limits, shifting interpretations from MACs, and the growing use of N35 denials triggering documentation requests. The episode outlines how practices should respond, including when to appeal, how to support medical necessity, and the risks of prematurely changing billing behavior without clear guidance. The key takeaway: stay disciplined, document thoroughly, and play the long game as policies continue to evolve.
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PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
April 3, 2026
In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where interpretation is driving real-world coding challenges: when a prostate biopsy truly qualifies as a stereotactic template-guided saturation biopsy (55706), and whether diagnostic cystoscopy meets moderate risk under E/M guidelines. The discussion breaks down what differentiates saturation biopsy from standard transperineal approaches, including the importance of 3D templating and full-gland sampling, and why payer expectations may not align with physician interpretation. They also revisit the E/M risk table, reinforcing why cystoscopy is generally considered moderate risk—even if not explicitly stated in current guidelines. The key takeaway: as coding becomes more nuanced, balancing guideline interpretation with payer expectations is critical to staying compliant and getting paid correctly.
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PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
March 27, 2026
In this episode, Scott, Mark, and Dr. John Lin dive into the challenges of navigating Medicare Advantage (Part C) plans—what happens when you’re out of network, why reimbursement can feel like a “surgical lottery,” and how to decide whether to participate at all. Prompted by a real-world scenario involving UnitedHealthcare narrowing its network, the discussion explores out-of-network billing strategies, patient responsibility, contract pitfalls, and the risks of unpredictable payments. The team also breaks down the key differences between traditional Medicare and Medicare Advantage, highlighting how payer incentives, network restrictions, and administrative burden impact both practices and patients. The takeaway: know your numbers, know your leverage, and be intentional about the payers you choose to work with.
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For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
March 20, 2026
In this episode, Scott, Mark, and Dr. Ray Painter break down a new UnitedHealthcare policy that could impact payment for professional components of diagnostic services—including urodynamics and other PCTC-coded procedures—and what practices must document to avoid denials. The discussion outlines the need for clearly separated diagnostic reports with findings and impressions, as payers increase prepayment scrutiny. The key takeaway: as payer oversight intensifies, precise, structured documentation—and understanding how rules are applied—is essential to getting paid.
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Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
March 13, 2026
In this episode, Scott, Mark, and Dr. Ray Painter tackle three emerging reimbursement challenges affecting urology practices: widespread denials for testosterone pellet (Testopel®) therapy, the growing trend of secondary payers requiring prior authorization for high-cost drugs, and whether urology questionnaires qualify as billable health risk assessments.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
March 6, 2026
In this episode, Scott, Mark, and Dr. Ray Painter break down the complex “alphabet soup” of Medicare coverage and auditing tools—including NCDs, LCDs, LCAs, RAC audits, and the emerging WISER program—and explain how they work together to shape reimbursement policy. Prompted by a new multi-state LCD affecting Botox coverage, the discussion walks through how coverage determinations are created, how Medicare contractors enforce them, and why documentation requirements continue to expand. The panel also explores how practices can adapt by building workflows, intake forms, and clinical documentation processes that capture the data Medicare expects—helping physicians navigate audits while still delivering appropriate patient care.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 27, 2026
In this episode, Scott, Mark, and special guest Dr. John Lin tackle real-world evaluation and management (E/M) scenarios submitted by members of the Thriving Urology Practice Facebook Group. Through practical examples—including BPH follow-ups, elevated PSA management, overactive bladder, recurrent UTIs, and constipation—they break down how to apply medical decision-making rules to determine the correct level of service. The discussion highlights chronic stable conditions, prescription drug management, documentation pitfalls, automatic downcoding, and the ongoing gray areas that make E/M leveling “clear as mud.” The key takeaway: understanding the rules is essential—but precise documentation is what ultimately gets you paid.
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
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Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 20, 2026
In this episode, Scott, Mark, and Dr. Ray Painter break down the financial realities of the new prostate biopsy CPT codes and what they mean for urology practices. Moving beyond coding mechanics, the discussion focuses on the economic differences between transrectal and transperineal approaches, MRI fusion versus ultrasound guidance, targeted lesion add-on payments, and the site-of-service differential between office and facility settings. They explore how practice expense values, capital equipment costs, disposable supplies, physician time, and block scheduling all factor into the decision to bring advanced biopsy techniques in-house. The episode emphasizes balancing clinical judgment with financial sustainability—helping practices evaluate whether expanding in-office prostate biopsy services makes sense now and in the future.
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Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 13, 2026
In this special live episode recorded at the Urology Advanced Coding and Reimbursement Seminar in New Orleans on January 31st, 2026, Scott, Mark, Dr. John Lin, and Marianne DeSciose dive into one of the most contentious coding battles in urology: billing E/M services with cystoscopy on the same day. Prompted by a real-world question from the Thriving Urology Practice Facebook Group, the panel explores when modifier 25 is appropriate, why denials happen, and how to build documentation and appeal strategies that get results. With input from attendees, the episode brings practical insights from the front lines of coding, billing, and payer negotiations.
PRS Coding and Reimbursement Hub
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PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 5, 2026
In this episode, Scott, Mark, and Dr. John Lin break down the latest telehealth news—Congress has officially extended Medicare telehealth coverage through the end of 2027, offering long-term stability for practices. They also answer a listener's question about billing 52235 and 51720 together, covering when a modifier can be used and how to document instillation in the recovery room properly. The episode wraps with a cautionary tale about “medically impossible days,” where excessive use of time-based coding and level 5 visits can trigger audits and serious compliance risk. Stay informed, stay compliant, and keep calm—telehealth on.
PRS Coding and Reimbursement Hub
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Free Kidney Stone Coding Calculator
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PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 30, 2026
On this episode, Scott and Mark Painter sit down with Dr. Sida Niu and Tyler Hamik, co-founders of docology, an AI-driven clinical intake and workflow automation platform. Dr. Niu explains how docology was born out of his own frustration with after-hours chart review, and how the tool now distills massive referral packets into clear, focused summaries—saving hours of prep time. Tyler shares how docology integrates with EMRs to automate front-end document intake and insurance data capture, dramatically reducing administrative overhead. They also discuss their recent selection to the AUA Innovation Nexus and invite physicians to help shape the future of the platform.
Get in touch with docology:
https://docologyhealth.ai
Tyler Hamik tyler@docologyhealth.ai
PRS Coding and Reimbursement Hub
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Free Kidney Stone Coding Calculator
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PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 23 , 2026
In this episode, Scott and Mark Painter discuss what the upcoming January 31 deadline means for telehealth coverage under Medicare, including expectations around funding extensions, potential payment delays, and bipartisan support for long-term access. They also introduce the expanded PRS Coding and Reimbursement Hub—an evolving resource offering disease-specific coding guides, product-specific reimbursement tools, prostate biopsy calculators, EOB insights, and more. Designed to help practices stay ahead of payer policy shifts and streamline claims for new technologies, the Hub is positioned to become urology’s go-to coding and reimbursement resource in 2026 and beyond.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 16, 2026
In this episode, Scott, Mark, and Ray Painter revisit the new prostate biopsy CPT codes and provide a key update on the use of ProMaxo for MRI-guided biopsies. Mark shares recent insights confirming that CPT codes 55713 and 55714 are appropriate for procedures performed with ProMaxo, clearing up previous ambiguity around the “in-bore” language. Then, the team shifts to deductible season challenges, emphasizing front-desk protocols, eligibility verification, patient collections, and how to handle the increased complexity brought on by insurance churn and Medicare Advantage transitions. This episode delivers practical tips for optimizing both coding confidence and cash flow in the new year.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 9, 2026
In this episode, Scott, Mark, and Ray Painter tackle the growing issue of automated downcoding by commercial payers—where level 4 and 5 E/M visits are silently paid at lower levels without a formal denial. They explain how this tactic evades typical RCM detection, outline steps to flag and appeal these incorrect payments, and emphasize why accurate documentation is more important than ever. From setting up payer-specific protocols to understanding how AI-driven reviews can misinterpret records, this episode offers practical strategies to protect your top line and push back against unjust reimbursement practices.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 2, 2026
In this episode, Scott, Mark, and Dr. John Lin dive into the complexities of billing G2211, the Medicare add-on code for complex E/M visits, which now pays nearly $18 per use. They unpack a real-world case where a hospital system’s blanket use of modifier 25 is preventing employed physicians from getting reimbursed for G2211, potentially costing them thousands in RVUs. The discussion covers payer-specific rules, how to appeal inappropriate denials, how contract structure affects physician compensation, and when to fight for carve-outs. They also explore why every urology practice should reassess payer mix and drop underperforming contracts when appropriate.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
December 26, 2025
In this episode, Scott, Mark, and Ray Painter answer listener questions about the new 2026 prostate biopsy CPT codes. They clarify global periods, explain the differences between transrectal and transperineal approaches, and tackle the nuances of coding for MRI-guided procedures—especially when using systems like Promaxo. They also break down the use of 55715 for additional targeted lesions, when modifiers like 52 may apply, and how payers might interpret these new codes differently. The team emphasizes caution, payer communication, and the evolving nature of both coding and coverage guidance.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
December 12, 2025
In this episode, Scott, Mark, and Ray Painter share highlights from the recent Urology Advanced Coding and Reimbursement Seminar in Las Vegas, including robust discussions on E/M coding, prostate biopsy changes, modifiers, and the Wiser program. They also provide an important update on the AMA’s recent meeting about coding and payment for algorithmic services, detailing how CPT and the RUC are approaching AI integration in healthcare. From potential reimbursement models to risk assignment and FDA considerations, this forward-looking conversation covers the groundwork being laid for AI’s role in clinical care and payment policy.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
November 21, 2025
In this episode, Scott, Mark, and Ray Painter explore the reimbursement challenges surrounding procedures that may not be covered by insurance, including those considered cosmetic, elective, or medically unnecessary. They discuss how to identify whether a service is reimbursable, when to use ABNs, how different payer rules come into play, and why collecting upfront may be the smartest move. You’ll also hear strategies for handling denials, gray-area procedures, and why knowing the rules—and your contracts—can make all the difference.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
November 14, 2025
In this episode, Scott, Mark, and Ray Painter discuss the impact of the government’s recent reopening on telehealth services for Medicare patients. With the new continuing resolution extending COVID-era telehealth flexibilities through January 30, 2026, they break down what this means for billing, coverage, and patient refunds. The team also explores what to watch for if another shutdown looms, how CMS might handle claims from the closure period, and why signs point to telehealth becoming a permanent fixture in Medicare.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
October 31, 2025
In this Halloween-themed episode, Scott, Mark, Ray, and special guest Dr. John Lin explore the “curse” of poor documentation and its real-world consequences, including payer audits, downcoding, and revenue loss. They discuss how vague or incomplete documentation—even when care is appropriate—can lead to denials and clawbacks, especially in today’s AI-assisted claims review environment. The team also covers practical strategies to improve documentation, the risks of overrelying on ambient AI tools, and why every clinician must understand the rules of E/M coding. This episode is packed with actionable insights to help you protect your revenue and stay ahead of payers’ increasingly aggressive tactics.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
October 24, 2025
In episode 264 of the Urology Coding and Reimbursement Podcast, Scott and Mark Painter sit down with Ken Mitchell, PA-C, a nationally recognized expert in men’s health and a champion for advanced practice providers (APPs) in urology. Ken shares insights on the growing urology workforce shortage, the evolving role of APPs, and recent payer challenges—like restrictions on APP-administered Xiaflex in Arkansas. He also introduces his nonprofit, Gynecology, which promotes men’s health education and training. This episode is a must-listen for practices navigating workforce limitations, payer pushback, and the future of urologic care.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
October 17, 2025
In this episode, Scott, Mark, and Ray Painter clarify the latest on the Medicare claims hold during the government shutdown, explaining that it applies only to services affected by expired COVID-era provisions like telehealth under traditional Medicare. They also address coding questions on billing for bladder stone removal during robotic prostatectomy—highlighting when to use 51050 vs. 51999—and revisit proper coding for Urocuff procedures following a UnitedHealthcare audit, emphasizing payer-specific strategies and the importance of reviewing operative details and coverage policies.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
October 10, 2025
In this episode, Scott, Mark, and Ray Painter address two pressing topics for urology practices. First, they provide the latest update on the government shutdown, its impact on Medicare claims processing, and the timeline for when the CMS-mandated 10-day hold may be lifted. They also clarify that Medicare funding is not in jeopardy—this is purely an administrative delay related to expiring telehealth and COVID-era waivers.
Next, they tackle a listener-submitted question about hidden processing fees on payer payments—specifically, credit card reimbursements that reduce practice income by 3% or more. Mark shares practical recommendations, including switching to ACH/direct deposit to reduce costs, proactively managing PECOS and credentialing, and negotiating cost-of-living increases in payer contracts. They also explain the risks of neglecting PECOS updates and why contract management should be a routine business process—not a reactionary one.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
October 3, 2025
In this episode, Scott, Mark, and Ray Painter discuss two timely and important topics. First, they break down the current government shutdown and its effects on Medicare claims processing, including the 10-day hold issued by CMS to allow MACs to adjust their systems—especially around telehealth billing. They offer practical recommendations for urology practices, including billing guidance and the use of ABNs during the shutdown.
Then, the discussion shifts to artificial intelligence in healthcare. After attending multiple urology meetings and AI sessions, Scott and Mark share real-world observations on how AI is being used across the urology landscape—from ambient documentation tools to claims scrubbing and patient scheduling. They emphasize the importance of human oversight, expertise, and carefully evaluating AI partners before implementing tools in your practice. Ray adds his perspective on the ongoing need for human knowledge and caution when embracing new technology.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
September 26, 2025
In this episode, Scott, Mark, and Ray discuss the looming federal government shutdown and how it could impact urology practices—especially telehealth services. They explain the latest developments in Washington, what Medicare and Medicaid payments will look like during a shutdown, and offer practical guidance for handling telehealth visits, front-office operations, and prior authorizations. Mark shares specific strategies and options for practices, including use of ABNs and billing considerations for Medicare Advantage and traditional Medicare patients. The episode wraps with insights on how the shutdown might delay CMS’s final rule and the broader implications for AI, reimbursement, and practice management.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
UCR 259: Bladder Cancer Reimbursement Strategies – Using Unlisted J Codes and the New Zusduri Hub Tools
September 19, 2025
In this episode, Scott, Mark, and Ray Painter dive into bladder cancer reimbursement with a special focus on billing strategies for new intravesical therapies like Zusduri, which currently lack established J codes. Mark outlines the complete reimbursement pathway from diagnosis coding through installation documentation, prior authorizations, appeals, and follow-up. They discuss the importance of accurate diagnosis flow, clear drug documentation, and the nuances of billing unlisted codes—including Box 19 tips and JW modifiers.
The episode also introduces PRS Network’s new Zusduri Reimbursement Hub, including a custom J Code calculator designed to help practices manage invoicing timelines, track payment cycles, and streamline claim submissions. This tool is a game-changer for practices adopting new therapies. The Painters wrap up with reflections on the importance of payer education, the role of pioneers in improving access to innovative urology treatments, and how this supports better outcomes for patients.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
September 17, 2025
In this episode, Scott, Mark, and Ray Painter break down the latest updates on the future of Medicare telehealth coverage as the September 30, 2025, deadline approaches. Mark shares insights into recent bipartisan efforts in Congress, including a proposed stopgap measure to extend current telehealth rules through November. They also discuss the political tug-of-war surrounding ACA tax credits and how the budget debate could impact telehealth services. Tune in to understand what this means for your practice, how to handle telehealth scheduling in October, and what documentation is needed if coverage lapses. Plus, final thoughts on why this remains a political football despite broad support for continuing telehealth.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
September 5, 2025
In this episode, Scott, Mark, Ray, and special guest Dr. John Lin delve into the nuances of coding and billing for steerable vacuum-assisted catheters used in large stone removal. They clarify the differences between DISS (Direct In-Scope Suction) and FANS (Flexible and Navigable Sheaths), explain the use of HCPCS code C9761, and discuss what it means for facilities, surgery centers, and urologists.
Urology Advanced Coding and Reimbursement Seminar
Information and Registration
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
August 15, 2025
In this episode, Scott, Mark, Ray, and special guest Dr. John Lin dive deep into Medicare’s upcoming Wiser Program—set to begin in 2026—which brings prior authorization to traditional Medicare for select urology services. Learn which states are impacted, what procedures are targeted, and what steps urologists need to take to prepare. The team also discusses the growing use of steerable ureteral catheters and how facilities can (or can’t) use code C9761 for reimbursement. Get practical advice on documentation, appeal strategies, and how to advocate for your practice in this evolving regulatory landscape.
NCDs
Sacral Modulation NCD
Incontinence NCD
Impotence NCD
PRS Coding and Reimbursement Hub
Access the Hub
Free Kidney Stone Coding Calculator
Download Now
PRS Coding Courses
For Urologist
For APPs
For Coders, Billers, and Admins
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
August 22, 2025
In this special episode, Scott, Mark, and Ray welcome Dr. Marc Rose, a practicing urologist in Vero Beach, Florida, to share his journey of transitioning to a hybrid urology practice that combines traditional insurance with concierge medicine. Dr. Rose walks us through the burnout that led him to make a change, how he structured his new model, and the lessons he’s learned since making the leap. He explains how the practice operates day-to-day, how patients respond to concierge options, and the role his nurse practitioner and support team play. Whether you’re a urologist exploring alternative practice models or just curious about the benefits and challenges of concierge care, this episode offers valuable firsthand insight.
Contact Dr. Marc Rose
concierge@marcroseurology.com
PRS Coding and Reimbursement Hub
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August 8, 2025
In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advantage plans, what it really means, and how to prepare your front desk and billing staff for potential patient coverage changes. Stay informed, stay proactive!
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August 1, 2025
In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Helpdesk.
- Pay er: Anthem BCBS
State: NV
Code/Codes: Tranurethral resection of bladder clot that was organized to facilitate removal
Catagory: Other - Question: I'm looking for a CPT code for : transurethral resection of bladder clot that was organized t facilitate removal Pt was inpt and Dr tried to do a clot removal from the bladder, but was unsuccessful as the whole bladder was the clot. So he used a resectoscope to resect the clot into smaller pieces and then removed them with a ridid biopsy forceps. This procedure took over 2 hours. I need help with a CPT code that will accurately describe this procedure
- Payer: N/A
State: TX
Code/Codes: N/A
Catagory: Other - Question: Do you have info or prior podcast on billing for updated h/p prior to surgery if prior h/p done greater than 30 days before surgery? Appreciate help or directions to podcast if available. Sincerely, Irene McAleer, MD,JD,MBA immmac@msn.com 948-610-9449 Sent from my iPhone
- Payer: Mix
State: Ohio
Code/Codes: 57 vs. 25 modifier
Catagory: Other - Question: When is best to use 25 vs. 57 same day procedure/OR - I thought anything requiring anesthesia would be OR procedure? Cysto/stent, cysto clot evaluation, etc would be 57 but is 25 more appropriate even if done in the OR?
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© 2025 Physician Reimbursement Systems, Inc.
July 25, 2025
In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Help Desk.
1) Payor: Medicare
State: FL
Code/Codes: 52353-52 and 52332-59-51
Catagory: Kidney Stones
Question: If I have to abort a planned ureteroscopy and laser lithotripsy because the UO is too narrow to pass the ureteroscope so I place a stent. Can I bill the 52353-52 and 52332-59-51
2) Can you clarify what documentation is required to be able to code 51729? Is the length of the urethra required to be documented or is it just a possible element?
The AUA policy & Advocacy brief for Urodynamcis shows the example documentation of the UPP as, “ Urethreal Pressue Profile: The maximum urethral pressue profile was 45 cm of water with a functional urethral lenght of 2.75 cm. At 200cc, coughing was iniitated. There was no demonstrable leak of urine at 117 cm of water with abdominal straining.”
My provider is only documenting: Leak point pressure testing: volume tested: 150mL, Stress Induced DO: Absent Valsalva Leak Point Pressure: No Leak.
Is that enough to capture 51729?
Thank you for your assistance!
3) Can you tell me the best way to document and correctly bill for prostate biopsy using 55700/76942 and 76872? I am told we are no longer getting paid for those.
4) What is the best way to document and code for placement of fiduciary markers under US guidance?
Thanks in advance
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July 18, 2025
In this episode, Scott, Mark, and Ray Painter break down their first impressions of the 2026 proposed Medicare physician fee schedule. From conversion factor changes and telehealth updates to significant RVU and facility payment shifts, they explore what’s in store for urology and what it all means for your bottom line.
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July 11, 2025
In this special episode, Dr. Peter Bretan—president of the AACU—joins Scott, Mark, and Ray to share his journey from transplant surgeon to national urology advocate. He highlights the power of grassroots advocacy, the importance of local engagement, and AACU’s evolving mission to support all urology professionals.
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June 27, 2025
Scott, Mark, and Ray discuss how new FDA rulings—like the recent update for Rezūm—impact coverage, coding, and reimbursement. They walk through the layers of medical necessity, CPT codes, payer policies, and documentation strategies needed to ensure payment.
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June 20, 2025
In this episode, Ray, Mark, and Scott answer questions that came into the PRS Helpdesk and give an update on Telehealth and where it stands.
- Patient with BPH and bladder stones. When treating both the BPH (N40.0) and bladder stones (N21.0) during the same surgery, is it appropriate to bill both 52649 {Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete…….)} & 52317 and/or 52318 [Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; …..]. There are no CCI edits in Coding today, so it appears they can be billed together. Please explain why or why not?
- New to urology and would appreciate some knowledge in male fertility and general urology
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© 2025 Physician Reimbursement Systems, Inc.
June 13, 2025
In this episode, Ray, Mark, and Scott discuss recent denial issues from Aetna and Humana and offer some possible solutions. They also revisit a question covered in Episode #234: billing for amniotic tissue grafts during prostatectomy procedures, outlining strategies to address denials effectively.
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- June 6, 2025
In this episode, Ray, Mark, and Scott welcome back Dr. John Lin to discuss topics brought up on the Thriving Urology Practice Facebook Group.
1) Just got a call from ER. 19 year-old cannot get an erection...
2) This notice came from the hospital last week regarding change in financial protocol about scheduled / elective surgical procedures.
Increased Patient Responsibility:
As is customary in the Phoenix market and in-line with other providers, we will move the down payment requirement to 50%. We will be increasing the required patient payment for deductibles and co-pays prior to the day of surgery from 20% to 50% of the estimated patient liability.
3) Our office will be beginning PAE {prostatic artery embolization) for BPH in the near future. This will be performed in the office, POS 11 by an interventional radiologist, who will manage the sedation and the performance of the procedure. We have not had to bill for conscious sedation in the office before. I was hoping to get some guidance on what codes should be investigated for the anesthesia portion (administration, meds, etc.) so we can better prepare ourselves for what is to come.
Bonus Topic
I received an email from a surgery center recently which stated the following:
Recently, we have been using a larger number of disposable ureteroscopes which are very costly to the Center. In order to capture the code C9761 for reimbursement of the disposable flexible ureteroscopes, we need your dictation to reflect the usage of that scope and that suction/aspiration was used.
A vendor’s representative has provided a few examples from other physicians that have resulted in successful reimbursement of these scopes. Below are the examples.
- The op report documents a steerable and suction/aspiration was used. It says "A disposable single use flexible scope with steerable and suction/aspiration was used to improve stone-free rate."
- The op report documents only a scope using a suction feature. It says "A disposable flexible ureteroscope utilizing a suction feature was utilized for the procedure."
If you are not already, please have your dictation reflect that you are using a disposable flexible ureteroscope with suction so that we can bill for reimbursement. As always, we appreciate your help with cost containment and appropriate reimbursement for the Center. Please let me know if have any questions or concerns
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May 30, 2025
In this episode, Mark and Scott address upcoming significant changes to the prostate biopsy codes and provide guidance on correctly applying modifiers 25 and 59 when billing procedure 51798 and an E/M service. They also discuss coding considerations for the emerging practice of robotic-assisted vasectomies.
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May 23, 2025
Scott, Mark, and Ray answer listener questions on coding for remote uroflowmetry, defining high-complexity MDM, and dealing with low Medicare Advantage reimbursements. They discuss CPT code options, provide examples of immediate-risk diagnoses, and offer strategies for contract negotiations.
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May 16, 2025
Scott and Mark switch roles to introduce the new PRS Coding and Reimbursement Hub, featuring Jelmyto as an example. The Hub helps practices simplify workflow, coding, and reimbursement processes. Scott explains how the Hub provides clear, trusted guidance, enabling urology practices to streamline reimbursement, reduce confusion, and accelerate patient access.
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May 9, 2025
In this episode, Scott, Mark, and Ray answer questions that came into the PRS Helpdesk.
- One of my specialties is pedsurology and there is just not much guidance for surgery coding.
Is it appropriate to use 54360 (plastic operation on penis to correct angulation) for correction of penile torsion?
I found an article from AAPC dated 2005 that stated to use 14040 for penile torsion repair when performed with a MAGPI hypospadias repair (54322).
What if the penile torsion repair is not performed with another procedure or at least without a hypospadias repair? - If Medical technologists (Medical assistants trained to perform Urodynamics) can perform this test why are Medical assistants not permitted by CMS to perform catheter insertion and removal in non regulated sites of services? (I have seen MAs in non regulated spaces perform catheter changes, bladder instillations--etc---how are practices able to get away with having MAs incorporated in their work flow as such?)
- In regulated sites of service (Hospital based clinics) what documentation should be used to ensure proper billing when an MA performs 51798 (bladder scan) (incident to billing for a hospital-employed physician).
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May 2, 2025
In this episode, Scott, Mark, and Ray share highlights from the AUA 2025 Annual Meeting in Las Vegas, discussing exciting new technologies, reimbursement challenges, key conversations, and updates from the urology community.
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April 25, 2025
Scott, Mark, and Ray discuss the pressures of Urology practice in 2025. They talk about what you need to be aware of and why you need to plan for the future.
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April 18, 2025
Scott, Mark, and Ray discuss questions that came into the PRS Helpdesk:
- For the past 8 months, I have been in an employed position with a county hospital system that provides inpatient and ambulatory services. Their coding consultants (acsteam.net) are telling the hospital that foley catheter insertions, bladder irrigations, and a list of other procedures commonly performed in urology clinics cannot be billed if they are not performed personally by the physician according to CMS. They reference a list of procedures from CMS and state that these services cannot be billed when performed by ancillary staff regardless of the level of supervision. They use https://www.cms.gov/status-indicators as their source citing the section on PC or TC indicators. Can this be true? Is it possible that this consultant is giving advice from a hospital perspective and not aware of differences between the ambulatory setting? The urology clinic I am working in is not a department of the hospital. It is freestanding. I have never worked in a clinic that did not bill for these services performed by ancillary staff with physician supervision.
- I look forward to your response.
- Good afternoon, my question is regarding "Incident to" required documentation. When we attended your seminar this past December, on Day 2, the new "Incident to Rule" was discuss. Can you please help clarify the new rule? My notes are not clear.
We are in the process of CMS Review -"Targeted Probe and Educate Round 1". The letter states we were chosen for review because of being in the 60th percentile for our jurisdiction for code 99214.
Our practice has the challenge of servicing and underprivilege community and estimated population of 590,142. We have 7 Urologist, 4 Apps and 1 Radiation Oncologist in our practice. Hence our volume is overwhelming.
Earlier this year we submitted a batch of approximately forty records. Today we received a notification request "Incident to documentation: needed 2 previous office visits done by MD to support physician/supervising provider's initiation and continued involvement in treatment, and documentation to support direct supervision met.
I appreciate any assistance with clarifying the “Incident to” rule.
Thank you in advance for your assistance. - Doctor did a stent pull in the ASC but not with Cysto scope. How would we go about billing this?
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April 11, 2025
Scott and Mark discuss questions that came into the PRS Helpdesk:
- Hello, Some years ago we were using the SRS urocuff. Can you tell me what the current codes are? I know this has been mentioned at the seminars- cannot find the slide :( Thanks
- How are groups coding for the new Revi procedure for urge incontinence, urgency of urination, for both professional and facility fees. Is it best to use a 0817T or a 64581 w/ crosswalk? Cannot find a lot of information about this. Any feedback or suggestions would be greatly appreciated!
- I would like your thoughts about the use of Pelvic Floor rehab CPT code 91122 in a urology practice. The company UroVal Inc. is promoting this procedure for urologists to perform in the office setting.
- E/M question pls. Thank you! For a follow up office visit, Pt has prostate cancer, and he is on "Active Surveillance". For Problem Component of E/M, would you consider pCA on Active Surveillance is a Moderate VS a Low-level problem? (as opposed to personal history of pCA - Watchful Waiting). I think it's a moderate level 4, but would like to hear your opinion, thank you!!
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April 4, 2025
Scott and Mark discuss who can perform biofeedback services, clarify billing requirements, and explore practical scenarios involving incident-to billing. Mark and Scott break down key Medicare guidelines, share best practices for documentation, and offer tips for optimizing biofeedback delivery within your urology practice.
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March 28, 2025
Scott, Mark, and Dr. Ray Painter discuss questions that came into the PRS Helpdesk.
- NGS sent a newsletter about the use of: cpt code G0463 as a primary code for G2211. Need more info if possible.
- Do nurse practitioners get paid at 100% for procedures like a PNE when signing notes in NM by themselves?
- a) Medicare NGS is denying CPT 52332 for bilateral stents with denial CO-151. This seems to be a constant problem with denials for frequency and/or bilateral stents.
Has the policy been changed; I have not been able to find any changes regarding stents insertion or exchanges.
Thanks
b)Hi,
Wondering if you can help me with this Medicare patients.
NGS is denying the claim on several patients stating that this code has a frequency limit on 52332.
NGS has a problem with both frequency and bilateral stents
I have searched everywhere and find no information on this code for frequency limits per year or bilateral stents.
Appreciate any help on this code.
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March 21, 2025
Scott, Mark, and Dr. Ray Painter break down the latest developments in telehealth policy and Medicare reimbursement. Mark shares the good news about the extension of telehealth flexibilities and the bad news regarding the unchanged (and still reduced) conversion factor. They also dive deep into the recent uptick in RAC audits, highlighting the procedures being targeted, documentation pitfalls to avoid, and best practices for navigating the audit and appeals process.
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March 14, 2025
Scott, Mark, and Ray discuss three coding questions from the PRS Community and the Thriving Urology Practice Facebook group.
- My question is regarding G2211. Is there a time frame for the follow-up that needs to be dictated. My doctor has been putting return to clinic in a year in the notes and billing G2211. Wondering if this is ok, or if the follow up must be sooner?
- Our new urologist started placing an amniotic tissue membrane graft around the urethral anastomosis during a laparoscopic robotic radical prostatectomy. Would this be included in the 55866 or is there a CPT code for this? I was looking at 15275 but not sure if that is correct either. I am a coder with questions.
- Would you be so kind to give me your opinion on 50548 for robotic radical nephroureterectomy versus using 50545 for that surgery?
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
March 7, 2025
Scott, Mark, and Ray discuss the latest updates (or lack thereof) on telehealth policies as the current extension nears expiration. They break down what practices should consider when scheduling telehealth visits, the potential impact of congressional actions, and how to prepare for possible changes.
The second topic dives into specialty designations within the same practice—what happens when different taxonomy classifications exist under the same tax ID, and how this affects new vs. established patient billing.
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Marianne Desciose
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Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 28, 2025
Scott, Mark, and Dr. Ray Painter break down the challenges of securing fair compensation for extra work performed in urology procedures when using modifier 22, unlisted codes, or Category III codes. They discuss effective strategies for communicating with payers and contract administrators, ensuring proper documentation, and negotiating fair work RVU adjustments.
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Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 21, 2025
Scott and Mark discuss questions from the PRS Network Community and the Thriving Urology Practice Facebook group.
- Does anyone bill out a removal of testicular appendix separately from the hydrocelectomy? I have a new physician that is submitting 55040 and 54512.
- After presenting Grand Rounds on billing/coding the question arose that our billing department is billing g G2211 with a modifier 25 and getting paid. That goes against what I learned and what I presented.
- Leveraging Provider Portals
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Marianne Desciose
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Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 14, 2025
Scott, Mark, and Ray discuss questions that came into the PRS Network Community.
- Our doctor's occasionally use the ESWL (Extracorporeal Shock Wave Lithotripsy) for bladder stones. Insurance requires a laterality modifier. I am not sure if we can bill for it or not. If we can bill for it, what is the correct way to do it?
- Can you please clarify the relaxation of the in person requirement for supervision in 2025? As I read it and as I understand that you have explained it, this is a new rule stating essentially that if I am a physician supervising a nurse practitioner, the in person supervision is waived and I only need to be available via telecommunication. Am I interpreting this correctly? My coders are pushing back saying that this only applies to telehealth visits not in person visits for my supervisoion of a nurse practitioner.
- Coding Challenging Stone Cases: Is there a CPT code I'm missing here? What financial incentive is there to use the suction/vacuum technology and perform FANS/DISS for larger stones? Just the 22-modifer? Seems like from a billing/time perspective, it's not worth tackling larger stones with either FANS or DISS.
- Does the 22-modifier really make that much difference? Can you provide an example of generally what additional time (ie double/triple, etc) actually generates for additional RVUs?
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Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
February 7, 2025
Scott and Mark welcome back Dr. John Lin and Marianne Descoise to discuss some key takeaways from the Urology Advanced Coding and Reimbursement Seminar, which took place in New Orleans from January 31st to February 1st.
Free Kidney Stone Coding Calculator
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Join the Urology Pharma and Tech Pioneer Group
Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.
https://www.prsnetwork.com/joinuptp
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
UCR 228: G0559 clarification, GC Modifier Explained, and G2211 documentation suggestion.
January 24, 2025
Scott, Mark, and Dr. Ray Painter address questions submitted to the PRS Network.
- I recently attended your Billing and Coding conference in Las Vegas this past December.
I need clarification on New CPT code G0559, can someone please contact me as soon as possible. - From a coding perspective, I have a question regarding the GC modifier for a teaching facility. Also, is there a difference between the coding perspective and the compliance side of the question?
How crucial is adding the modifier GC to the encounter when a patient is seen by both the Resident and the Faculty member? - Appreciate any insight y'all can provide.
- My coder is requiring me to add a statement for G2211 codes.
- "E and M visit today is associated with current or anticipated ongoing medical care services related to a patient's single serious condition or complex condition."
Is this necessary? Reading the CMS guidelines they say no. They are worried about "Bulletproof" Documentation. I am coding these with many of my follow up patient who have chronic BPH, OAB, ED and cancer. Thoughts on how to respond to them?
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
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Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
January 17, 2025
Scott, Mark, and Dr. Ray Painter are joined by special guest Marianne Desois, COO of PRS Managed Services, to dive into the growing issue of payer recoupments. They discuss the tactics payers use, common pitfalls practices face, and actionable strategies to identify and appeal recoupments effectively, helping you safeguard your revenue stream.
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Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
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Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 13, 2025
Mark, Scott, and Ray discuss how the new free Kidney Stone Coding Calculator, supported by Calyxo is a great tool for double-checking, teaching, discussing, and calculating kidney stone coding scenarios.
Free Kidney Stone Coding Calculator
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Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
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Click Here for Information and Registration
Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
January 8, 2025
Mark, Scott, and Ray discuss new rule changes and what is ahead in 2025
Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
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Click Here for Information and Registration
Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
December 27, 2024
Mark and Scott discuss the American Relief Act and the impact it will have on urology practices.
Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
Register Now for the Urology Advanced Coding and Reimbursement Seminar
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Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
December 20, 2024
Ray, Mark, and Scott welcome back Dr. John Lin to discuss Episode 212 which United Healthcare asked us to take down.
Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
Register Now for the Urology Advanced Coding and Reimbursement Seminar
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Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
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December 13, 2024
Ray, Mark, and Scott discuss the top takeaways from the Urology Advanced Coding and Reimbursement Seminar in Las Vegas, Dec 6-7, 2024
Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
Click Here to Start Your Free Trial of AUACodingToday.com
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
November 22, 2024
Mark and Scott answer two questions that came in through the coding course:
- Can you help me to clarify, if the stone in the bladder was fragmented by basket and removed, can we bill CPT 52317 or 52310.
Thank you so much! - Is it ok to bill CPT 52601 if CPT 0421T denied (for example, Experimental)
The provider performed the procedure, what is your suggestion?
I really appreciate your help and clarification!
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
November 15, 2024
Ray, Mark, and Scott talk about the CMS Final Rule for 2025 in part 2 of this two-episode discussion.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
November 8, 2024
Ray, Mark, and Scott talk about the CMS Final Rule for 2025 in part 1 of this two-episode discussion.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
November 1, 2024
Ray and Scott talk PRS MS Director of Operation, Marianne Desciose about Revenue Cycle Management (RCM) current and sometimes hidden issues.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
UCR 217: Split shared and incident to visits
October 25, 2024
Ray, Mark, and Scott talk about split shared and incident to visits.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
October 18, 2024
Ray, Mark, and Scott talk about the top 3 ICD-10 Challenges of 2024.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
October 11, 2024
Ray, Mark, and Scott discuss the upcoming Urology Advanced Coding and Reimbursement Seminar, why you should attend, and the agenda for the upcoming seminars.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
© 2024 Physician Reimbursement Systems, Inc.
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October 4, 2024
Ray, Mark, and Scott talk about the Telehealth status, payer down coding, and level 5 E/M services in urology
Urology Coding and Billing Certification Course for Coders, Billers, and Admins
Use code: DCBSE24 for a special price through October 7th, 2024. Now is the best time to invest in training.
Click to Register
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Click Here to Start Your Free Trial of AUACodingToday.com
September 27, 2024
Ray and Scott welcome guest Marianne Desciose to discuss Prior Authorizations, Pre Certifications, and Eligibility.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 20, 2024
Mark, Ray, and Scott welcome guest Dr. John Lin to share a discussion with a Medical Director and his team from a large payer about what level an undesired fertility, pre-vasectomy, obesity counseling visit should be and the documentation required for reimbursement.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 13, 2024
Mark, Ray, and Scott discuss questions from the PRS Community.
- Hi, In your Urology Times article on July 30th, there is mention of a proposed change to the practice expense component of cystoscopy due to updates in the supply valuation by CPT RVU Update committee. It talks about "packs SA045, SA058 and SA042". What are these packs and can you explain further how this will impact the in-office RVU for CPT 52000?
thanks - We are looking for some guidance regarding images and the accessibility. When coding procedures such as 50431 (images included in code) or 51600 or 51610 (images billed separately). Does the coder physically need to see the images before submitting charges? Or can charges be submitted if provider clearly documents images available? We know the images are readily available and are attempting to prevent additional work uploading to the chart for coder review. Should we consider having a written policy in place? Appreciate any advice or suggestions y'all may have.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 6, 2024
Mark, Ray, and Scott address follow-up questions from the previous episode concerning the billability of ureteral stents during procedures. They clarify distinctions between inherent procedural components and separately billable services, emphasizing the importance of documentation.
The episode also reviews coding for G2211, where Mark adjusts his stance to include hypogonadism for long-term management. Additionally, the hosts discuss the supervision levels required for radiologic services and recommend AUACodingToday.com for efficient coding. Emphasizing up-to-date knowledge and precision in documentation, the episode closes with insights on adapting to evolving coding regulations.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 30, 2024
Mark, Scott, and Ray talk about questions that came into the PRS Communities.
- Hi, I have a coding question pls. Thanks so much.
Our urologist performed HIFU a month ago. Pt. had come back for Dysuria postop complication, has been having dysuria for 2 weeks. Our urologist decided to perform Cystoscopy for this.
Cystoscopy performed, but we did Not bring Pt. back to OR. So, it should Not be a billable service
But then, Per NCCI, Diagnostic test and procedures may be paid as a separate service during global.
Should we bill CPT 52000? and If so, will modifier be -58, since it did not occur in OR so -78 would not be an appropriate modifier?
Please suggest, thank you!
2. Modifier 73 Question: Can this modifier be used when the patient is in the pre op area and he/she was given Dilaudid and another mediation and then prepped for surgery but then the patient decided they did not want to proceed because the pain medication made them feel better(Patient had a Kidney Stone). It seems resources were used and a block of time was scheduled for the facility. Wording can be a little different from our MAC, CPT, etc when some state the patient has to be taken to the operating room. Thanks for your time.
3. Hi, We are getting some pushback and would like to know when/if ureteral stents are billable intraoperatively. Our providers are placing a stent, performing pyeloplasty in the same ureter, and the stent is routinely removed one week later.
Is this stent placement an inherent part of performing the primary procedure, or is this a billable service? Thank you!
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 23, 2024
Mark, Scott, and Ray talk about two questions that came into the PRS Communities:
- I have Optum requesting records on all of our clot evac cases where something in the bladder was fulgurated during the same session and after record review we fail the audit.
Now compliance is very quick to say refund it, stop billing it, its bundled, etc.
But we know a modifier is allowed so when is it allowed???? - Everything I find online like AAPC says to bill both 52214 and 52001-59 but there is nothing recent and nothing concrete about what is considered distinct. I mean using a clot evacuator is different than using a loop electrode. Below are the Optum rationales.
So the urologist does a cysto on hematuria work up, and they wind up using an evacuator to remove huge amounts of clot burden. Then use a loop electrode to fulgurate some areas that look suspicious.
Why is that service not considered distinct? Compliance says its incidental but they can't tell me when it wouldn't be incidental and I don't want to let optum take back money without an argument. - Hi, I would like to ask a coding question please. Thank you so much!
- For Robot-assisted left partial nephrectomy and Resection of a left renal hilar lymph node, Do we code any additional CPT to capture renal hilar lymph node, in addition to partial nephrectomy 50543?
- Pathology report had a separate report for Renal hilar lymph node dissection, which was negative for carcinoma. And for partial nephrectomy, path showed Renal cell carcinoma.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Location:
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New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
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Join the discussion:
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August 16, 2024
Mark, Scott, and Ray talk about G2211 and 99459 updates and two CPT description questions that came into the PRS Communities:
- I have received a denial for px 50545 stating the adrenal gland was not removed, therefore, 50545 is not supported. PX description: Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy). I recall reading a PRS article regarding what constitutes a a radical nephrectomy (of course, currently I can not find my reference). But if I recall correctly, the main criteria for radical is the removal of the Gerota's facia. The nodes, adrenal and fatty tissue were not the determining factor, and did not have to be removed to classify as radical 50545. Can y'all please help direct me to the correct understanding? Does the adrenal gland have to be removed in a radical nephrectomy? Thanks for any input y'all can provide.
- The CPT book does not define limited vs complete for penile duplex scans the way it does for other vascular studies. How do we choose between 93980 and 93981, and what do we look for in documentation to determine whether it is complete or limited If it is not a follow up? I have never had a provider perform this procedure before and want to make sure i am understanding the codes correctly. Thank you!
AMA Paranthetical Link
https://cpt-international.ama-assn.org/cpt-implementation-guide-component-2-primer
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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August 9, 2024
Mark and Scott discuss the 2025 Proposed CMS Rules.
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 2, 2024
Mark, Scott, and Dr. Ray Painter discuss FAQs that came into the PRS communities.
- Can you bill a voiding trial after a patient had a procedure that has 0 day global (UROLIFT).
- Hi, a question on IPP coding pls. How do you we code for "2-piece Ambicore IPP placement"?
With this new Ambicore IPP, the penile prosthesis consists of only One pair of Cylinders and a Pump and eliminates the need for a separate Reservoir. Are we coding with 54405-52? VS no modifier 52? Thank you! - EmanoFlow
Hello all,
I see there is a podcast on this topic from April 2022. I was hoping there may be some updates on coding and/or information.
One of our doctors has started using EmanoFlow. There is no device for this app. We realize there can only be one billed per calendar date with 51741-26
If the doctor reads the uroflows as they are done and creates encounters with documentation of his review, for each day the patient completes the uroflow, is it correct to assume that the doctor can bill for each one?
Also does anyone have experience on what the financial responsibility is to patients? The rep was very vague on patient responsibility. I'm assuming (never the best idea) that it is just based on the clinics fee schedule for uroflows with a 26 on them. - Hi,
I have a question regarding coding for psoas-hitch with laparoscopic approach. Should these be coded with unlisted 50949 and bench marked to 50785 or does 50948 include the psoas-hitch?
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
July 26, 2024
Scott, Mark, and Dr. Ray Painter interview Dr. Willie Underwood, a urologist with over 20 years of experience and a key figure in the American Medical Association's leadership. Dr. Underwood discusses the importance of physician involvement at state and national levels, the AMA's stance on telehealth advancements, and the necessity for collective action and financial contributions to influence healthcare policies. The conversation highlights how unified efforts and innovative solutions can transform the medical profession and improve health outcomes nationwide.
Urology Advanced Coding and Reimbursement VIRTUAL SEMINAR
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Special Early Bird code: 25UACRS732
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
July 19, 2024
Scott, Mark, and Dr. Ray Painter explore effective billing practices for Part B drugs, using Jelmyto as an example. They discuss challenges such as prior authorizations, correct dosing, and site-specific billing considerations, emphasizing the need for accurate documentation and communication within healthcare settings. The episode also highlights strategies to manage Medicare and private insurance requirements efficiently, focusing on setting up internal processes to safeguard against common billing errors and ensure compliance.
Urology Advanced Coding and Reimbursement VIRTUAL SEMINAR
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PRS Billing and Other Services - Book a Call with Mark Painter or
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Special Early Bird code: 25UACRS732
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
July 12, 2024
Scott, Mark, and Dr. Ray Painter are joined by Dr. John Lin. In this episode, they answer two questions that came into the Thriving Urology Practice Facebook group:
- Pearl:
We use 55700 for the MRI fusion prostate biopsy. The docs want to use 55706 instead when MRI
fusion biopsy is done with the transperineal approach. Is that OK? - Kimberly:
Can someone please explain to me if codes 52214 and 52224 can be billed together? If yes, what
modifier are you using? Also, how is code 52224 a component of 52214??? These codes blow my
mind!!!
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Special Early Bird code: 25UACRS732
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
June 28, 2024
Scott, Mark, and Dr. Ray Painter are joined by Dr. Eugene Rhee, a key figure in urology and healthcare policy. Dr. Rhee, who recently completed his term as Chair of the AUA Public Policy, shares his insights on the challenges facing urology, notably the supply-demand gap in the workforce, and the increasing importance of telemedicine. The discussion covers the impact of the pandemic on telehealth adoption, legislative efforts to sustain telehealth services, and the strategic role of advocacy in urology. Dr. Rhee also touches on his potential candidacy for the AUA Presidency and emphasizes the significance of grassroots involvement in policy-making.
Urology Advanced Coding and Reimbursement VIRTUAL SEMINAR
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
June 21, 2024
Mark, Scott, and Ray celebrate their milestone episode by reflecting on the origins, achievements, and future goals of the podcast.
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
June 14, 2024
Mark, Scott, and Ray discuss topics that came into the PRS communities.
- Can you bring this back up again as it relates to Audio only calls. Question i have is if you are just reviewing results that were ordered during a visit, this is essentially not a billable event. Isnt it considered double dipping because the review of the results and test order is included when ordered. Aside from the results, going over a treatment plan could be a billable event. Truly depends on what you are using this visit for. I have added an AMA sheet that will help with the different scenarios.
- Please let me know your thoughts
- Ordering a test is included in the category of test result(s) and the review of the test result is part of the encounter and not a subsequent encounter.”
And, from the CPT Assistant, (AMA publication) November, 2020, page 5: “It is assumed that the physician or other QHP would review the results of the test ordered; therefore, the physician or other QHP would not receive dual credit toward MDM for service-level selection for both ordering and reviewing the test.” - Hi, a question please. Thank so much.
- For Robotic assisted retroperitoneal lymph node dissection, Lap Resection of right gonadal vein/Spermatic cord stump.
- I coded Robotic assisted retroperitoneal lymph node dissection with 38589 (benchmarked to 38780),
- but I have a question for Lap Resection of right gonadal vein/Spermatic cord stump,
- Should these be coded with two CPT codes: One to capture right gonadal vein resection and another one to capture Spermatic cord stump? VS these two are on the same location and should only be coded with one CPT code? Thank you!
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PRS Billing and Other Services - Book a Call with Mark Painter or
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
June 7, 2024
Mark and Scott discuss FAQs that came into the PRS communities.
- Are you obligated to bill the new Category 3 CPT code for penile shockwave therapy, which we currently provide as a cash service? Specifically, do we have to use the Category 3 code when billing Medicare patients, even though there is no payment associated with it, and can we continue collecting cash without making it a Medicare billable service?
- Is cystoscopy a moderate risk (level 4) procedure for medical decision making purposes absent other risk factors? Does it matter for MDM risk what discussion or thought process is documented? Or would that only be toward the medical necessity of the procedure?
- CPT code 55250 says it is including postoperative semen examinations. So far we have done these in house but my physicians would like to no longer perform those and are currently looking into purchasing FELLOW kits to sell to the patients. We do not have any labs in town that perform post vas semen analysis. Any advice on what to do when patients refuse to purchase the kit?
- If Trimix is a compounded drug wouldn't J7999 - Compounded drug, not otherwise classified be more appropriate to vs J3490?
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
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Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
May 31, 2024
Mark and Scott welcome Marianne Desciose to discuss what are the biggest issues right now in RCM.
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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Special Early Bird code: 25UACRS732
Click Here for Information and Registration
Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
May 24, 2024
Mark, Ray, and Scott welcome Dr. Una Lee and Dr. John Lin to share their thoughts about their AUA IBL presentation "The Business of Urology – What I have Learned on How to be Clinically Productive"
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PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars
Register Now for the Urology Advanced Coding and Reimbursement Seminar
Special Early Bird code: 25UACRS732
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Event Details
Location:
Las Vegas: December 6-7, 2024, at Horseshoe
New Orleans: January 31-February 1, 2025, at Harrah's
Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm
Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
May 17, 2024
Mark, Ray, and Scott discuss FAQs that came into the PRS Network Community.
- Are there payers not paying for 99459?
- Hello, the max units for J2704 is 80. I have searched and searched and can't figure out how to bill additional units if more than 80 units is administered. I have tried modifier 59 and my claim was still denied. Any help would be greatly appreciated.
- Can we bill 13 units for 87798 for UTI PCR and Rectal swab PCR?
Would charging 87801 be better for rectal swab PCR? VS 87798
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PRS Billing and Other Services
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
May 10, 2024
Mark and Scott discuss FAQs that came into the Urology Coding and Reimbursement Group.
- MRI fusion biopsy update
- Hi,
- Can you please help us with the below questions.
-
- Pessary Insertion – does it require a physician to be onsite? What about Pessary cleaning?
- Urodynamics – we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?
- Biofeedback - we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?
- Hi, a question regarding NCCI edit pls. When unbundling is not allowed between two CPT, due to an indicator "0", never billed together. If the secondary CPT has more work-RVU than primary CPT, i.e. 51705 (primary) wRVU 0.9; and 52000 (secondary) wRVU 1.53, Are there any rules that we must bill Primary 51705? VS Can we choose to bill 52000 instead, knowing that 52000 has more wRVU than 51705? Thank you,
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PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
April 26, 2024
Ray, Mark, and Scott discuss the upcoming AUA Annual meeting in San Antonio and what PRS plans to do there.
New Courses Available for Urologists and Urology APPs
Documentation for Reimbursement Challenge for Urologists
Use Special Discount Code:DRC5624 and Save 36%
Documentation for Coding and Reimbursement for APPs
Use Special Discount Code: DCRA5624 and Save 36%
Certification for Urology Coders
Documentation, Coding, and Billing Certification Course for Urology Coders
Use Special Discount Code: DCBSC5624 and Save 36%
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
April 19, 2024
Ray, Mark, and Scott discuss the nuances of communicating with payers and clearinghouses during the post-operative global period.
New Courses Available for Urologists and Urology APPs
Documentation for Reimbursement Challenge for Urologists
Use Special Discount Code:DRC5624 and Save 36%
Documentation for Coding and Reimbursement for APPs
Use Special Discount Code: DCRA5624 and Save 36%
Certification for Urology Coders
Documentation, Coding, and Billing Certification Course for Urology Coders
Use Special Discount Code: DCBSC5624 and Save 36%
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
April 12, 2024
Mark and Scott discuss questions that have come into the PRS communities:
- Hi is there any documentation, regarding the age limit for G2211 or 99459?
Our MD think that they only apply to patients over 65 years old. Is this true or is there documentation stating we can use them on patients under 65 years old. 2. If a patient fails a Trial of void, and a catheter is placed, would the 51700 be coded or just 51702? Should it matter if pass its fail? The service was still performed. And the 51702 is a component of the 51700. 3. What are the codes that I use for gemcitibine bladder installation in the office. I know I would use 51720 would be the cpt code but how do i bill for the medicine? 4. For Scrotoplasty, complicated (CPT 55180), Does it need to be performed with either Graft of Flap, to call for "complicated"? I am trying to differentiate between 55175 (scrotoplasty, simple) and 55180 (scrotoplasty, complicated), thank you!
New Courses Available for Urologists and Urology APPs
Documentation for Reimbursement Challenge for Urologists
Use Special Discount Code:DRC5624 and Save 36%
Documentation for Coding and Reimbursement for APPs
Use Special Discount Code: DCRA5624 and Save 36%
Certification for Urology Coders
Documentation, Coding, and Billing Certification Course for Urology Coders
Use Special Discount Code: DCBSC5624 and Save 36%
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
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April 5, 2024
Mark, Scott, and Ray discuss why PRS developed two new courses, one for Urologists and one for APPs
These courses aim to tackle the challenges practices face with documentation for reimbursement and efficient use of Electronic Health Records (EHR), emphasizing the importance of a unified team approach to stay updated on coding, billing, and documentation. They also discuss the critical role of Advanced Practice Providers (APPs) in urology, their billing nuances, and the necessity of continuous education to ensure financial health and combat provider burnout. The discussion wraps up with insights into the evolving landscape of medical coding and billing, stressing on AI's role in audits and the need for precise documentation. Links to further details about the courses can be found below.
New Courses Available
Documentation for Reimbursement Challenge for Urologists
Use Special Discount Code: DRC5624 and Save 36% (ends 5/6/24)
Documentation for Coding and Reimbursement for APPs
Use Special Discount Code: DCRA5624 and Save 36% (ends 5/6/24)
Certification for Urology Coders
Documentation, Coding, and Billing Certification Course for Urology Coders
Use Special Discount Code: DCBSC5624 and Save 36% (ends 5/6/24)
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
March 28, 2024
Mark, Scott, and Ray welcome Dr. David J. Ellis to discuss the evolution of urology practice, leadership strategies, the role of organizations like LUGPA, AUA, and AACU, and the importance of communication and education in the field.
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
March 22, 2024
Mark, Scott, and Ray discuss the Change Health cyberattack, G2211 developments and questions that came into the PRS Network.
- We have been receiving denials for our Urodynamics appointments because authorization was obtained under a provider that differs from the provider that signed off on the note day of services. For non-medicare plans (and plans that do not adhere to 100% of medicare guidelines) are we able to have a provider that is not on-site at the time of the UDS appointment sign off on the note?
- We are a multi-specialty practice that all share one TIN. If we send an established patient to be seen by a provider that practices under a different taxonomy, can this provider then bill under a new patient encounter? For example, Urology refered to Urogynecology or if Oncology referred to Urology? Additionally, can these pts be seen by differing specialties, at different office locations on the same day?
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
March 15, 2024
Mark, Scott, and Ray discuss questions that came into the PRS Network.
- Hello,
What is the recommendation on documentation for new code 99459? Our practice is wanting to create a template for this procedure code. I know documenting a chaperon is key. Thank you - Hello,
I need help.
I am having issues with multiple insurance companies denying diagnosis code N30.10 stating it is an invalid code. Anyone else experiencing this issue? Any indication on what the issue is?
I looked in the ICD10 code book and it states it is a billable code.
Thank you - Hi I have a coding question for peds urology.
Can CPT 51701 be used for a urine capture for UAs? Since this is peds our payor mix does not include medicare. I was under the impression that for commerical payors 51701 cannot be used for urine capture and that it would bundle into the E/M service.
Also, shouldn't we be able to code 81001-81003 for the UA? The provider is only coding an E/M service with 51701.
Thanks!
PRS Billing and Other Services
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
March 8, 2024
Mark, Scott, and Ray discuss questions that came into the PRS Network.
- Hello all, I have a CPT coding question,
- Indications = Urinary Obstruction // Post-Op DX = Obstruction of neck of Urinary Bladder
- Resectoscope per urethra into the bladder under direct vision. There was moderate trabeculations with no evidence of mass or stones. The bladder neck was noted to be elevated as seen on prior clinic cystoscopy. This was causing obstruction of the bladder outlet without significant prostatic hypertrophy.
- The bipolar resectoscope was used with the plasma button attachment to perform a TUIP at 5 o'clock, vaporizing the bladder neck fibers until the bladder neck was able to open properly and drain appropriately. Electrocautery was used for any small bleeding vessels and hemostasis was adequate at the end of the procedure.
- The recommended Code is: 52450, but the Coder is recommending Code: 52500.
- We're also taking Codes: 52276 & 52214 into consideration.... Please advise on what you recommend with the Rationale. Any assistance is greatly appreciated.
- I completed a tapered ureteral reimplant 50783 on the left and a standard Non tapered ureteral reimplant on the right 50780 - does adding LT and RT modifiers allow both codes to be billed as follows:
50783 LT
50780.51.RT
does adding R /L mods address the bundling issue?
Coders noting that 50783 includes 50780 -- however this is 2 different sides and can't bill bilateral tapered 50783.50, as only tapered one side, and bilateral reimplant 50780.50 is undercoded for the additional time and complexity of ureteral tapering 8. Has anyone billed for bladder injection of Lipiodol before? I have a provider who resected a large bladder tumor, then injected Lipidol in and around the resection site to aid with the patient's radiation planning for invasive bladder cancer. I was thinking this may be included in the 52240, but the office is suggesting unlisted code 53899 benchmarked to 52287 or 52283. Thoughts?
Registration is open for the Documentation for Coding and Reimbursement for APPs Course - Starts 3/11/24
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PRS Billing and Other Services
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
March 1, 2024
Hosts Scott, Mark, and Ray discuss the upcoming MIPS submission deadline of April 1st and address common questions about MIPS submissions.
Registration is open for the Documentation for Coding and Reimbursement for APPs Course - Starts 3/11/24
Click Here for Information and to Join
PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
February 23, 2024
Mark, Scott, and Ray discuss questions that came into the PRS Network:
- Regarding the most recent podcast episode on shard/split visits: Medicare's policy states that only one practitioner must have face-to-face time with the patient. In our practice the physician documents an addendum on the APP's note with the medical decision making portion of the visit. Per the episode, the physician must demonstrate involvement during the visit (not afterwards) in order to bill under the physician's NPI. Is there a guideline that states the physician must document their portion in real-time as the visit with the APP takes place? If they document the MDM portion of the visit in its entirety, isn't that enough to bill for the "substantive portion of MDM" as required by Medicare?
- For 52001, we commonly use this code for cysto and clot evacuation for gross hematuria under general anesthesia requiring rigid scope. Are physicians allowed to use this code for cystoscopy and irrigation of a clot with a syringe under local procedure or should they use 52000 + 57000?
- For 52281, does passage of the cystoscopy to dilate a narrowing in the urethra or meatus count? Or it is only meant to be used for cases where the meatus is cut or dilators or DVIU are used?
Join the Documentation for Reimbursement Challenge - Starts 2/26/24
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PRS Billing and Other Services
Click Here to Get More Information and Request a Quote
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
February 16, 2024
Ray and Scott discuss the importance of documentation for reimbursement.
They emphasize the need to communicate effectively through documentation with billers, computers, and AI systems to ensure accurate coding and payment for services provided. They also mention the significance of using the right words in documentation to justify the level of service, multiple procedures, and modifier usage in order to obtain appropriate reimbursement. Additionally, they talk about the upcoming "Documentation for Reimbursement Challenge" that aims to help urologists and APPs improve their documentation skills for maximum reimbursement.
Join the Documentation for Reimbursement Challenge - Starts 2/26/24
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PRS Billing and Other Services
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
February 9, 2024
Ray, Mark, and Scott discuss questions that came in about split or shared Visits.
Our questions are:
When our doctors cover hospital patients, we often have Physician Assistants in the hospital rounding on new and follow up patients. Recently there is an Incident-to policy change, but I don’t think that applies to the hospital PAs since hospital charges cannot be billed incident-to. Regardless, what do you think of the following:
- Are our physicians able to bill for those visits at 100 percent?
- If yes, could they still bill via supervisory role to the PAs (i.e., the PA see the patient and discuss the patient’s case with the on call physician. The physician then formulates a follow up plan and communicate it directly to the PA without physically seeing the patient)? Or do the physicians have to physically see the patient to be able to bill?
- Are physicians able to bill for procedures done by the PAs at the hospital?
Thank you so much for your assistance and guidance on this matter.
G2211 Guidance Document [free download]
Click Here for the Link to Download the Guidance Document
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The Thriving Urology Practice Facebook group.
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Join the discussion:
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Click Here to Start Your Free Trial of AUACodingToday.com
February 2, 2024
Ray, Mark, and Scott answer and discuss the following questions:
- The seminar this past week was great. I have one question that I asked during the seminar but still not sure of the correct answer. For an initial hospital consultation, I have been using 99223 and generally 99232 for follow up visits. Is this correct.
- Seeking clarification for the best way to code:
- Ureteroneocystostomy; anastomosis of single ureter to bladder with vesico-psoas hitch
- --Robotic approach
- is it an unlisted code or 50948? Thank you in advance :)
- I've received several questions recently on whether or not certain procedures can be performed in office by an APP alone (51720, 95972, Eligard/Firmagon injections etc.). Most codes as long as they are not surgical can be performed by an APP since they are a qualified healthcare provider, correct? Not sure where I can find info on this. I did check state statutes but found nothing specific about which procedures. Thanks!
- If a patient comes in for routine SPT change or lupron injection, and provider states return in a week or month for next change or injection, is that enough for a modifier -25 to billed?
- For the 99459 we have a gynurologist she does pelvic exams on almost all her patients unsupervised can we still add this code to her visits? Thank you
G2211 Guidance Document [free download]
Click Here for the Link to Download the Guidance Document
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The Thriving Urology Practice Facebook group.
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January 19, 2024
Scott and Mark discuss the topics of G2211 and code 99459. They clarify some common questions and confusion surrounding these codes, provide guidance on their appropriate use, and share updates on their experience with Medicare, Medicare Advantage plans, and private payers. They also talk about code 99459 and the importance of documenting the presence or absence of a chaperone during a female pelvic exam.
G2211 Guidance Document [free download]
Click Here for the Link to Download the Guidance Document
___
The Thriving Urology Practice Facebook group.
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Join the discussion:
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January 12, 2024
Scott and Dr. Ray Painter discuss the top issues impacting urologists and their practices.
G2211 Guidance Document [free download]
Click Here for the Link to Download the Guidance Document
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
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January 5, 2024
Mark, Scott, and Dr. Ray Painter discuss the new G2211 code. How it should be used, examples, provide scenarios, and share questions about using the code.
G2211 Guidance Document
Click Here to get free Download Link (available January 8th, 2024)
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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December 29, 2023
Mark, Scott, and Dr. Lin discuss topics from the Thriving Urology Practice Facebook Group:
- There is still no CPT code for extricating the penis from a foreign body, right?
Guy used a 2.5 pound weight plate as a penis ring. Took an ortho saw to remove it.
Medtronic Midas Rex handheld device with a circular Diamond bit saw was used to cut the plate at 3 and
9 o’clock positions. 2 separate Medtronic Midas Rex devices had to be used due to heat generation.
Complete transection of the plate was performed. Penis was protected from the heat and the blade to
effect a successful extrication. - How do we bridge the gap between those urologists and APPs who are practicing
happily and getting paid for everything they do, not spinning their wheels, not burning
out, vs. those who continue to suffer?
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More Information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
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December 22, 2023
Mark, Ray, and Scott answer questions from the PRS Urology Coding Community:
- I have multiple providers who want to bill 55867 & 51860 for the same procedure. While there’s isn’t an NCCI Edit for these codes, you can see that the procedure description includes both the making of an incision in the bladder wall and then later the suture repair. Coding guidelines dictate that since you could not perform the main surgical procedure without the minor one, then the minor is bundled into the major. As a coder I don't feel that there is support for separate reimbursement when the two codes are routinely billed together. Their contention is that there are 2 ways to do a simple prostatectomy. The first is through the capsule of the prostate gland without a bladder incision. The simple prostatectomy code has traditionally encompassed the first way of not making a bladder incision and if an incision was made then a cystorrhaphy was billed. With the addition of the new code specifically for the simple prostatectomy, I would like some direction on how these codes should be billed.
- Have you been able to lookup what the reimbursement will be for the new CPT code 99459 for female pelvic exam?
- Can 51741 and/or 51798 be billed twice on the same day?
For example, if a patient does the first urofow and the volume is not adequate and then we have him drink and come back later for a second uroflow. - When billing 51700 for voiding trial post-op after prostatectomy (90 day global), is a modifier needed ? Such as modifier 58
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 15, 2023
Mark, Ray, and Scott welcome Dr. Richard Pelman to discuss the importance of State Urology Societies and why you should participate.
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 8, 2023
Mark, Ray, and Scott welcome Dr. John Lin to discuss the 2024 Urology Coding and Reimbursement Seminar and share their thoughts about the 2024 Urology Coding and Reimbursement Seminar in Las Vegas, on December 1st and 2nd, 2023.
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More Information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 1, 2023
Mark, Ray, and Scott welcome Dr. Jonathan Rubenstein to discuss the big CMS changes for urology in 2024 and how to implement them.
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
November 22, 2023
Mark, Ray, and Scott discuss Part B drugs and how a practice can compare clinically similar drugs.
Telehealth Resource Centers
https://telehealthresourcecenter.org/
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
Mark Painter and PRS Consulting
Schedule a call with Mark Painter or Larry Kemp / PRS Consulting
November 17, 2023
Mark, Ray, and Scott have a conversation with Dr. Finkelstein about Telehealth in Urology.
Dr. Finkelstein's expertise illuminates key considerations for urologists seeking to harness the potential of telemedicine, offering a roadmap for successful implementation. This episode equips listeners with invaluable knowledge to navigate and leverage telehealth for enhanced patient outcomes and practice efficiency in urology.
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
Mark Painter and PRS Consulting
Schedule a call with Mark Painter or Larry Kemp / PRS Consulting
November 10, 2023
Mark presents the summary of the newly released CMS 2024 Final Rule.
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More Information and Registration)
Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
Mark Painter and PRS Consulting
Schedule a call with Mark Painter or Larry Kemp / PRS Consulting
November 3, 2023
Mark and Scott welcome back Larry Kemp, FACHE to continue the discussion on Integrated Practice Wide RCM.
Mark Painter and PRS Consulting
Schedule a call with Mark Painter or Larry Kemp / PRS Consulting
Urology Documentation, Coding, and Billing Certification
For Urologists and APPs
(Click Here for Pricing, More Information, and Registration)
Documentation, Coding, and Billing Fellowship - Urology (DCB-FS)
For Coders, Billers, and Admins
(Click Here for Pricing, More Information, and Registration)
Documentation, Coding, and Billing Specialist Certification (DCB-SC)
Documentation, Coding, and Billing Master Certification (DCB-MC)
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
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Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
October 27, 2023
Mark and Scott welcome back John Lin to answer more questions that have come into the Thriving Urology Practice Facebook Group.
- Can I bill for a modifier- 25 if the E&M service was provided in the procedure room where the patient had a cystoscopy?
- BCBS is not paying N52.9 for office visit E&M. What is the replacement code?
Mark Painter and PRS Consulting
Schedule a call with Mark Painter / PRS Consulting
Urology Documentation, Coding, and Billing Certification
For Urologists and APPs
(Click Here for Pricing, More Information, and Registration)
Documentation, Coding, and Billing Fellowship - Urology (DCB-FS)
For Coders, Billers, and Admins
(Click Here for Pricing, More Information, and Registration)
Documentation, Coding, and Billing Specialist Certification (DCB-SC)
Documentation, Coding, and Billing Master Certification (DCB-MC)
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
October 20, 2023
Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group.
- I am a solo urologist newly working with a P.A. that I hired. What is the modifier for billing "incident to" or what is the mechanism for billing "incident to?" thank you
- This is in regards to Optilume, cat III code 0499T. I know there will be a cat I code of 52284 that will take effect 1/1/2024, so we sent one claim in with the cat III code of 0499T. Medicare denied it and the claim adjustment code given was PR-173. Balance is the patient's responsibility due to the fact that 'service/equipment was not prescribed by a physician". Does this mean we need to write a script for the drug on the balloon?? It just doesn't make sense to me.........
Mark Painter and PRS Consulting
Schedule a call with Mark Painter / PRS Consulting
Urology Documentation, Coding, and Billing Certification
For Urologists and APPs
(Click Here for Pricing, More Information, and Registration)
Documentation, Coding, and Billing Fellowship - Urology (DCB-FS)
For Coders, Billers, and Admins
(Click Here for Pricing, More Information, and Registration)
Documentation, Coding, and Billing Specialist Certification (DCB-SC)
Documentation, Coding, and Billing Master Certification (DCB-MC)
Urology Advanced Coding and Reimbursement Seminar
(Click Here for More information and Registration)
Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
Reserve your spot and save!
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
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October 13, 2023
Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group.
- Are injections like Lupron and Prolia and the administration given by an advanced practice provider subject to the 85% reimbursement or are these reimbursed at 100% even if given by a nurse practitioner?
- Are 11006 and 97606 appropriate here for wound vac?
OPERATION: Debridement of Fournier's gangrene.
DRAINS: Wound VAC, 16-French Foley catheter.
OPERATIVE TECHNIQUE: The patient was brought into the operating room, placed in supine position on the operating room table. After administration of IV antibiotics and anesthesia, the patient was repositioned in dorsal lithotomy position, prepped and draped in the usual sterile fashion. The wound measured approximately 30 cm x 14 cm and went from the left inguinal region through the left perineum and to the posterior left buttocks. Using a curettage, we proceeded with additional debridement of all the raw surfaces. Spot electrocautery was used as needed for hemostasis and the wound was irrigated copiously with antibiotic irrigation. The sharp debridement was done to the level of the dartos fascia and Colles fascia. Once we had finished the sharp debridement, we went ahead and decided to place a wound VAC. A black sponge was placed into the wound and then carefully placed using the sticky plastic and put it to suction. Given the location, it was a bit challenging but we were able to place the wound VAC to suction. Given that the wound extended near the posterior buttocks, it was near the anus which would likely be an issue for maintaining suction if the patient had a bowel movement. The patient tolerated the procedure well.
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October 6, 2023
Ray, Mark, and Scott discuss important topics from recently attended national and regional Urology meetings.
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September 29, 2023
Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:
- I'm trying to verify the correct CPT code for insertion of an Estring to treat vaginal chagnes in menopause. AAPC has two different answers, but they are almost 20 years apart! I'm looking at CPT 57160 and 57170. 57160 is insertion of pessary OR other intravaginal support device. 57170 is diaphragm or cervical cap fitting with instruction. In the AAPC post that is most recent (9/10/21) they said to use 57170 for the Estring. If 57170 is mostly to prevent pregnancy, I can't see how this would be appropriate for a woman in menopause.
- Hello. I have a question regarding trimix billing. I know that there is not a HCPCS code since it is a compound drug. From my own research i have found conflicting information with some saying to bill each drug separately and others to bill unlisted J3490. In your opinion, what is the best practice for coding Trimix? Thank you!
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September 22, 2023
Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:
- We are looking to hire a certified coder. We are open to the position being remote if the candidate has urology experience. If you know anyone interested, please send them my way. Also, feel free to email me your resume or if you have any questions.
- Patient has a nurse visit for removal of a foley catheter that was placed during a procedure with a 00-day global (i.e TURBT). Visit was 2 days after surgery. Documentation by nurse states; Pt in for foley cath removal. 10 ml sterile water removed from balloon, balloon deflated, foley cath removed. Pt tolerated well. Should we be billing a 99211 nurse visit, a 51700 for bladder irrigation or considered part of the surgical package and would not be billable?
- My question is what if I use a modifier that Coding Today indicates a modifier is required, and the insurance company still denies the second procedure with the modifer as included in the primary procedure, such as CPT's 52332 and 52005-59. Is this appealable?
- To clarify the Assistant Surgeon, is this is completely separate from a pre op consult to place stents for ureteral identification or an intraop consult for cystoacopy or foley placement or to repair a bladder injury?
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September 15, 2023
Ray, Mark, and Scott discuss what Targeted Probe and Educate (TPE) and Recovery Audit Contractor (RAC) Audits are and how they are different.
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September 8, 2023
Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:
- We use shared visits to facilitate our inpatient consultations. Typically our APP will perform history and exam, and the physician will perform the elements of the MDM. Our coders are having a controversy as to if this is acceptable for using FS modifier stating shared visits have to be based on time and feel should be billed as the APP doing the substantive work. Our understanding is that those changes (time based only) were delayed until 2024, so for remaining 2023 the physician can continue to be the billing provider as long as we are doing the MDM element as the “substantive portion.”
Any further clarification available?
(Also In that scenario, would it be conceivable to be the billing provider even in the absence face to fave encounter if the elements of MDM are met. Thoughts?) - Does anyone know where to find "Procedure to Provider" edits? We have a PCR lab in Illinois and two of the billed codes are being denied with CO B7 reason code. This reason code indicates the provider is not eligible for
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September 1, 2023
Ray, Mark, and Scott welcome special guest Dr. Eric Tygenhof to talk about his experience switching to and using ModMed in his practice.
Dr. Eric Tygenhof is a partner in Southland Urology a 3 Urolgist group. Eric is also the urology team lead at Modmed.
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August 25, 2023
Ray, Mark, and Scott discuss the 2024 Urology Advanced Coding and Reimbursement Seminar Agenda. What topics were chosen and why they were chosen.
AGENDA
DAY 1
- Optimizing Urolgy E/&M Coding
- Exploring Urology Revenue Opportunities
- Unlocking Urology Telehealth Success
- Elevating Urology Front Office Efficiency
- Urology AR Follow-Up and Appeals Strategies
- Breakout Session A1 - Bridging the Gap
- Breakout Session A2 - Navigating Urologist Compensation and Practice Options
DAY 2
- Annual Update - Urology Coding and Reimbursement
- Mastering Modifiers and the Global Package
- Journey of a Urologist
- Ensuring Urology Coding Compliance
- Urology Coding Workshop
- Urology ICD-10 Coding
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Urology Advanced Coding and Reimbursement Seminar
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Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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August 18, 2023
Ray, Mark, and Scott discuss 3 questions that came into the Urology Coding and Reimbursement Group (see below for link to sign up free):
- Hello, I still need more clarification on billing CPT 52332 and CPT 52005 if in the description states that retrograde pyelogram was used/performed. Its correct to bill for both codes?
- Hello, I have a question regarding CPT code 99457 & 99458. I have a provider who is working with Starling pilot and wanted to start billing these codes. Can you please advise what are the guidelines for these codes? Thank you so much!
- Hello, I have a question regarding urodynamics. I have a new provider selecting code 51729 but when reviewing his documentation I do not see an urethral pressure profile study. What should the documentation include to capture this code? Are there certain values we should be looking for?
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Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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August 11, 2023
Ray, Mark, and Scott discuss 2 questions that came into the Urology Coding and Reimbursement Group (see below for a link to sign up free):
- Good Evening
Our office is looking into Chronic Care Management. We know that CCM requires the patient to have 2 chronic conditions. Most of these patients have prostate cancer and diabetes, and or hypertension. Which brings me to my question our providers will be treating and managing the cancer but as for as the diabetes goes they are not treating this or managing it in any way. Would we still be able to use this in out CCM billing? - Hi, What CPT code set would you bill for Excision Scrotal Lesion(s)? (Path Report: Benign). Would you code with 11420-11426 or 11106-11107 or 54060 or something else? NOTE DETAILS: FINDING(s): Numerous scattered superficial skin lesions, In total 20cm skin removed. "We began by marking out the areas of concern with elliptical incisions. There were numerous lesions but they were spread out enough that we decided to do multiple separate incisions. After the lesions were marked the skin was anesthetized with 0.5% Macaine. Incisions were made sharply along the previous marked ellipse. The skin was then carefully dissected sharply from of the underlying dartos tissue. Hemostasis was achieved with bipolar cautery. This was repeated for all lesions."
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Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).
Use code: 24UACRS733
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August 4, 2023
Ray, Mark, and Scott discuss 3 questions that came into the Urology Coding and Reimbursement Group (see below for link to sign up free).
- Thank you for your recent podcast 147 with attention to updated Urocuff billing. The recent change from our MAC NGS was helpful as this went into effect June 1, 2023 and they are now recommending billing 55899 as opposed to 51728-52. My question specifically relates to how to bill Medicare Advantage plans. Do we follow the private payor rules that manage the plan or the MAC recommendation. For example, commercial payor A prefers the urocuff claim submitted as 51728-52. If the Medicare advantage plan is administered through commercial payor A and we still have to follow their rules regarding prior authorization, utilization of specialty pharmacy for Botox rather than buy/bill for traditional Medicare, etc... It would seem that the urocuff in this case should be billed how we would bill the private payor using 51728-52 vs 55899. Any insight on this would be appreciated.
- I am new to urology coding and Medicare rules. We have had a couple of patients admitted to the hospital during a surgical global period. These admissions are not related to the surgery. I coded the e/m code with a 24 modifier, but they were denied. Any help would be appreciated on how to get these claims to process.
- if our urologists, in the hospital setting, perform a procedure (ex. Ureteroscopy) and also they themselves administer the moderate sedation, are there additional CPT codes they can bill for? If so, what are those codes? the cpt book in the anesthesia guidelines seem to indicate that perhaps cpt codes 99151 99152 99153 may be coded to show this? thank you
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As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).
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July 28, 2023
Ray, Mark, and Scott discuss staff shortages. Mark shares insights on some of the things you can do to address the issue.
Urology Documentation, Coding, and Billing Certification
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Documentation, Coding, and Billing Fellowship - Urology (DCB-FS)
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Urology Advanced Coding and Reimbursement Seminar
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As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).
Use code: 24UACRS733
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July 21, 2023
Ray and Scott welcome special guest Marianne Desciose, Director of Operations for PRS Managed Services, LLC., to discuss Prior Authorizations and Prior Authorization Denials.
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Documentation, Coding, and Billing Specialist Certification (DCB-SC)
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Urology Advanced Coding and Reimbursement Seminar
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Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).
Use code: 24UACRS733
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July 14, 2023
Mark, Ray, and Scott discuss the newly released 2024 CMS Proposed Rules. Mark provides a preliminary analysis of what changes are important to urology.
Urology Documentation, Coding, and Billing Certification
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Documentation, Coding, and Billing Fellowship - Urology (DCB-FS)
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Urology Advanced Coding and Reimbursement Seminar
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Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
New Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).
Use code: 24UACRS733
Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.
The Thriving Urology Practice Facebook group.
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July 7, 2023
Mark, Ray, and Scott discuss the problem section of E/M medical decision making. The following question was asked that sparked this discussion:
Undiagnosed new problem with uncertain prognosis: When does a problem go from being new to chronic? For example, patient has an elevated PSA at their new patient appointment (new problem), some tests are ordered, then they follow up in one month. Could we use "undiagnosed new problem" again since we are still trying to diagnose and figure out what's going on? Or is it no longer a new problem because we have seen the patient before?
Inspired
Comment
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The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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June 30, 2023
Mark, Ray, and Scott welcome back John Lin to answer more questions that have come into the Thriving Urology Practice Facebook Group.
- My billers are now getting a sh*t ton of denials of 99214 billed with modifier 25. Our documentation is correct. We have sent in OV notes and appealed and the insurance companies still deny. Most of the denials are coming from Anthem but some from Cigna.
We are taking it to the next level of appeals and involving the "patient advocate" for the insurer, but I'm not sure what else to do.
This is maddening and I'm sure they're just hoping we give up, but I KNOW (because of John C Lin) that they need to pay me for these appropriately coded E&Ms!!
Anyone else seeing this? What else can be done?
2. 52332
52235 51
It was denied for unbundling.
NCCI Edits show that this can be billed with a modifier.
My CPT shows that we can bill 52332 with another procedure with Modifier 51
52332 was done due to tumors overlying area of left ureteral orifice.
Has anyone else had trouble billing these two codes together.
Payer: Centene Ambetter, a Marketplace plan that pays better than Medicare.
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Urology Advanced Coding and Reimbursement Seminar
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Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.
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June 23, 2023
Mark, Ray, and Scott welcome back Larry Kemp, FACHE to continue the discussion on Integrated Practice Wide RCM. In part 2 of this 4-part series, Larry shares information about Point of Service Actions.
Key Points of Action:
- Sustaining practice RCM metrics.
- Understanding basic billing and collections actions
- Implementing performance improvement change – Theory versus effective application
- Often practices are missing far too much uncollected reimbursements. Why? Due to poor business practices that cause RCM leaks. These are preventable.
- Every missed pre-authorization call, uncollected deductible, and overlooked filing deadline cost the practice money.
- Losses are not sustainable in today’s business of tight operating margins.
- Uncollected reimbursements due to leaks in RCM processes are preventable
- Every missed pre-authorization, uncollected deductible, eligibility verification, and overlooked filing deadline is lost revenue.
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Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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June 16, 2023
Mark, Ray, and Scott discuss questions that came up during a May monthly training webinar: Coding for prostatic artery embolization (PAE); Urocuff payment coverage, reports of diagnosis denials
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June 9, 2023
Mark, Ray, and Scott welcome back Dr. John Lin to discuss 2 questions that came into the Thriving Urology Practice Facebook Group [click to join].
- What codes should we be using for MRI fusion biopsy of the prostate? Is it all the TRUS biopsy codes (76872, 76942, 55700, 64450 A4512) with no additional?
- Medicare denied a claim stating patient died 03/02/23. Actual date of death was 03/23/23, so this was obviously a data entry error. Any ideas how to correct? My biller says Medicare only accepts edits from patients, but that is unlikely to happen in this case (and if it does getting paid for the claim is the least of my worries).
Urology Documentation, Coding, and Billing Certification
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Documentation, Coding, and Billing Master Certification (DCB-MC)
Registration Now Open: Urology Advanced Coding and Reimbursement Seminar
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Las Vegas, December 1&2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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June 2, 2023
Mark, Ray, and Scott discuss coding for 2 E/M services on the same date/patient; coding for services provided to a patient from an SNF in the office.
This question originated from a comment on the Thriving Urology Practice Facebook Group [click to join]:
Jonathan Starkman
Thanks for posting John C Lin I would love to see how a commercial payor like UHC or Cigna would process 2 E/M claims on same day using a 25 modifier as in the first scenario presented...I'd bet a ton of money it would get denied, denied, denied I just wanted to comment on the last scenario which involved a cardiologist seeing a patient from a SNF in their office. The experts suggested using a code 99214. We have had a number of denials in this situation and it seems that because a patient is in a SNF or acute rehab facility they are still considered a "registered inpatient" and according to CMS would need to use inpatient CPT codes to bill for the encounter in your office. My administrator pulled this off our MAC website Outpatient Services for Registered Inpatients
There are occasional circumstances in which a registered inpatient may require a service that is not available at the inpatient facility. These inpatient facilities include acute-care hospitals (POS 21), skilled nursing facilities (POS 31), psychiatric inpatient facilities (POS 51) and comprehensive inpatient rehabilitation facilities (POS 61) as well as other types of hospitals represented by place of service (POS) code 21 unless there is a more specific POS code. Such outpatient services are performed on a same-day basis; the patient is transported to another facility or physician’s office and returned to the original facility on the same date of service.
When such services occur, the following rules apply:
For Part A services (nonphysician outpatient services) performed outside of the facility at which the patient is a registered inpatient:
The facility which provides a Part A service must seek compensation from the original facility at which the patient is a registered inpatient. That original facility is responsible for the cost of the service(s) performed at the outside facility and will make payment from Medicare’s reimbursement for the inpatient stay.
The original facility includes the nonphysician outpatient services on its inpatient claim. This is commonly referred to as under arrangement billing.
Examples of services that may be performed under these circumstances (generally referred to as “under arrangement”) include outpatient dialysis, radiation therapy, and diagnostic procedures such as MRI.
For Part B services at a physician’s office, performed outside of the facility at which the patient is a registered inpatient:
The physician’s office service must be billed with the POS code that reflects the inpatient facility at which the patient is a registered inpatient (i.e., POS codes 21, 31, 51 or 61 as described above).
The physician’s office service must be coded using a CPT code correlative to the POS code used on the claim. For example, an office service for a new patient would be represented by an inpatient CPT code in the range of 99221‒99223, while an office service for an established patient would be represented by an inpatient CPT code in the range of 99231‒99233.
The important factor here is that the POS code must correlate to the CPT code. Claim editing is set to allow a subset of CPT codes per POS and claims will deny when this correlation is not established on the claims. Such denials, of course, are subject to appeal. Would love to get your take on this or Mark Painter
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May 26, 2023
Mark, Ray, and Scott discuss 4 questions that came into the Urology Coding and Reimbursement Group.
- I'm trying to understand the Multiple Procedure Payment Reduction (MPPR) rules for OPPS/ASC payments for endoscopic procedures. Do I use the standard 100%/50%/50% discounting rules for OPPS/ASC payments, or do I use the special rules that apply to the professional fees for endoscopic procedures?
- InterStim Procedure Discontinued:
Pt had an attempted Insertion of Interstim Procedure Stage 1 (INSERTION PERCUTANEOUS STIMULATOR ELECTRODE). However, procedure was stopped because surgeon was unable to visualize the sacrum completely. He did try and pass a needle in the area where the S3 foramen should have been but that was unsuccessful. Procedure was stopped and all needles were removed.
Medicaid is denying 64561/53 stating they want the anatomical modifier, however I am unable to determine from the op notes what side he planned on placing the electrodes.
After reviewing this I am now wondering if 64561/53 would even be correct since he did not truly start the procedure.
I would love to know your thoughts on this.
3. No Surprises Act question:
Do we have to provide a good faith estimate for the new patient visit too? Or just for higher dollar services like surgery?
So if a self-pay new patient comes in and there is no surgery or any other services needed just the new patient visit. Do we need to provide this patient with a good faith estimate for the visit?
4. Hi,
When ureteral surgery (pyeloplasty, ureteroureterostomy, etc) is performed and a stent is placed at the end of surgery to promote healing is it separately billable (52332)? or is this an inherent part of the surgery on the ureter?
I have conflicting resources but the most recent (2018) states it is not separately billed if placed in the same ureter to promote healing. And if it was placed in the opposite ureter, for example for hydronephrosis, this might be a billable service? Thank you!
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May 19, 2023
Mark, Ray, and Scott talk about a question Dr. John Lin asked on a recent Noridian Mac Call about billing a Modifier -78 with POS 11 (hear the recording on the Thriving Urology Facebook Group). Also, they answer 3 questions that came into the Urology Coding and Reimbursement Group.
- Robot-assisted Laparoscopic Evaluation of LEFT Distal Ureter:
- How would you code this? dr put 50949.
- Hello,
- We have a question for your regarding ADT injections/visits for:
- Eligard injection- HCPCS: J9217
Camcevi injection-HCPCS: J1952 - We have recently hired an experienced NP to launch an Advanced Prostate Clinic. For our pts on ADT therapy, can they be seen by our NP and bill a level 3 or 4 office visit as she will be discussing bone health, sexual health, and incontinence issues?
- What are other clinics doing nationwide for this type of visit and what is appropriate/recommended? Please let me know if there is any additional information I can provide.
- I really enjoy your webinars, thank you so much for providing this service!
- [To clarify, this would be for an E/M and therapeutic injection (ADT) in the same visit? ]
- Thank you,
- Riley
- Is there a cpt code for removal of a urethral stone using forceps, no cysto involved? Every code I see is for cysto with removal. Can we bill a 52310 with a modifier 52 for reduced services? Or should we use unlisted code 53899?
Thank you!
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May 5, 2023
Mark, Ray, and Scott share some general observations from last week's 2023 AUA Annual Meeting in Chicago and Mark gives a quick update on the implications of the PHE ending.
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April 28, 2023
Mark, Ray, and Scott talk about coding for urology drug installation. They use coding for Jelmyto, Mitomycin, BCG as examples.
Jelmyto Billing and Coding Guide
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April 21, 2023
Mark, Ray, and Scott talk about Reimbursement for New technology. With the 2023 AUA Annual meeting in Chicago coming up they thought it would be a good time to discuss this topic. Companies often use the AUA meeting to introduce new medical devices, new drugs, and other new medical technology.
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Las Vegas, December 1&2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday
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April 14, 2023
Mark, Ray, and Scott revisit coding for Optilume and provide an update, and also discuss two questions about robotic prostatectomy coding.
- Can you share your thoughts on billing 51990 & 55866? I saw your post in 2018 however wanted to see if you have the same stance in regards to not billing 51990 when performed without incontinence.
- When coding a robotic radical prostatectomy with BPLND- 55866 states it includes use of robot so S2900 should not be billed but since 38571 is done as well does that support reporting the S2900?
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April 7, 2023
Larry Kemp joins Mark, Ray, and Scott as a special guest to delve into Integrated Practice Wide RCM in this first part of a two-part series. In the episode, Larry offers his expert insights on what you need to do to make your Pre-service Work effective and efficient.
Schedule a Call with Mark and/or Larry
Click the link to select the date and time below:
https://calendly.com/prsnetwork/call-prsnetwork-consulting?month=2023-04
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Available March 31, 2023
Mark, Ray, and Scott discuss FAQs:
- What codes should we capture for OPTILUME? 52276 w/0499T? Or should we be looking at something else?
- For an antegrade ureteroscopy done via an established nephrostomy- would you recommend coding 50951 or an unlisted 53899?
- When coding for torsion, is the proper coding of px captured with cpt code 54600, if torsion is repaired? Laterality modifier would be appropriate if the torsion is unilateral, ie: LT or RT. Correct? If the torsion is bilateral, modifier 50 would be appropriate? After discussing with my co-workers regarding Orchiopexy 54640 versus 54600, we were a bit unsure of the term within the procedure description: Reduction of torsion of testis, surgical, ""with or without fixation of contralateral testis"". What is the correct interpretation of fixation of the contralateral side?
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March 24, 2023
Mark, Ray, and Scott discuss FAQs:
- Would you consider interposition of peritoneal flaps separately billable with a Prostatectomy/lymphadenectomy? “The peritoneum at the dome of the bladder was folded over itself and anchored to the front sides of the bladder”. There is no guidance out there that I can find for coding, other than studies that show it is more of a prophylactic procedure to prevent lymphoceles. I am currently not coding for it but was wanting a second opinion.
- With the PHE ending on 5/11/2023, but telehealth being extended thru 12/31/2024, what is the ruling on using non HIPAA compliant platforms such as Facetime? Will this exception being going away with the 1135 waiver ending ?
- If a provider is only interested to do a post void residual (51798) and do not have a bladder scanner, can we use the ultrasound information (76857) as a post void residual and charge that way? Can you bill 76857 since the provider interprets the result of the post void residual? Thank you.
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March 17, 2023
Ray and Scott discuss a question that came into the PRS Community: When your coder and EMR disagree, what do you do?
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March 10, 2023
Mark, Ray, and Scott discuss questions that came into the PRS Community.
- We want to do a prehab clinic for patients to improve conditions before surgery. They would be using a PT/Dietician to help improve post op complications. The reason we are contacting you is we are trying to find out the best coding scenario for this. What would you suggest regarding CPT/DX? Would we be able to do an E/M with coding such as muscle weakness etc.?
- We are having an issue with BCBS Medicare advantage claiming we are using 51701 inappropriately. I was not aware there were other codes for passing a straight catheter, but it was brought to our attention that we should be using P9612. Have you guys run into this before? any guidance you can offer in clarification of the use of 51701. When i was looking into this P9612 is also implying taking the urine sample from an indwelling SPT or foley, not necessarily the act of placing the disposable straight catheter in the patient to collect the sample.
- Have you guys seen this? what are your thoughts on 51701 vs P9612. This is my first time seeing this.
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March 3, 2023
Mark, Ray, and Scott discuss questions that came into the PRS Community.
- Do you have any suggestions for CPT code for the penis stuck in the foreign object /plastic bottle on penis/per op repor "tonge depressor w KY jelly placed under mouth of the botle dorsal aspect of penis, cast cutter utilized to make two adjacentcuts in mouth of bottle"
Should I bill for unlisted 55899, but what crosswalk apply?
Thank you so much! - Group visits - can you bill for the time spent in a group visit with patients?
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February 24, 2023
Mark, Ray, and Scott discuss questions that came into the PRS Community.
- I listened to the most recent podcast episode regarding the updated PCNL codes and I'm still confused on why we can't bill 50436 or 50437 with 50080/50081? Dilation was deleted from the code description and I attended an AUA webinar in Dec 2022 that said the dilation could be reported separately. What's changed?
- Good morning, Does 50548 include laparoscopic bladder cuff, or would the bladder cuff be separately billable with 51999? Bladder cuff is not mentioned in the code descriptor.
- It was discussed at New Orleans seminar that retrograde pyelogram (74420) was not appropriate to report with stent exchanges/ureteroscopic procedures (as it is considered included as part of the guidance for these procedures). Is this direction based on CPT guidance or is there another reference?
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February 17, 2023
Mark, Ray, and Scott welcome back Dr. John Lin to discuss telehealth in 2023 and learn about the new changes. Dr. John Lin shares his best practices based learned from over 4000 audio and video telehealth encounters.
The telehealth platform that Dr. John Lin uses: https://doxy.me/
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February 10, 2023
Mark, Ray, and Scott discuss questions and current topics.
- "Good afternoon,
Our practice has a lot of mid-level physicians. The question has arose about “direct' supervision and provider being immediately available. I provided the below-
How does Medicare define direct physician supervision?
Direct supervision: The physician or AP providing supervision must be “immediately available” and “interruptible” to provide assistance and direction throughout the performance of the procedure; however, he or she does not need to be present in the room when the procedure is performed.
One of the mid levels shared this: In the office but not immediately available. Remind physicians that they should not perform procedures while supervising incident-to visits. The supervising physician must be able to drop what they are doing right away, even if the physician is performing a relatively simple procedure such as a trigger point injections, that would break the requirement that the physician be ready if the non-physician practitioner needs help or guidance.
Now I am getting all kinds of questions.
The rule above is only pertaining to “incident to” situations correct? if the APP is listing a supervising provider for the day for insurance purposes only: such as the insurances that don't recognize /credential mid-levels (UHC for instance) would/should you follow the same rule as above? How are other practices handling this? 2. Hello Independent Interpretation of test
If we own the CT and US machines can our providers still get credit for interpreting films done in our office? We do bill these studies global once the radiologists does his reading. 3. Our office has purchased equipment to start doing creatinine tests (82565) on contrast CT patients in the office. Is this billable? And what codes would we bill? What are the documentation requirements? 4. If I bill only for CPT 51798 and 51741. Can only the MA /technician being the signer or does it need to be MD as a billing provider.
Thank you!
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Dr. John Lin's interview with Dr. Sarabeth Martin
https://youtu.be/_N2NfWBiAqA
Urology Advanced Coding and Reimbursement Seminar - Registration Open
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February 3, 2023
Mark, Ray, and Scott discuss questions and current topics.
- CODE 50081 - Our providers are interpreting the use of imaging guidance i.e. fluoroscopy to create the tract and imaging guidance to remove the stones. Not for the imaging to position of the neph tube at the end of the case - Can you confirm?
- Establishing access with PCNL procedure was discussed and CPT codes 50436/50437 were suggested to report for the access created with PCNL when Urologist performs this. However, I have seen AUGS guidance which suggests 50432-52 (since tube is include in PCNL) would be appropriate to report when access is created by Urologist for PCNL procedure. Which is correct? 50436/37 state "existing tract" in CPT verbiage which is confusing.
- Urodynamics:
I have a denial from the insurance company for 51741. They are stating that they are following the International Incontinence Society guidelines that the pressure flow void volume should be >150ml. Not sure on where this information is from. I did not think that it had to meet certain standards. - Does anyone have guidance on the billing pricing for 0421T? Medicare doesn't have a fee schedule, but that doesn't mean they won't pay it if billed.
Thanks for your help! - Can I bill CPT 0421T with the modifier 22 if supported in medical records?
- So, if our physician(s) orders the CT, but it is performed at an outside entity, would they be able to count the review and interpretation of that CT? Also, if the ordering physician does review and interpret the CT, then refers the patient to one of their partners for a procedure/surgery and that physician documents they have reviewed and interpreted, who or how would that be counted?
Purchase the PRS Urology Documentation, Coding, and Billing Plan and start implementing it today!
Pricing and More Information
The Thriving Urology Practice Facebook Group
https://www.facebook.com/groups/ThrivingPractice
Dr. John Lin's interview with Dr. Sarabeth Martin
https://youtu.be/_N2NfWBiAqA
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
January 20, 2023
Ray, Mark, and Scott discuss what a Urology Documentation, Coding, and Billing Plan should include and what PRS has put together for you to efficiently and cost-effectively implement a plan.
Purchase the PRS Urology Documentation, Coding, and Billing Plan and start implementing it today!
Pricing and More Information
The Thriving Urology Practice Facebook Group
https://www.facebook.com/groups/ThrivingPractice
Dr. John Lin's interview with Dr. Sarabeth Martin
https://youtu.be/_N2NfWBiAqA
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
January 13, 2023
Ray and Scott discuss the top 3 reasons why you should have a good documentation, coding, and billing plan: 1) money 2) time 3) peace of mind
The Thriving Urology Practice Facebook Group
https://www.facebook.com/groups/ThrivingPractice
Dr. John Lin's interview with Dr. Sarabeth Martin
https://youtu.be/_N2NfWBiAqA
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
© 2023 Physician Reimbursement Systems, Inc.
January 6, 2023
Mark, Ray, and Scott discuss the new law's impact on urology. CMS released updated national Medicare physician payment files that incorporate the changes in the Consolidated Appropriations Act of 2023. Specifically, Congress reduced the 4.5% cut to Medicare physician payment by increasing the 2023 conversion factor by 2.5%. The updated 2023 Medicare physician payment schedule conversion factor will be $33.8872. The previously finalized conversion factor was $33.0607. The 2022 conversion factor was $34.6062.
Also, they have a discussion about the CCI Modifier -25 guidelines:
"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25."
Want to talk with Larry Kemp, FACHE?
Please email us at info@prsnetwork.com
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 23, 2022
Mark, Ray, and Scott welcome Larry Kemp, FACHE to discuss compensation plans and how to approach in 2023.
Want to talk with Larry Kemp, FACHE?
Please email us at info@prsnetwork.com
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 16, 2022
Ray and Scott discuss some highlights from the Urology Advanced Coding and Reimbursement Seminar. They revisit the 2023 changes impacting urology, talk about the importance of coding and billing being a "team sport", and why the attendee interaction is so important.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 1, 2022
Mark, Ray, and Scott welcome Ambulatory Surgery Center expert Chris Setzler and discuss ASCs in Urology. Chris shares insights from lessons learned in Urology ASC build-outs.
Want to contact Chris Setzler?
Please send us an email: info@prsnetwork.com
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
December 1, 2022
Mark, Ray, Scott, and Dr. John Lin discuss why they are excited about the Urology Advanced Coding and Reimbursement Seminar in Las Vegas - December 2 and 3, 2022.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
Available November 25, 2022
Mark, Ray, and Scott wish all a Happy Thanksgiving and answer a question about getting paid for E&M for groin dissection counseling during a penectomy global.
How does one code this: I performed a penectomy now the patient is in the global period but I would like to counsel and set up for a groin dissection. Is the counseling for the groin dissection within the global period free care or is there someway to code for/get paid for this visit separately within the global period using the same dx code for penile cancer?
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
November 18, 2022
Mark, Ray, and Scott discuss a PCNL question and how it should be coded under today's rules, and how this will change based on the new description revisions of the PCNL codes for 2023.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
November 11, 2022
Mark presents the summary of the newly released CMS 2023 Final Rule.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Please submit scenarios you would like us to cover to info@prsnetwork.com
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
November 4, 2022
Mark and Scott discuss the Day 2 agenda for the Urology Coding and Reimbursement Seminar what we included and why it's important right now.
Urology Advanced Coding and Reimbursement Seminar Day 2 Agenda
8:00 AM – Urology Coding Workshop: real-world scenarios, common complicated coding examples
10:15 AM – Urology Coding Workshop: E/M, Telehealth and New Technology scenarios, examples discussion
12:00 PM – Lunch (provided by PRS): Interactive Practice Management Q&A Open Discussion
1:00 PM – Getting Paid, No Takebacks: Documentation, Appeals, Team Communication
Compliance: Auditing, Education, Defense
3:15 PM – Diagnosis Coding: why ICD-10 codes are important and which codes you should avoid
4:00 PM – New Revenue Opportunities: Primary Care Management, Critical Care Management, Ambulatory Surgical Centers, In-Office Dispensing
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
October 28, 2022Mark and Scott discuss the Day 1 agenda for the Urology Coding and Reimbursement Seminar what we included and why it's important right now.
Urology Advanced Coding and Reimbursement Seminar Day 1 Agenda
- 8:00 PreService/Front Office: Strategies to promote, maintain, and enhance optimal front office workflow - How to make the Front Office work for you.
- 10:15 E/M 2023 Interactive Session: Making sense of the new rules to maximize efficiency and productivity.
- 12:00 Lunch - Optimizing patient place of service-clinic, ASC and inpatient
- 1:00 Annual Update - Medicare Policy: How upcoming Medicare changes will affect your practice operations and revenue.
- 2:00 Global Package and Modifiers: Getting paid more for what you already do
- 3:15 The Business of Urology: Coding, Billing, and Business Metrics, RVUs, Productivity Measurement, Market Trends, Contracting, Private Equity, QHP Compensation
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
October 21, 2022
Mark, Ray, and Scott welcome back special guest Dr. John Lin. They discuss two questions that came into the Thriving Urology Facebook Group:
- It is possible to have a billable "pre-operative clinic visit" with an APP before surgery but after the visit where the decision for surgery was made? The proposed purpose is to make sure clearances and cultures are done prior to their urologic surgery? I thought this was bundled already and that this type of visit would not be billable encounter? Thanks for your insight!
- New paradigm for ureteral stent removal. Stent-Removing Snare avoids crossing the sphincter, the most invasive part of the procedure, minimizing discomfort. Reusable, easy to use, avoids a cysto setup, time saving. CPT 50386 with increased RVU’s. National av reimbursement $799 (see CMS.gov physician fee tool). I look forward to your posts. Best
AUA Stent Removal Coding Article: https://aua.codingtoday.com/restricted/cpt/general/50386/
PHE Extension October 15, 2022: https://aspr.hhs.gov/legal/PHE/Pages/covid19-13Oct2022.aspx
Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
October 14, 2022
Mark, Ray, and Scott welcome special guest Dr. John Lin. Dr. Lin shares he almost lost over $8k due to documentation/appeal snafu and how he finally won it at the ALJ level.
Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
October 7, 2022
Mark, Ray, and Scott discuss ICD-10 in week 2 of Urology Coding Month (October). Mark gives the ICD-10 overview as it pertains to urology and shares current denial trends.
Monthly Webinar
Webinar Topic: Will the NEW CPT CODES for January help solve current coding problems?
Now Free to All Thank You to Our Monthly Webinar Series Partner: ModMed (learn more at https://www.modmed.com/prsnetwork)
Watch the replay here: https://www.prsnetwork.com/mie-recordings
Free Urology Coding Training For Residents
https://www.prseducationfoundation.org
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 30, 2022
Mark, Ray, and Scott kickoff the Urology Coding Month (October) with a discussion of rules and why its so important to know what they are and how to apply them. Also, as an example they discuss a few of the new 2023 CPT codes for urology.
Monthly Webinar
Webinar Topic: Will the NEW CPT CODES for January help solve current coding problems?
Now Free to All Thank You to Our Monthly Webinar Series Partner: ModMed (learn more at https://www.modmed.com/prsnetwork)
Date: October 6th, 1 pm Eastern Link to join at 1pm EST Thursday (10/6): https://us02web.zoom.us/meeting/register/tZcuduqrqDkiGt2rpXrfdy8o4HDHj_vW81D_
Free Urology Coding Training For Residents
https://www.prseducationfoundation.org
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
Available September 23, 2022
Mark, Ray, and Scott discuss Pediatric Urology Coding and some of its nuances. Also, they answer 2 pediatric urology coding questions:
- I think the great majority of us know that if a patient has been seen by me or one of the other providers in my practice within the past three years then he/she is considered an established patient. However, there is some controversy in my new practice. I left hospital employment and started a new private practice. Some information suggests that because this is a new practice with a new tax ID and a new Group NPI number that any patient seen is considered a new patient. I wish that were true but I think that is incorrect and even though this is an entirely new practice any patient seen by me or my nurse practitioner in the past three years should be considered an established patient for coding and billing. Which is correct? Thank you.
- I am needing clarification on if a patient can be seen by nurse/MA with no provider in office? Examples would be foley removals, phlebs, ua's, etc. It was my understanding in the past we could not, but this issue came up recently when a doctor was ill and was not able to be in office.
Thanks! - Provenge billing: how many diagnoses? what about the Q codes - what's included?
Test Your Knowledge - What is your urology coding score?
https://www.prsnetwork.com/uroscore
Free Urology Coding Training For Residents
https://www.prseducationfoundation.org
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 16, 2022
Mark, Ray, and Scott discuss Pediatric Urology Coding and some of its nuances. Also, they answer 2 pediatric urology coding questions:
- Case was for non-palpable testis(UDT) so plan was laparoscopic approach for UDT and, at time of laparoscopy, no intraabdominal testis found, so an open exploration with separate incision was done and atrophic testis found in canal. billed as diagnostic laparoscopy (49320)and as no testis found in abdomen, separate orchiectomy billed from separate incision. (54520)-- can this be billed? Same day procedure but testis not in abdomen to do planned lap approach but needed to have UDT addressed.
- Is there/what is appropriate code for artificial erection at time of surgery for possible chordee in boy but no chordee found? An artificial erection needs to be done to prove or disprove chordee-- tissue needs to be dissected down to get appropriate erection test so not just circumcision but no chordee found after complete dissection. Currently, using 54250 as there really isn't a specific peds urology code. Suggestions?
Test Your Knowledge - What is your urology coding score?
https://www.prsnetwork.com/uroscore
Free Urology Coding Training For Residents
https://www.prseducationfoundation.org
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 9, 2022
Ray and Scott discuss why it is so hard to get paid accurately for all the services provided.
Test Your Knowledge - What is your urology coding score?
https://www.prsnetwork.com/uroscore
Free Urology Coding Training For Residents
https://www.prseducationfoundation.org
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
September 2, 2022
Mark, Ray, and Scott discuss what you should do when you have a surgery that includes both open and laparoscopic approaches. Also, Mark recaps the Monthly Webinar "How to avoid unspecified diagnosis denials".
Link to Monthly Webinar: "How to avoid unspecified diagnosis denials"
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 26, 2022
Mark, Ray, and Scott discuss the reliability of a manufacturer's coding guidance and the Discarded Drug Rebate in the CMS proposed rule for 2023.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 19, 2022
Mark, Ray, and Scott discuss questions that came into the PRS community:
- I just listened to the podcast on Order of modifiers on a claim. Just one question. I've been taught that the global modifier doesn't apply to an assistant surgeon. So if the patient is in a global you wouldn't add the 78 or 79 modifier to their claim. It would only be added to the primary surgeon. I have been coding for over 20 years and never used a global modifier on an assistant claim with no denied claims. Correct me if I'm wrong. Thanks for your time in advance
- Good Morning, Just need to clarify. If my doc performs a 52356-RT DX N20.0 and due to unrelated Hydro on the left a 52005 is performed on left side only. Can 52005-LT be billed also ? According to the edits it cannot be billed even though it is not related. Any input would be great! Thank you, Linda
- My clinic is confused on coding for trimix injections. We have patients that are coming for teaching on how to do a trimix injection. Should I be coding 54235 if the patient is injecting them self during the teaching and bringing their own needle and medication for the injection? I think we should not be coding 54235 unless the doctor/PA/NP is injecting the medication. Please let me know what you think.
- Would you be able to go over the difference in coding TUR bladder neck contracture, TUI BNC, Cysto incision of BNC, TUR or Inc postoperative BNC. These can get pretty confusing.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 12, 2022
Mark, Ray, and Scott discuss how modifiers should be ordered. Mark shares what modifier sequencing is, why modifier sequencing is important and provides examples of how to order modifiers on a claim.
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
August 5, 2022
Ray, Mark, and Scott discuss two questions that came into the Urology Coding and Reimbursement Gropou about billing a TURBT even though the whole tumor was not removed also they discuss coverage of repeat Urolift procedures.
PRS Education Foundation
https://www.prseducationfoundation.org
Urology Advanced Coding and Reimbursement Seminar - Registration Open
Las Vegas, NV - December 2-3, 2022
New Orleans, LA - January 27-28, 2023
Register Now
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
© 2022 Physician Reimbursement Systems, Inc.
Home
July 29, 2022
Ray, Mark, and Scott discuss a question regarding injection codes and why it may be an excellent decision to bill the injection code even though you know it will probably be denied.
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
July 22, 2022
Ray, Mark, and Scott discuss a question regarding antegrade ureteroscopy with laser lithotripsy to treat a ureteral stone and compliance plans.
Compliance Plans
Questions or need help, please send us an email: info@prsnetwork.com
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
July 15, 2022
Ray, Mark, and Scott discuss the 2023 CMS Proposed Rules and how they will impact Urology Practices. Mark breaks down what's important to urology in the new proposed rules.
Urologists’ Coding Workshop
July 23, 2022 - 10 am - 3 pm EST
Register Now
Special 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate).
"Beef Up" On your Urology Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
- Dr. Ray Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
Happy Coding!
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
July 8, 2022
Mark, Scott, and Ray clarify some concept nuances that may have been misinterpreted or misunderstood.
Urologists’ Coding Workshop
July 23, 2022 - 10 am - 3 pm EST
Register Now
Special 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate).
"Beef Up" On your Urology Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
- Dr. Ray Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
Happy Coding!
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
July 1, 2022
Mark, Scott, and Ray discuss ICD-10 "Unspecified" codes and the increase in denials.
Urologists’ Coding Workshop
July 23, 2022 - 10 am - 3 pm EST
Register Now
Special 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate).
"Beef Up" On your Urology Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
- Dr. Ray Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
Happy Coding!
Join the discussion:
Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Click Here to Start Your Free Trial of AUACodingToday.com
June 24, 2022
Mark and Scott welcome Dr. John Lin to the podcast to discuss in detail Modifier -25.
Skyline Urology to Pay 1.85M to Settle False Claims Act Allegations of Medicare Overbilling
https://www.justice.gov/opa/pr/skyline-urology-pay-185-million-settle-false-claims-act-allegations-medicare-overbilling
Also Corporate Integrity Agreement
OIG Audit Modifier 25
https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf
NCCI Policy Manual: https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare
Chapter 7: GU System
The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
Cigna:
https://www.cmadocs.org/newsroom/news/view/ArticleId/49780/Cigna-to-require-medical-records-for-all-modifier-25-claims
Cigna’s Modifier Policies: https://static.cigna.com/assets/chcp/resourceLibrary/clinicalReimbursementPayment/medicalClinicalModifiersPolicies.html
Cigna’s Modifier 25 Policies:
https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf
Horizon BCBS: Beginning on August 1, 2022
https://www.horizonblue.com/providers/news/news-legal-notices/claim-reimbursement-update-e-m-codes-appended-modifier-25
BCBS of Massachusetts: Effective July 18, 2022,
https://provider.bluecrossma.com/ProviderHome/portal/home/news/news/claims-coding-payment/all%20networks/!ut/p/z0/rZBNb8IwDIb_Sjj0OMUU6ODYsbVl0E1oApVcJtMGyEiTkkZl_PulaEP70G4c4_eJ_diU0YwyhY3YohVaoXTvFQteE38y7k6H8BwHywjms_5o6N8uAOYBfaTMAcswSO6ixIdhGkUwefLjcBHFPRj12w7i7XBgIWW5Vpa_W5pVRjei4IZU2liU5BwoS6RYGzQnDy5A7soGpavs0JSYu0wbFwi1JSUvRH4WrT0oUUhSc9OInJMv-NPuog8T_x7mD93kpRdNexAH17KrLaoCpVbcAzT5TjS8IIof63aAb9JxuqWsQru7EWqjafaT-WX598j_NJHS_bdHbfb1tRZpfTzIJYqydnzR3rnCU-lyt9n3gdWerQeymW1SO1iFnc4H0ChcIg!!/
June 17, 2022
Mark and Scott discuss the most popular topics of the first 100 episodes and why they were popular.
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
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- Dr. John Lin
- Mark Painter
- Scott Painter
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June 10, 2022
Mark, Scott, and Ray discuss questions that came into the PRS Community Forum
1) Can we bill for cpt 76377 or it is considered a Radiology procedure. My doctors want some direction if we can bill for this during prostate biopsy. Do you have any advice on this? Thank you so much!
2) We have a small path lab and pathologist will be out of town for a week and we are trying to figure out how to bill these charges while she is on vacation.
Since we are a small lab, what if we did not have a locum but just had the histo tech prepare the slides and we charge the technical (bill it under the pathologist who is in vacation) Avero charges the professional?
What would we miss out on from a billing standpoint for doing this?
Our pathologist is saying that lab does it all the time.
I would love to hear Mark’s opinion on this.
3) I need some more education on billing for Biofeedback. Our office code for Pelvic floor therapy 91122, 51784, 97530, 97750 and 97032 They perform (Accessory Muscle Performance Measurements,
Anorectal Manometry, Pelvic Floor Muscle Simulation and EMC - Evaluation report with EMG leads). Is this correct billing for Biofeedback
Or this billing should be for the initial and then after we should bill 90912 and 90913 for all 4 tests performed for Pelvic Floor Therapy each time.
Thank you so much for all your recommendation and suggestions!
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- Scott Painter
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Available June 3, 2022
Mark, Scott, and Ray discuss Mark's call with a payer making the argument that an E&M service can be billed with a Vasectomy on the same day.
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).
"Beef Up" On General Coding Knowledge
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- Dr. John Lin
- Mark Painter
- Scott Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
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May 27, 2022
Mark, Scott, and Ray discuss questions that came into the PRS Community Forum.
- Independent historian. For pediatric visits, I'm a little unclear what counts as an independent historian. I see the definition from CMS indicates "an individual (eg, parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patientwho is unable to provide a complete or reliable history (eg, due to developmental stage, dementia, or psychosis) or because a confirmatory history is judged to be necessary."
Does a parent providing a history count as an independent historian for a baby? I can see an argument for no (i.e. "provides a history in addition" to the patient's history - baby provides no history) but also for yes (baby isn't able to provide history due to developmental stage). Curious your thoughts on this.
- Newborn (post-hospitalization) circumcision consult. Trying to determine how this one is billed. Not talking about the routine circumcisions that happen right after birth (usually done by OB/pediatrics anyways) but rather about the ones referred to pediatric urology because the parents wanted a circumcision but peds / OB didn't think they should do it because of concern for something like penile torsion.
- Risk: I presume would be level 4 (minor procedure with risk factors).
- Problem: I'm not sure about this one. I presume if something like penile torsion is noted on exam, this would be a level 4 problem (chronic not at treatment goal). What if it turns out the exam is normal? Is it still chronic not at treatment goal because the parents / patient desire circumcision? This seems to be the key question for whether this visit type would be a level 3 or 4.
-
Data: perhaps irrelevant if problem and risk are 4's, but perhaps a 3 (independent historian) or just a 2 (review of outside records).
-
This is a question posed by our ASC.
I appealed the insurance denial and they upheld the denial stating “Our review, with medical records, has determined that per published evidence-based coding literature the following diagnosis code(s) is not compatible with the procedure code(s) billed: T19.1XXD and 52310.” They state “the specific code combination listed above was denies based on published evidence-based coding literature. There is a more appropriate diagnosis code for the procedure billed per medical record documentation which states removal of ureteral stent, not a foreign body; please submit corrected claim.”
What more-appropriate diagnosis code is there? History was of UPJ stone with hydronephrosis, since resolved on one and ureteral stone, also resolved, on the other. Because the conditions were treated during surgery, the only reason the patient was coming back in was for removal of the ureteral stone and we’ve always used T19.1XXD w/out issue for that. Other possibilities I’m finding are Z46.6 (Encounter for fitting and adjustment of urinary device) or T83.192D (Other mechanical complication of indwelling ureteral stent, subsequent encounter) but they don’t feel appropriate.
- Do you have experience with the code 0421T? I need to come up with RVU's to assign to the Temporary code 0421T. (Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed). I see other health systems with a definitive RVU number. Can you offer guidance on how to assign a RVU to this procedure?
May 20, 2022
Mark, Scott, and Ray talk about the recent AUA Annual meeting in New Orleans.
Also, we had a question come in about using the same data in medical decision making in two different encounters. Can you count the same category 1 data twice?
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
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"Beef Up" On General Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
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May 6, 2022
Mark, Scott, and Ray discuss a question about a scenario regarding coding the most comprehensive code:
Scenario 6 module 9, Cystectomy, with continent diversion, bilateral pelvic lymphadenectomy and prostatectomy. I captured both 55845 and 51596 and I also looked at the possibility of 51575 (Cystectomy with bilat lymphadenectomy, 50825 continent diversion including intestine anastomosis, and 55840 proctectomy. Do I not choose the 50825 (along with other codes) because of the intestine anastomosis? I tend to overthink px coding, am I over coding or under coding? What would y'all suggest to help, when I get lost in the "forest"? :) Thank you, Rhonda
Mark, Scott, and Ray talk about past AUA Annual Meetings and look forward to the upcoming meeting in May 2022.
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).
"Beef Up" On General Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
It's a great idea to make your life as easy as possible.
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April 29, 2022
Mark, Scott, and Ray discuss two current topics:
1) Letter of notification from CMS/Qlarant, a provider was selected for prepayment claim review. We have received two record requests from them on urine PCR code 87798.
2) United Health Care proposing a plan to encourage e-consults for urology providers.
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).
"Beef Up" On General Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
It's a great idea to make your life as easy as possible.
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Available April 22, 2022
Mark, Scott, and Ray answer questions
1)I have been asked if it is appropriate to bill for "misfired" Urolift implants?
2) I know Jon's opinion on this, but was wondering what the Painters think....chief complaint--do you have to be more detailed than stating "follow up"?
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).
"Beef Up" On General Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
It's a great idea to make your life as easy as possible.
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Register Now - Take advantage of VIP special pricing (the guaranteed lowest price) Ends soon.
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Available April 14, 2022
Mark, Scott, and Ray answer questions
1) If a patient is being set up for a telemedicine visit with an MD in the MD's secondary clinic and the MD is in his/her primary clinic. Do we bill under the primary clinic with a place of service 02? Also, should documentation support where the patient is located?
2) How should I code for Bladder Interstitial Fiducial Marker placements in a female patient? The markers are placed cystoscopically and are used to guide radiation therapy for bladder cancer. For male patients we were using 55876, but that is being rejected for female patients. Is there an unlisted code for cysto procedures that we can use. or any other equivalent code?
3) Is CPT 64646 correct to bill for Botox injection to pelvic floor. In description of the procedure my dr. states “ the entire length
Of the levator musculature was injected on either side. Injected 100 units on each side with spinal needle.
CPT 64646 is correct to bill?
NEW ONLINE WORKSHOP - Urologists’ Coding Workshop
Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).
"Beef Up" On General Coding Knowledge
PRS Network Presentation Team
- Dr. John Lin
- Mark Painter
- Scott Painter
From the perspective of a practicing Urologist and experts In Urology Coding.
The majority of your income is from what you do in the clinic...
It's a great idea to make your life as easy as possible.
Mastering medical coding will ensure you reach the pinnacle of your game, so you can have time and energy for patient care and a happy life.
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Available April 8, 2022
Mark, Scott, and Ray answer questions
1) My clinic is trying out the app through Emano Flow that tracks a patients urine flow for 14 days and then the Urologist goes over the results with the patient when the trial is finished. My clinic is very confused on whether or not each individual day needs an interpretation written by the doctor in order to bill a uroflow (51741) on a particular day?
2) [9:05] I am working on an appeal letter to Regence Blue Shield for in Interstim device. In their criteria for coverage, the covered diagnoses for this type of treatment are: a. Urge Incontinence (N39.41), b. Non-obstructive urinary retention (R33.8), c. Overactive bladder (N32.81) and d. Urgency-Frequency syndrome (??). For D, I could use the symptom codes of R39.15 and R35.0.........but is there anything else that might be better? The documentation states the female patient has Fowler's Syndrome, but there isn't an ICD-10 for that either! Suggestions???
3) If a Medicare has a TURP 52601 and then two months later has a bladder scan in the office 51700 should Medicare pay for that bladder scan?
4) What is the difference betweent simple prostatectomy codes 55821 and 55831. What is the best way to code for Robot-assisted laparoscopic simple prostatectomy on a Medicare patient? And, same question for a commercially insured patient?
UTI – PCR UPDATE
The following Medicare Administrative Contractors (MAC) aka Carriers, have issued a proposed multi-jurisdictional Local Coverage Decision (LCD) for Multiplex Nucleic Acid Amplification Test (NAAT) PANELS FOR INFECTIOUS DISEASE Testing, Wisconsin Physician Services Insurance Corporation, CGS Administrators, LLC., Noridian Healthcare Services, LLC., and Palmetto GBA.
Each has also issued an associated Local Coverage Article (LCA) with coding instructions and limitations on coverage. Each of these states participate in the MolDX program administered by Palmetto GBA. The coverage change takes effect April 17, 2022 in all states within each jurisdiction...
[READ MORE]
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April 1, 2022
Mark, Scott, and Ray discuss an update on the MolDx guidelines for PCR billing set to take effect on April 17th, 2022. They also talk about Modifier -22; should you use it and what it takes.
UTI – PCR UPDATE
The following Medicare Administrative Contractors (MAC) aka Carriers, have issued a proposed multi-jurisdictional Local Coverage Decision (LCD) for Multiplex Nucleic Acid Amplification Test (NAAT) PANELS FOR INFECTIOUS DISEASE Testing, Wisconsin Physician Services Insurance Corporation, CGS Administrators, LLC., Noridian Healthcare Services, LLC., and Palmetto GBA.
Each has also issued an associated Local Coverage Article (LCA) with coding instructions and limitations on coverage. Each of these states participate in the MolDX program administered by Palmetto GBA. The coverage change takes effect April 17, 2022 in all states within each jurisdiction...
[READ MORE]
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March 25, 2022
Mark and Scott discuss the new MolDx guidelines for PCR billing set to take effect on April 17th, 2022.
Urology Coding Course Spring Registration Is Open!
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Mark, Ray, and Scott discuss comments and questions from PRS Forums: PRS Community and Urology Coding and Reimbursement Group:
1) Re: RE: New Podcast Episode: -TC and -26 modifiers - Urodynamics billing: split or global? (3/11/22)
If the UDS tests are done on Monday and the ordering doc isn’t in the clinic, but there is a supervising doc, I know we would bill for the TC under the supervising doc.
If the ordering/interpreting doc doesn’t even see the tests until 2 days later, you’re saying in today’s podcast that we bill the global service with Wednesday’s date and not Monday’s date??
OR because of the MLN article SE17023 Revised 2/1/2019, we can chose which date to use, that we could bill the global charges with Monday’s date and the interpreting docs name…..even though he wasn’t in the clinic on Monday?
I think we should bill everything under the interpreting doc on the date the service was rendered, even if he isn’t in house, based on the 2019 MLN, and not on the date he interprets it.
2) I am asking for more info and cpt help on VUDS
3) Anterior exenteration question.
I have several different opinions about how to code this surgery. My two urologists operated together. The bladder was removed, the uterus, vagina, tubes and ovaries, pelvic lymph nodes, and ileal conduit created. so we start with 51597 with the wording for pelvic exenteration (my surgeons don't feel we qualify because we didn't remove the colon). The AUA recommendation I received was to use the 51597 with 50820. not sure i agree with that. the CPT book in its description says and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof.
I guess im not sure what the and/or means. Is the colectomy part necessary to perform the 51597? My doctors think we should piecemeal the coding which im not a fan of. Appreciate some advice here. Hoping there is some clarification from experts!!
4) I have started coding for a group of Urologists that bill for their prophylactic antibiotic injections separately from the procedure performed in the office.
For example: the patient comes in for a planned cystoscopy w/ Botox injection. The codes that the provider wants billed are the botox codes 52287 and J0585 and the injection of antibiotics 96372 and J0696. They will also bill them with cysto's , prostate biopsies, and other minor office procedures. I thought that I understood that prophylactic antibiotics were inherent to the office procedure, but my providers are adamant that they can be reported separately. I've tried it their way and I'm getting denials all over the place. Could you help me with this? Are my providers wrong, or my payers? Thank you!!!
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March 11, 2022
Mark, Ray, and Scott discuss -TC and -26 billing for urodynamics. There was a rule change in 2019 that updated how urodynamics should be billed in regards to the -TC and -26. Prior to that rule change, we recommended split billing but now recommend the global billing.
Below is the question that prompted this discussion:
Can we bill a TC and 26 modifiers on same day for the 51728, 51741, 51784, 51797? TC under direct supervision provider and 26 for interpretation from ordering provider on same day? My understanding is if we want to split it out, we bill the TC the day of the procedure and the 26 out the day it was interpreted or otherwise we would bill the whole global under the interpreting provider?
Med Learn Matters Article That was Referenced in the Podcast
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17023.pdf
PRS Education Foundation
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Urology Advanced Coding and Reimbursement Seminar - The Recordings
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March 3, 2022
Scott and Ray discuss the upcoming free webinar [March 10th, 2022]:
How to Tell if You Need More Urology Coding Training and How to Get It
They discuss why it is important to understand what you know.
Link to Register for the Free Webinar
How to Tell if You Need More Urology Coding Training and How to Get It
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February 22, 2022
Mark, Scott, and Ray discuss how to answer the question below and how to approach answering similar questions:
What would be the appropriate CPT codes to bill for Pelvic Wave (pelvic floor PT)?
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February 11, 2022
Mark, Scott, and Ray discuss why data is so important and how you can learn more in the upcoming Free Webinar:
Essential Coding and Billing Data and Reports for Urology Practices Workshop (2/17/22)
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February 4, 2022
Mark, Scott, and Ray discuss contracts and answer questions about the No Surprises Act.
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January 21, 2022
Mark, Scott, and special guest Dr. John Lin discuss the No Surprises Act. Mark provides an overview of the act and the three discuss how will the act is going to impact urologists and urology practices.
AMA: Implementation of the No Surprises Act
AMA toolkit for physicians: Preparing for implementation of the No Surprises Act
From CMS: Provider requirements and resources (No Surprises Act)
From CMS: example of what a good faith estimate may include (PDF)
Urology Advanced Coding and Reimbursement Seminar - Virtual Event
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Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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January 14, 2022
Mark, Ray, and Scott discuss the new modifiers and urodynamics coding
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January 6, 2022
Mark, Ray, and Scott discuss the change of the Urology Advanced Coding and Reimbursement Seminar from in-person to online. Mark provides an update on the QPP reporting that was just announced. The PRS 2022 event calendar is previewed.
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December 21, 2021
Ray and Scott discuss and answer questions from the PRS Communities.
1) I have a question regarding BPH w/LUTS; if a patient is treated successfully with a TURP, no longer having any LUTS, would the diagnosis then be BPH w/o LUTS (N40.0) or would it be Personal Hx of disease of other male genital organs (Z87.438)
2) If a patient is in the office for the postop visit after prostatectomy, and the urologist moves on from going over postop care topics to cancer counseling(further testing/cancer surveillance/possible need for future treatment like radiation/review pathology/need for genomics/etc.), can an E/M code be billed based on time with a 24 modifier?
If so, should the 24 modifier EM code be documented on a separate note or at the bottom of the postop visit note?
If this is allowed, can you provide a sample of what the documentation should look like on the 24 modifier EM code?
3) The practice I work for has a medical oncologist who often sees patients referred by one of urologists. A question has come up about whether the oncologist can order tests prior to seeing the pt. Aside from pt confusion about having tests ordered by someone they have not seen, I don’t think there is a problem—the initial encounter would still be a new patient visit since he has not performed a procedure or supervised a test. He could count the review of the tests he previously ordered in data since they were not counted when ordered. Is this correct?
4) Presenting Problem vs Assessment
Her presenting problem is Annual: Rec UTIs.
CC/HPI:
Follow-up recurrent UTIs, recommended management is D-mannose and Estrace, timed voiding, hygiene, copius fluids. Compliance had been suboptimal in the past but she re-reports better compliance over the last year. She's had no interval UTI's. She has no other urinary complaints.
UA today negative.
The patient's bladder is emptying adequately, with a documented post-void residual today of (mL): 7
A/P: stable rUTI on D-mannose and Estrace, timed voiding, hygiene, copius fluids
Refill Estrace, continue above lifestyle mods and d-mannose. F/U 2 years w/ PVR
Our coders said they would not feel comfortable using both assessment codes based on the above note. I’ve asked the provider to add an appended note linking the ICD-10 codes to the presenting problem, but I’m having a hard time defending the coders on this one because I understand the pathophysiology! Also, they say that they interpret this to mean the Estrace is ‘treating’ the rUTI, but it’s not……just helping to prevent one, not like an antibiotic.
I think the doc should start the note with,” Follow-up of recurrent UTI with atrophic vaginitis.” Wouldn’t that be sufficient???
5) Do I need an E/M code when I do Urodynamics procedures?
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December 13, 2021
Ray and Scott discuss the highlights of the Seminar and share some of the takeaways for each session.
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December 9, 2021
Ray and Scott discuss the highlights of the Seminar and share some of the takeaways for each session.
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December 1, 2021
Mark, Ray, and Scott discuss a correction to the preliminary analysis of the 2022 payment changes to the ASC payment for Urolift. They also discuss the final agenda of the upcoming 2022 Urology Advanced Coding and Reimbursement Seminar (December 3rd - 4th, 2021 Las Vegas and January 28th - 29th, 2022 in New Orleans)
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November 15, 2021
Mark, Ray, and Scott discuss some E&M 2021 FAQs.
Is pyuria and hematuria 2 points or one?
If it appears to be clearing, would it still be considered “with exacerbation”?
Can a problem be considered chronic if you expect the problem will last >1 year or it is only considered chronic if the problem has existed for >1 year?
If Medicare does not cover Bladder Scans for UTI would we count it
If the provider documents that he reviewed "records from the ER" then lists out imaging and documents a brief over view of what happened at the ER. Does this still count as 2 data points? Or would this be double dipping on the record review from the same entity?
Cystoscopy are they counted as minor surgery or just data point
Please explain what you meant when you said each cpt counts as one point
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October 22, 2021
Mark presents the preliminary summary of the newly released CMS 2022 Final Rule
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October 22, 2021
Mark, Ray, and Scott discuss the PHE, telehealth place of service update, and urology Coding Month finale.
Free E&M Training - 4 Sessions (30 minutes each)
Session #1 - Why E&M 2021 is So Important [10/25/21 at 3-3:30 pm EST]
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Session #3 - Time, Shortcut Tools, and Best Practices [10/28/21 at 1-1:30 pm EST]
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October 15, 2021
Mark, Ray, and Scott revisit a question from Episode 068 about an Implantable Penile Prosthesis. Also, they discuss several additional IPP questions. Finally, they had a question about PTNS that sparked an "Incident To" clarification discussion.
Free E&M Training - 4 Sessions (30 minutes each)
Session #1 - Why E&M 2021 is So Important [10/25/21 at 3-3:30 pm EST]
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Session #3 - Time, Shortcut Tools, and Best Practices [10/28/21 at 1-1:30 pm EST]
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October 12, 2021
Mark, Ray, and Scott discuss the new Urology CPT and ICD-10 Codes.
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October 1, 2021
Ray, Mark, and Scott discuss the global surgical package and the global days. Understanding these concepts is critical to understanding the basics of coding.
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September 28, 2021
Ray, Mark, and Scott discuss the question: Should Urologists/APPs do their own coding? This was a recent topic in the monthly webinar for PRS Network customers that we also wanted to share with the podcast listeners.
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September 21, 2021
Mark and Scott discuss questions from the Urology Coding and Reimbursement Group
Question 1 (:55)
I received a denial from local HMO insurance company for 52310-58 stating the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
The patient on 8/11 had an obstructing ureteral stone and was stented pushing the stone back into the kidney billed 52330 and 52332.
On 8/19 the patient had ESWL billed 50590.
8/24 billed 52310-58 in office.
I contacted the insurance company and this was their response.
After reviewing all the claims it appears that claim for DOS 8/24/21 processed correctly as billed. In order for a claim to pay during the global period it must be separate and identifiable from the global service, and billed with the appropriate modifier showing it is separate and identifiable. The documentation submitted must also show it is not related to the global procedure performed. The providers office should be utilizing the appropriate modifiers during a global period showing it is a distinct procedural service. This information is also available on the CMS website. CMS also details which modifier to utilize for reporting removal of multiple stones.
Any suggestions on how to proceed?
Thank you
Joan
Question 2 (9:20)
A) Please help me code this! Patient already had the procedure and there is a pending auth. that won't be approved until I send them the code(s). Thanks!!!
Revision of IPP including cystotomy removal & replacement of IPP Reservoir.
b) How do I code this scenario?
IPP Reservoir eroded into patient's bladder, Dr. Removes the foreign body in the bladder and replaces the 1 component of the IPP. Any help would be greatly appreciated!!! Thanks! Ethel
Question 3 (14:30)
For Pediatric Urology practice, what is the difference between CPT codes 54300 and 54304 as the allowed dx codes are the same for both and the service is for chordee, not hypospadias. Thank you!
Question 4 (17:55)
I have a question about the QW modifier. We are billing 85014 which is on the CMS CLIA waived test list. Should we only bill 85014 with the QW to Medicare or does this apply to commercial insurances too?
Question 5 (19:25)
We recently started drawing blood to send for BRAC analysis testing for our Prostate Cancer patients. I'm thinking the CPT code to use is 36415 but when I look on the CMS website there is no fee and the status is X.
Can we bill a nurse visit for this and is there a DX code besides C61, prostate cancer, that we should be using for the blood draw? It may not be a lot of money but we are buying the supplies and taking up a nurse's time to do this, shouldn't we be reimbursed?
Thank you,
Joanna
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Monthly Webina
September 7, 2021
Ray, Mark, and Scott discuss Ray's quest of helping Urology be the best coding specialty. They discuss the free Urology Coding Score Quiz and how it can help identify your coding needs.
Click Here to Take the Free Quiz Now
PRS Network has declared October as "Urology Coding Month" and is offering a 50% discount to the Urology Coding Course for Urologists and APPs and the Urology Coding Course for Coders / Billers and Admins.
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Monthly Webinar Recording
Recording of the 2022 CMS Proposed Rules and the Impact on Urology Practices webinar is now available.
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August 27, 2021
Mark, Ray, and Scott discuss questions from the Urology Coding and Reimbursement Group
Question 1: 55 Seconds
CORRECTION - Renal Pelvic Washings CPT Code - 52005
Question 2 - minute 5:26
I need something in writing from Dr. Ray painter for my Urologist. I have this info from the AMA and Noridian both, but they want to hear it from you. We are told by Noridian and also the AMA who is the author of the CPT book that an Exam is still needed.
Question 3 - 22:56
What level E/M are you using for the new 2021 codes? Previously they did not have 4 HPI to meet a level 3 E/M, so we coded them to a 2. Now, they do not need to have 4 HPI. It is a major procedure, which is one of the two needed for a level 4. Do you consider a vasectomy consultation/permanent birth control a stable chronic (level 3 E/M) or a minor problem (level 2 E/M)? I listened to the podcast twice and didn't get a clear answer.
Adapting Practice Compensation Plans Workshop
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August 20, 2021
Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group
Question 1: 55 Seconds
Is Rezum (53854) reimbursement dropping in 2022?
Question 2 - minute 9:26
CPT 55866 was denied when billed with C67.9 and C67.2. It has an LCD/NCD that only lists dx codes related to gender identity. Surely those are not the only conditions that support medical necessity! Does anyone know how to appeal to a payer that denies for a more specific condition? Thanks for your help!
Question 3 - minute 13:50
I have received denials from Medicare on the CPT 74425 when it's not billed with 50690. They claim it's an add-on code even though it's not listed as such in any CPT book or website that I've found. I've also not been able to find an LCD or NCD for it. Does anyone else have this issue and if so, how did you proceed? Thanks for your help!
Question 4 - minute 18:22
Is there a cpt code for Renal Pelvic Washings?
Adapting Practice Compensation Plans Workshop
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August 17, 2021
Ray, Mark, and Scott discuss Recovery Audits. Mark shares what you need to look for and how you need to react. He also shares some current common audit requests.
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August 9, 2021
Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group
Question 1: 49 Seconds
What documentation could I look for to differentiate 51728 and 51729. There is no clear mention of “urethral pressure profile study” in UDS documentation.
Question 2 - minute 10:22
What are the criteria for billing 45990 - the CPT book lists "requiring" anesthesia.
Can I bill 45990 since the DRE was done under anesthesia after a cystoureteroscopy
Question 3 - 15:19
If patient came in for f/u visit and provider did a pvr. Should you bill E&M code with Mo-25?
Medicare prime
51798
99214-25
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August 3, 2021
Ray, Mark, and Scott welcome Larry Kemp to discuss urologist compensation and key concerns we see working directly with physician groups nationwide.
Change is needed and not easy, communicating concerns softly, using practice data as keystone aligned
with key goals and sustainability.
Webinar Recording
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July 23, 2021
Ray, Mark, and Scott discuss the Advanced Practice Provider (APP) and their increasing role. Also, they discuss how the 2022 CMS Proposed Rule has a change that will impact PAs.
Webinar Recording
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July 16, 2021
Ray, Mark, and Scott discuss the 2022 CMS Proposed Rules and how they impact the Urology Practices. Mark breaks down the proposed changes and how they will impact urology practices.
FREE Webinar - July 22, 2021
2022 CMS Proposed Rules and how they impact the Urology Practices
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July 9, 2021
Ray, Mark, and Scott try to answer the question "why bother with QPP?". Mark shares the reasons why the implementation of value-based medicine is important. In the discussion, they share the 4 main reasons why you should bother with QPP.
Read more about QPP at:
https://qpp.cms.gov/
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July 2, 2021
Ray, Mark, and Scott welcome back Dr. John Lin to clarify PCNL coding and answer some questions from the Thriving Urology Practice facebook group. Mark corrects information provided on a previous podcast.
Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
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June 29, 2021
Ray, Mark, and Scott discuss some highlight statistics and metrics presented in the online course: "Important Revenue Cycle Management (RCM) Metrics; How to use them to identify and fix issues". What metrics should you be reviewing and how do you compare to others.
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June 18, 2021
Ray, Mark, and Scott discuss PCNL coding. We have been getting more questions about PCNL coding. Mark explains PCNL coding and how you should code and bill. Also, they have a discussion about stone coding in general and Mark gives his approach to coding stones. What do you start with Location? Approach? Number of Stones? what's next?
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_____________________________________________________________________
June 11, 2021
Ray, Mark, and Scott welcome Dr. John Lin to discuss Medical Decision Making. When it seems like a level 4 but MDM will only get you to a level 3, what can you do?
Question from Michael:
I'm still having a hard time with less straight forward #MDM. I had a patient with left testicular pain x 3 mos. He fell from a ladder and had back pain with radicalar pain down into his leg and likely testis. GU exam is unremarkable. UA is normal. I have ordered an MRI of the lumbar spine. The best I seem to get is a level 3, but it seems to be more complex. Thoughts and justifications?
Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
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_____________________________________________________________________
June 8, 2021
Ray, Mark, and Scott discuss the importance of physicians and other QHPs providing accurate documentation to communicate what they have done. Since the QHP is the only one able to communicate what services were provided during the encounter.
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_____________________________________________________________________
May 28, 2021
Ray, Mark, and Scott welcome Dr. John Lin and discuss TURBT vs. Bladder fulguration and biopsy codes (52204 and 52224). The discussion is a deep dive into what circumstances the codes are used and how to differentiate in the documentation.
They also share information about the "Bundling Matrix" on AUACodingToday.com (click for free trial)
Finally, they discuss the Urology Advanced Coding and Reimbursement Seminar - Live In-Person Events (Information and Registration)
Dr. Lin runs The Thriving Urology Practice Facebook group and this topic has generated a lot of discussions. What does it mean if you are not within the average range?
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
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_____________________________________________________________________
May 21, 2021
Ray, Mark, and Scott welcome Dr. John Lin to discuss payer's letters to physicians regarding their E&M billing levels relative to their "peers". Dr. Lin runs The Thriving Urology Practice facebook group and this topic has generated a lot of discussion. What does it mean if you are not withing the average range.
The Thriving Urology Practice Facebook Group link to join:
https://www.facebook.com/groups/ThrivingPractice/
_____________________________________________________________________
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_____________________________________________________________________
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_____________________________________________________________________
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May 17, 2021
Ray, Mark, and Scott discuss clinical pathways and coding and how they impact patient care. They also discuss why accurate coding and documentation are important parts of clinical pathways and patient care.
_____________________________________________________________________
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May 11, 2021
Ray, Mark, and Scott discuss physician supervision, incident to, and IDTF (Independent Diagnostic Testing Facility), also answer questions from the PRS Community and the Urology Coding and Reimbursement Group
FAQs
- [14 minutes and 01 Seconds] Our Urology group bills inpatient hospital codes when we get called in for initial visit (99221-99223). We have always been paid without issues and I have read Medicare guidelines stating this can be billed by each specialty. In the past few months Aetna started denying these codes stating only one doctor, regardless of specialty is allowed to bill and we were told to bill subsequent day codes. Now, Anthem is requesting takebacks on payments of these codes dating back to 2019. I'm looking to see if anyone else is having this issue and is this correct for the payer?
Thank you.
Carrie - [19 minutes and 50 Seconds] Is biofeedback billable service after prostate surgery during the global days?
- [26 minutes and 02 Seconds] I need your assistance in coding a 2 surgeon surgery.
Summary...I shortened immensely
My urologist performed cysto open ended stent placement in ureter. The surgery was passed to the general surgeon for robotic lap sigmoid colectomy. The general surgeon dissected the colon from the bladder.My urologist now took over and robotically closed the colovesical fistula. The surgery was passed back to the general surgeon to finish his part.
Would I use CPT 51999? and equate it to ? CPT code.
The 52005 would be included correct?
These combined 2 surgeon surgeries where my urologist performs the
colovesical fistula closure always confuses me.
I appreciate your help.
Thank you,
Linda
May 3, 2021
Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group
FAQs
- [40 Seconds] Our patients bring in there own testosterone and we bill out the administration code 96372.. Is the NDC # required to be documented?
(We do document j code, dx , patient provided,amount given, Lot# and expiration.) - [8 minutes and 57 Seconds] One of my physicians completed a TURBT of multiple bladder tumors but he never listed any size. Instead, he says "aggregate greater than 5cm." My understanding was that we cannot use this and he would need to note the largest tumor resected. Could you please provide some clarification and education so I can let the provider know how to proceed or if using the aggregate size is sufficient for billing?
- [11 minutes and 15 Seconds] One of our providers is using a vacuum device called Calyxo when they do cysto/litho procedures that remove the stone fragments after being lasered. Is this something we would bill for? 52352 maybe? As always, thanks for help.
- [14 minutes and 40 Seconds] What is the correct code for excision of scrotal cyst.?
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April 23, 2021
Ray and Scott discuss why you need to provide complete documentation for lab tests. Payers are starting to focus audits and takebacks on lab test reimbursement. Mark talks about how to document your test properly.
We receive frequent questions on Robotic procedures and the proper coding. Mark, Ray and Scott discuss the proper coding for Robotic and laparoscopic procedures.
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April 20, 2021
Ray and Scott discuss the common question from urologists "Why do I need to learn to code? I have a team that does that". Over the years many Urologists have asked this question. Ray shares his thoughts on how much coding urologists need to know and why they need to know it.
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April 12, 2021
Mark, Ray, and Scott discuss the new PRS Network series: The Optimizer. Why they decided to develop the Optimizer Series and what they hope to help urology practices accomplish.
Also, they discuss part 1 of the series: Optimizing the Front Office and Critical Processes. Mark shares a story of 1 practice that lets $100,000 of uncollected AR walk through the door each month. They continue the discussion of how the series can help you focus on specific parts of your practice and optimize those functions.
Learn More about the Optimizer Series Part 1: Optimizing the Front Office and Critical Process
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April 3, 2021
Mark, Ray, and Scott had a question this week on whether or not you could use the bilateral modifier (-50) for code:
54351 - Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic
You may be surprised at the answer!
This prompted the discussion on data and where it comes from and how we have interpreted it and summarized it in AUACodingToday.com. The interpretation and summarization help make coding more efficient.
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March 26, 2021
Mark, Ray, and Scott discuss a problem with United Health Care and payment delays for higher-priced claims (ie Provenge, Urolift). What options do you have? What should you do?
Share your payer stories with us
Email: info@prsnetwork.com
or on the free Q&A forum Urology Coding and Reimbursement Group.
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March 19, 2021
Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:
Question 1 (:55)
For bilateral Ureteroscopy Laser lithotripsy with stent placements can we bill 52353, 52332 (using N20.0 as diagnosis) & 52356 (using N20.1 as diagnosis)
Question 2 (5:35)
For Urodynamics- when patient has foley catheter in place prior to procedure and will need a foley catheter placed after the procedure can we bill for the foley catheter cpt 51702
Question 3 (9:47)
Can we bill a cystoscopy with an sp tube change at the same visit? CPT codes 52000 & 51705
Question 4 (17:00)
So in today's (3/18/21) webinar, the subject of prostate cancer screening came up and it made me think of this question. It sounded like Mark was saying we would count the family history of prostate cancer as more risk, but not as an actual problem assessed for this patient. Could I please ask for clarification on this again? Thanks
Question 5 (24:24)
Hi, looking for some clarification on the data collection/review of the new E/M guidelines. and documentation requirements .if our providers review an outside note, lab, xray etc.. they should document what was reviewed in their notes ?
I have not found anything that specifically says to document what you reviewed that I can show our providers.
any help appreciated
thanks
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March 12, 2021
Ray, Mark and Scott discuss technical revisions that the AMA released March 9th, 2021. The team breaks down what's different and what urology practices need to understand.
In addition to the details, they will also give urology examples so you understand the concepts.
Link to the CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes:
EM 2021 Guidelines Technical Corrections 3-9-21
March Edition of the Monthly Webinar Series, live March 18th, 2021 at 1 pm Eastern.
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March 7, 2021
Ray, Mark, and Scott discuss deductibles and the impact they have on urology practices. The importance of previsit planning and training to ensure a healthy practice.
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UCR 040: "Incident to" billing; When to bill the 99211- Nurse Visit
February 26, 2021
Ray, Mark and Scott discuss incident to billing and when to bill the 99211 nurse visit.
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February 19, 2021
Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group
Question 1: 40 Seconds
Hello, one of our physicians has been doing multiple ESWL's (cpt 50590) on the same dos for treating more than one stone..i.e one kidney stone, one ureteral stone or bilateral stones..i have found info that says only one 50590 per dos and also to unbundle with an X modifier
any clarification much appreciated
thanks
Question 2 - minute 5:03
We are seeing denials from Cigna Medicare plans where they are denying 96372 as bundled into 55700, 76872. We added a modifier of 59 to 96372 to break it out of the bundling per the AUA coding today, since we are administering an antibiotic but the the insurance plan is stating it is part of the 55700 procedure. As far as I know Medicare is not denying this. Please advise. Thanks for you help.
Question 3 - minute 15:49
How important is it to check the vital signs on every patient for every office encounter? I understand the medical necessity and utility of it occasionally but is it at all essential to check the vital signs on every patient (or any patient for that matter) with the new 2021 E&M guidelines for documentation/billing purposes?
It is part of the physical exam so I think that it is not important at all for billing purposes. Is that correct?
Question 4 - minute 21:55
Please clarify using 99441-99443 codes. We have a provider that wants to bill for these to call patients with test results which one of them has resulted in scheduling a surgical procedure. These calls are not scheduled as a telehealth visit would be. Please advise.
Thank you for all your help.
Question 5 -
When billing a private/commercial payer, can we bill codes 51702 and A4344 together?
Thanks
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February 16, 2021
Ray and Scott discuss what a urology QHP should do and what they should not do. As we teach at PRS, you should always work at the top of your license. This does include some coding and billing. Ray and Scott discuss and give some examples of the role the QHPs.
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February 5, 2021
Mark, Ray, and Scott discuss Risk under the new E&M 2021 guidelines. Mark lays out a position that you can have a level 2, 3, 4, and 5 for watchful waiting for patients with prostate cancer. Your documentation is the key.
You need to provide the complete picture to include clinical and medical reimbursement perspectives.
Take the 30 Day "Code like Mark Painter" Challenge and finally master urology coding.
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UCR 036: Why Modifier -25 is so important and how it works with the EM 2021 Rules
January 29, 2021
Mark, Ray, and Scott discuss Modifier -25 and how it fits in with the new E&M 2021 Rules. They discuss why Modifier -25 continues to be so important and give examples of what changes with the new guidelines. You can save time by knowing the rules and how to use new guidelines. Your defensible documentation should be much easier to produce.
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UCR 035: E&M 2021 Q&A: Other qualified health professional definition, Data - can I count note and PSAs in the note as separate data points? Is BCG with assessment a level 2 E/M? Prescription drug management clarification.
January 15, 2021
Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:
Question 1
It's now 2021 and I'm reviewing the coding seminar that I attended virtually in September. On the discussion of E&M coding based on time the phrase:
Distinct time spent by physician and "other qualified health professional" for the visit on the E/M encounter on the date of service
appeared on one of the slides. (The quotes and italics were added by myself.) What is the definition of "other qualified health professional?" Is that a nurse? Could that be a certificated medical assistant who takes time to track down a lab result or helps the patient fill out an IPSS score sheet?
Question 2
Regarding the 2021 E&M new rules, if I see a new patient for elevated psa and review the referring doctor's clinic note including three psa tests that are in that note does that count as four items in Element 2 of Medical Decision making?
For example, I review the note (one item), I review a unique psa from 2/4/2018 (second item), I review another psa from 3/5/2019 (third item), I review another psa from 6/2/2020 (fourth item). All the psa tests share a similar CPT code but they are from different dates and are unique tests. I reviewed them from the doctor's note and not directly from the Lab Corps documents. Did I get 4 items for Element 2?
Second question. For Element 2 do I just need to qualify for Category 1 or Category 2 or Category 3 or do I need to qualify in two out of three of the categories in Element 2?
Question 3
Would it be considered legitimate to bill a level 2 E/M with BCG with assessment below? The reasoning is at the time of service, the decision to proceed is based on results of UA performed that day, & how well the patient did with prior treatment so they are evaluating and making a decision for the procedure on the same day even though it is scheduled in advance.
Would you consider it ok to bill for a level 2 E/M with a BCG?
"Bladder cancer Here for #6 out of 6 of BCG induction therapy which he has tolerated well. Urinalysis ordered today shows moderate pyuria and microscopic blood, no bacteria. This is consistent with his BCG treatments, no signs or symptoms of infection. He feels well with no urinary symptoms today. Proceeded with instillation of half dose BCG."
Question 4
We have had a couple of questions from our providers that we’d like clarification on. They are as follows:
If you are continuing a medication on a patient but they don’t need refill is it acceptable to renew the med in urochart but not send to a pharmacy? This way you get credit for prescription drug management and still bill a level 4.
Is there a place where I can get clarification on the wall chart information like what classifies as a “minor risk” and “new interpretation of test” and “new ordering of test”.
I’ve watched several webinars and gone through power point slides, but I think examples are the most helpful.
For example, does a PVR count as a “review of unique test” or “order of unique test”?
If I review CT images and summarize my findings is that “independent interpretation test”? Is that true if it was performed at UA or ARA?
What is a minor surgery without risk? Where can I find a list of “risks”?
Element 2 explanations are giving me the most trouble.
UCR 034: 2021 last-minute changes, G2211 update, MRI fusion biopsy of prostate coding, and initial vs subsequent dilations
January 8, 2020
Mark, Ray, and Scott talk about the last-minute changes- Congress passed a Covid Relief package that included a few impactful changes.
They also, discuss the changes with the new code G2211 which now cannot be Paid until 2024.
Finally, they answer 2 questions from the Urology Coding and Reimbursement Group:
1) How do I code for MRI fusion biopsy of the prostate? Do I bill the unlisted 55899 and send in documentation?
and
2) CPT 53600 VS. CPT 53601 When are we able to rebill initial dilation again?
So, is there a time limit in between dilations that would justify initial dilation again or only when the patient is considered a new patient again?
The doctor I work for is wanting to know this answer. Please advise
Urology Advanced Coding and Reimbursement Seminar - Virtual Live Event
January 29th and 30th, 2021
10am - 6pm EST each day
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Mark, Ray, and Scott talk about lessons learned from the first 33 episodes. Also, they answer the question "what do you see as the biggest challenge (or opportunity) coming in 2021"? Lastly, they discuss where the podcast is headed in the future.
Urology Advanced Coding and Reimbursement Seminar - Virtual Live Event
January 29th and 30th, 2021
10am - 6pm EST each day
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Part 2 of 2 - The final Medicare rule was published on 12/2/2020. Mark presents what has changed, what is important, and the impacts the new rules are going to have on your practice. He also points out what you need to do to prepare your practice.
Last Chance to Learn the New E&M Rules in 2020
Live Workshop
December 21st, 2020
7pm - 10pm EST
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Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.
Part 1 of 2 - The final Medicare rule was published on 12/2/2020. Mark presents what has changed, what is important, and the impacts the new rules are going to have on your practice. He also points out what you need to do to prepare your practice.
Last Chance to Learn the New E&M Rules in 2020
Live Workshop
December 21st, 2020
7pm - 10pm EST
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November 24, 2020
Happy Thanksgiving!
Mark, Ray, and Scott discuss the Urology Advanced Coding and Reimbursement Seminar Agenda. Mark explains what we have included and why. Ray emphasizes that there are a lot of big changes this year that can lead to positive outcomes for urology practices.
Here is the Agenda for the Upcoming Virtual Live Event:
Friday 12/4/20
Time (EST) | Topic
10:00 AM | Welcome 2021 - Back to the Future
10:30 AM | Globals and Modifiers Part 1
11:00 AM | Globals and Modifiers Part 2 OP note communication
12:00 PM | Optimizing Patient Collections -Integrating system-wide solutions
1:00 PM | Lunch: New Technology
2:00 PM | Globals and Modifiers Procedural Scenarios
3:00 PM | MIPS, MACRA, Medicare Updates
4:00 PM | Operative Communications, Scheduling, Prior Auths - Break out share your processes
5:00 PM | Compensation Trends - Private and Hospital-Based
Saturday 12/5/20
Time (EST) | Topic
10:00 AM | Welcome 2021 - Back to the Future
10:30 AM | E&M 2021
11:00 AM | E&M 2021 Continued, Transition, New Documentation Hints
12:00 PM | Practice Operational Challenges and Lessons Learned
1:00 PM | Lunch: Online Reputation Mgmnt Presentation
2:00 PM | E&M 2021 Scenarios
3:00 PM | Telemedicine Optimization - Rules, In Practice
4:00 PM | Positioning the Practice for Sustainability - 2021 and beyond
5:00 PM | ICD-10 - Update. Examples ICD-10: Hematuria, Bladder Ca, BPH, CaP
Urology Advanced Coding and Reimbursement Seminar+ Bundle
Live Virtual Event
December 4th and 5th, 2020
10am - 6pm EST Each Day
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November 17, 2020
Mark, Ray, and Scott discuss the 2nd wave of the pandemic and what that means to the urology practice.
The first wave was dedicated to figuring out how to deal with the shutdowns/slowdowns and telehealth. This next wave, if there is a slowdown there are some opportunities to use that time to streamline your practice. Given the new Zoom skills we have all developed, there are opportunities to educate patients and leading to a higher return encounter.
Urology Advanced Coding and Reimbursement Seminar+ Bundle
Live Virtual Event
December 4th and 5th, 2020
10 am - 6 pm EST Each Day
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Mark, Ray, and Scott talk with Larry Kemp, FACHE about assessing your business practices, digging deep to identify the core problem, developing a road map, and then solving the root of the problem. Larry points out that "Being Paid is Not the Same as Paid Accurately".
You have to make sure you efficient in the things you can control in your practice. It is hard to extract more income from payers unless you have leverage in that market. But you do have options to limit exposure to the bad actors.
Urology Advanced Coding and Reimbursement Seminar+ Bundle
Live Virtual Event
December 4th and 5th, 2020
10 am - 6 pm EST Each Day
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Mark, Ray, and Scott discuss some lessons and nuances that they learned during the discussion at the recent E&M 2021 workshops. Mark shares the reasoning behind a vasectomy consult and what level it will probably fall with the new guidelines. Also, he discusses the question - will all prostate cancer E&M visits be a level 4?
Ray shares why the new guidelines are going "back to the future". Documenting using the new guidelines is going to be like it was before the original documentation guidelines introduced in the early 90s.
Why you should attend the Urology Advanced Coding and Reimbursement Seminar - Live Virtual Event.
Urology Advanced Coding and Reimbursement Seminar+ Bundle
Live Virtual Event
December 4th and 5th, 2020
10 am - 6 pm EST Each Day
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Mark gives an update on the status of the Public Health Emergency (PHE). Mark, Ray, and Scott discuss FAQs:
- Coding for a stent removal using a snare without radiologic guidance.
- CPT code is for the i-Tind procedure
- Can you code a consultation visit (non Medicare) for new patient office visit seen in the ER
- Additional clarification on the 25 modifier.
Urology Advanced Coding and Reimbursement Seminar+ Bundle
Live Virtual Event
December 4th and 5th, 2020
Upcoming E&M 2021 Live Online Workshops
Dates (all times Eastern)
October 28, 2020 - 5:00 pm
Scott and Ray discuss the Urology Advanced Coding and Reimbursement Seminar. Ray shares how it all began and why. They discuss how the Urology Advanced Coding Seminar is going to be different this year.
Not only is it going to be a live virtual event but have added additional products and services to help practices prepare for 2021.
Mark, Ray, and Scott answer questions from the Urology Coding and Reimbursement group. Mark gives
1) Can urologist bill for Covid intake screenings? We hear from a provider that when patient walks in the door and we perform the Covid intake screening ( we do these anyways), we can bill for this?
We would have to submit out Covid form, a medical form, and a SOAP note, these can be signed by an NP for submition to the insurance?
2) Can a Urologist bill a 50590 and a 76000? It says only if medically necessary. What would be considered medically necessary?
3) Can you explain in an office setting when you would only bill a 51702 for catheter change for management of chronic urinary retention pt VS including an E/M charge 99213 VS when to use a modifier 25?
From my understanding there is no charge for a catheter removal and this is included in the E/M portion of the charge, so shouldn't every chronic catheter pt (for NGB, urinary retention) also have an E/M charge in addition to the 51702?
Good news from the resolution act: regarding the Medicare repayment
Mark, Ray, and Scott discuss the new ICD-10 codes that go into effect 10/1/20. Make sure your Electronic Health Record and Practice Management System are up to date with the new codes. Luckily there are not that many new codes and will not have a big impact on most urology practices.
Download a copy of the ICD-10 additions and changes here:
Urology ICD-10 Changes Effective 10-1-2020.pdf
Get a copy of the E&M 2021 Sneak Peek here:
Sneak Peek E&M 2021 Pocket Card
September 18, 2020
Scott shares the 3 simple steps PRS uses to create the PRS education projects.
We have, over the last 30 years, developed a system for creating education products. We used this tested and proven method to develop the upcoming E&M 2021 Live Online Workshop.
Upcoming E&M 2021 Live Online Workshops
Learn More
Dates (all times Eastern)
September 18, 2020 - 5:00 pm
September 26, 2020 - 10:00 am
October 8, 2020 - 6:00 pm
October 28, 2020 - 5:00 pm
Mark provides an overview of Telehealth utility now and post Public Health Emergency. He shares 3 opportunities to explore using Telehealth, if you are not doing so already.
1.) Basic Telehealth - Synchronous Audio Visual
2.) Communication Technology Based Services (CTBS)
3.) Remote Monitoring Services
Join the discussion:
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Upcoming E&M 2021 Live Online Workshops
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Dates (all times Eastern)
September 18, 2020 - 5:00 pm
September 26, 2020 - 10:00 am
October 8, 2020 - 6:00 pm
October 28, 2020 - 5:00 pm
Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement Group
- Scenario:
New patient being seen via telemedicine for the first visit. Dr. has ER reports and a CT with finding of "a nodular mass-like extension from the left posterior aspect of the prostate into the seminal vesicle and an impression of "Probable prostate cancer extending into the left seminal vesicle". A PSA was done and came back at 950.0 ng/mL. At the time of the Trusp/Bx, Dr coded D40.0, Neoplasm uncertain behavior of prostate. The physical findings at the biopsy were "Large, nodular hypoecoic mass left base & mid-gland of prostate". I think Dr. was trying to show that he didn't have pathology to prove malignant neoplasm and since there isn't an "Unspecified neoplasm" for prostate, I think he should just code what he knows for sure.....nodular prostate and elevated PSA......possibly also use N42.9 Disorder of prostate, unspecified which means anything from an abnormal prostate on exam to cancer. Could N42.9 be used as the "neoplasm of prostate, unspecified behavior"?? - Hi, dr did a laparoscopic radical nephroureterectomy for ureteral cancinoma and also a repair of a lumbar hernia
i came up with 50548 for the nephroureterectomy but am unsure of the hernia
thanks - Can you clear up when to use modifier -57 and modifier -25?
Is -57 for clinic AND hospital consults? Does the surgery you are planning for the same day have to be a surgery with 90d global? what if it's just ureteroscopy? Does putting in a catheter after an ER consult need a -57 modifier?
Is -25 used for separate E/M ONLY if they have a separate procedure? (for instance come in for cysto but then mention a genital wart that is then removed) Or can you add -25 for a totally unrelated problem that requires medicine or counseling but no procedure (for instance come in for cysto and then mention ED and discuss options/prescribe viagra)
Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement Group
- Can CPT code 50386 be done in the office? The provider wants to remove the stents without cysto whenever possible as he says it is more comfortable for the pt and less risk of infection. Does this still need ultrasound guidance to do in the office? Haven't done one of these before in the office. Please advise. Thank you.
- Good morning, new to ASC billing for my Urologist. My doctor performed a TRUS/BX at an ASC and I am billing the facility charge. For the facility, can I bill CPT 55700 with 76872, 76942, 96372 & J1580. I have searched on line but unable to find anything relevant. Please advise
- Help please.
Pt had gross hematuria and BPH. Would CPT 52214 be correct or 52601-52?....the resectoscope has me questioning my code choice..... "...........cystoscope was removed and a 26Fr resectoscope was inserted. Using the bipolar rollerball the entire prostatic fossa was fulgurated. Hemostasis was attained. The resectoscope was removed and a 20fr 3-way catheter was inserted." Doc said TURP but think I'd need him to re-phrase his op note.....no?
Thank you
Mark, Ray and Scott discuss the 7 steps your practice needs to take to ensure a smooth transition to the new E&M rules in 2021.
- Choose a transition captain
- Update Compliance Plan
- Train the team
- Update Processes
- EHR Template Update, Testing and Training
- Estimate Financial Impact
- Schedule Ongoing Training and Review
Upcoming E&M 2021 Live Online Workshops
Learn More
**Dates (all times Eastern)
September 18, 2020 - 5:00 pm**
September 26, 2020 - 10:00 am
October 1, 2020 - 6:00 pm
October 2, 2020 - 5:00 pm
Mark outlines the proposed rule and the 8 items that will have the most impact on the Urology practice.
- Final rule posting late this year
- Conversion factor decreasing by 10.6%
- E&M 2021 changes being adopted and will include increased RVUs for the E&M codes
- RVUs for non-facility codes increasing enough to offset conversion factor decrease
- RVUs for facility procedures are all decreasing
- ASC payments are set to increase
- MIPs has a couple of changes but they are not major changes to the current program
- Telehealth is going to continue with the same rules during the Public Health Emergency. Once the PHE is over then covered codes will change and be separated into 3 categories of covered codes
Mark, Ray and Scott discuss answer and discuss questions asked on the Urology Coding and Reimbursement Group.
Can you bill a consultation (99245) when one of our providers is sending his pt to another provider in the same group to discuss doing a RALP. Ins plan UMR/UHC. I don't think you can since they are under the same Tax ID #. The provider that did the consult says you can for a non CMS plan. Please advise. Thanks
[more]
Mark, Ray and Scott discuss how to find the right codes or solutions by asking questions. The problem is that if you don't ask the right questions you may get the wrong solution.
Often times in coding and reimbursement the answers are not clear. There is a lot of "gray" and involves finding the right solution based on all the information you have.
For PA and NP phone call only visits, what codes should be used? Additionally, can phone only codes be billed as incident to for established patients?
Good morning!
Can 52281 needing to be performed during global period of 52601 because of developed N35.811 meatal stenosis and increased self- catherizations be billed with a modifier? I am looking and the EncoderPro.com service I have through my employer says: "A modifier is not allowed to override this relationship".
Thanks again!
Mark and Ray present the current CMS and CPT rules and how those rules affect coding for multiple stones. As most are well aware, the rules are not always black and white and in this instance, the rules leave plenty of room for interpretation. Mark and Ray present the current rules and lay out a case for a fair interpretation based on work performed.
Larry talks about how teamwork is one of the most important aspects of an efficient office. Learn about one of the best ways to train your office. Larry has helped many urology practices and over the years developed and tested systems and strategies to help practices of all sizes.
Brent shares what most Urologists are missing on their website. Do you explain what you do? Have pictures related to your practice? Have a clear call to action? Learn some simple changes you can make to your website to help attract your ideal patient.
Should you have video on your website? How important are testimonials? Get the answers to all these questions and more as Brent discusses what's important for today's urology website.
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In this episode, Mark interviews cybersecurity expert Jeffery Daigrepont, from the Coker Group.
Jeffery shares some items you should consider to protect your practice. Did you realize that one of the most important tools is cybersecurity insurance and most out of the box policies don't cover a common cyber breach potential?
Also, most practices don't know that many breaches occur because of individuals actions within the practice. These actions are not intentional but can lead to significant issues.
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Mark, Scott, and Ray talk modifier -25. In addition to a general overview of the definition, they give several urology specific examples.
Modifier -25 definition: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.
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UCR 008: RVUs - Overview and How They Can Help You
Mark discusses RVUs and why they are important to the urology practice. Not only are they important for reimbursement but they can also be used as a tool to assess practice productivity and efficiency.
Learn why not understanding the RVU basics could be costing you in many aspects of your practice.
UCR 007: Voice Recognition in Today's Practice with Brad Sclar
Scott talks with voice recognition expert Brad Sclar. Learn how Brad, who has a Doctorate of Musical Arts, got involved with healthcare. Find out if voice recognition belongs in today's practice. Why the dictation software and algorithms on your phone and computer just don't cut it in the medical profession.
Questions for Brad? Interested in Dragon Naturally Speaking?
Click Here
UCR 006: How Dr. John Lin is "reopening" his urology practice as the pandemic restrictions are easing
Mark and Scott talk with Dr. John Lin, a solo practitioner from Gilbert, AZ in the Phoenix metropolitan area. Dr. Lin shares his strategies and the steps he is taking to "reopen" his practice.
Find out if he sees telehealth in his practice moving forward and if there are any efficiencies to be gained from what he has learned.
UCR 005: Do you know what you are not billing?
We hope you and your families are safe and healthy.
In this episode, Scott and Ray discuss two commonly overlooked billing mistakes that cost urology practices money. You can't find this on any report but yet it occurs in all practices unless you have the right system.
Ray outlines the simple but effective way to identify procedures performed, that may not have been billed. They also discuss a second issue, contractual denials, and outline a strategy to address them.
UCR 004: Telehealth/Telemedicine Shared Visits Clarification
We hope you and your families are safe and healthy.
In this episode, Mark clarifies the rules associated with Telehealth/Telemedicine shared visits. We have been getting questions regarding shared visits.
Mark answered a question on the recent webinar and his answer sparked additional discussions on this topic.
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UCR 003: How to Document Telehealth/Telemedicine Visits and Comply with the New Rules
We hope you and your families are safe and healthy.
This crisis has impacted us all in many ways. We are all in this together and we want to help.
Are you overwhelmed with all the new Telehealth/Telemedicine changes?
This is a replay of a webinar that aired Thursday, April 10th, 2020. Mark outlined how to properly document Telehealth/Telemedicine visits and select the appropriate level of service during the Public Health Emergency.
The rules were released and then adapted to the changed Telehealth environment. Mark also reviews the new rules and how to apply them in a Urology practice.
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Tags: 003
UCR 002: Telehealth/Telemedicine: New Rules in the Wake of the Coronavirus
This episode focuses on the new Telemedicine / Telehealth rules. With the quickly changing Telemedicine / Telehealth rules, due to the coronavirus pandemic, it is hard to keep up with the changes. Mark Painter breaks down the latest guidelines and rules and explains what urology practices need to know.
Telemedicine technology options mentioned in the podcast:
Doxy.me
Chiron
What’s App
Updox
VSee
Zoom for Healthcare
Google G Suite Hangouts have said that their products will help physicians comply with HIPAA and that they will enter into a HIPAA BAA.
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UCR 001: Welcome to the Urology Coding and Reimbursement Podcast!
Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your cohosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.
Get your questions answered and learn from others by joining our free group Urology Coding and Reimbursement Group here:
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