Urology Coding and Reimbursement Podcast artwork

Urology Coding and Reimbursement Podcast

238 episodes - English - Latest episode: 7 days ago -

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.

Health & Fitness
Homepage Google Podcasts Overcast Castro Pocket Casts RSS feed

Episodes

UCR 188: Change health cyberattack updates, G2211 developments, FAQs - Urodynamics authorization, taxonomy multi-specialty practice

March 21, 2024 23:00 - 29 minutes - 20.6 MB

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 app...

UCR 188: Change Health cyberattack updates, G2211 developments, FAQs - Urodynamics authorization, taxonomy multi-specialty practice

March 21, 2024 23:00 - 29 minutes - 20.6 MB

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 app...

UCR 187: Change Health cyberattack update; FAQs - 99459 documentation, N30.10 denials, and 51701 for urine capture

March 15, 2024 12:00 - 30 minutes - 20.8 MB

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 i...

UCR 186: FAQs - Bladder neck resection or TUIP; LT/RT ureteral reimplant; and Lipiodol injection coding

March 08, 2024 13:00 - 23 minutes - 16.3 MB

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 signif...

UCR 185: Countdown to the MIPS submission deadline - are you prepared?

March 01, 2024 13:00 - 23 minutes - 16 MB

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 j...

UCR 184: FAQs - Clarification of split shared visit, and cystoscopy, dilation, and clot evacuation coding

February 23, 2024 13:00 - 19 minutes - 13.6 MB

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...

UCR 183: Unleashing the power of words, the importance of Documentation for Reimbursement

February 17, 2024 00:00 - 15 minutes - 10.5 MB

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...

UCR 182: Clarifying Split or Shared Visits

February 09, 2024 18:00 - 26 minutes - 18.1 MB

 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 tho...

UCR 181: FAQs - Hospital E/M Codes, Ureteroneocystostomy coding, and Pelvis Exam Clarification

February 01, 2024 21:00 - 26 minutes - 18.3 MB

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...

UCR 180: Revisiting G2211 and understanding code 99459 and its usage

January 19, 2024 22:00 - 14 minutes - 10.3 MB

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 ...

UCR 179: Top documentation, coding, and billing issues impacting urology

January 12, 2024 23:00 - 24 minutes - 17 MB

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, 2024 8 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 pre...

UCR 178: Using G2211 - discussion, questions, and scenarios

January 05, 2024 21:00 - 32 minutes - 22.1 MB

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, 2024 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday Reserve your spot and save!  Get sign...

UCR 177: Discussion with Dr. John Lin - Removal of foreign body from penis; A great way to combat physician burnout

December 29, 2023 00:00 - 35 minutes - 24.3 MB

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 transectio...

UCR 176: FAQs - Can you bill simple prostatectomy and cystorrhaphy; Value for new pelvic exam code; Can you bill uroflow and/or PVR twice on same day; and can you bill voiding trial post-op after prostatectomy?

December 22, 2023 15:00 - 25 minutes - 17.6 MB

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 bun...

UCR 175: Why All Urologists and Staff Should Join and Participate in a State Urology Society - a discussion with Dr. Richard Pelman

December 15, 2023 13:00 - 37 minutes - 26.1 MB

 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, 2024 8 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...

UCR 174: 2024 Urology Advanced Coding and Reimbursement Seminar - Key Takeaways and Insights

December 08, 2023 14:00 - 37 minutes - 25.7 MB

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, 2024 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday Reserve your spot and save!  Get signed up today and get ...

UCR 173: Implementing 2024 changes - understanding G2211 and exploring new category 3 codes with Dr. Jonathan Rubenstein

November 28, 2023 18:00 - 56 minutes - 38.9 MB

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, 2024 8 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 Prac...

UCR 172: Part B drugs - calculating reimbursement and how to compare clinically similar drugs for your practice.

November 22, 2023 19:00 - 18 minutes - 13.1 MB

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, 2023 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday New Orleans, January 26 & 27, 2024 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday Reserve your spot and save!  Get signe...

UCR 171:Unlocking Telehealth's Potential in Urology: A Conversation with Lisa Finkelstein

November 17, 2023 01:00 - 30 minutes - 20.9 MB

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...

UCR 171:Unlocking Telehealth's Potential in Urology: A Conversation with Lisa Finkelstein, DO

November 17, 2023 01:00 - 30 minutes - 20.9 MB

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...

UCR 170: CMS Final Rule 2024 - Analysis and Summary

November 10, 2023 21:00 - 42 minutes - 29.1 MB

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, 2023 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday New Orleans, January 26 & 27, 2024 8 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 T...

UCR 169: Integrated Practice Wide RCM, Part - 3: Key Practice Indicators, Data, Analytics, Trends and Implementing

November 02, 2023 20:00 - 35 minutes - 24.6 MB

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,...

UCR 168: FAQs with Dr. John Lin - Can you bill an E/M if provided in a procedure room after cysto?; BCBS not paying for ICD-10: N52.9 ED - unspecified, what to do?

October 26, 2023 16:00 - 50 minutes - 34.9 MB

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...

UCR 167: Incident To - additional clarification; Not prescribed by a physician denial

October 20, 2023 16:00 - 23 minutes - 16.4 MB

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 cla...

UCR 166: Incident To - billing injections; Coding debridement of Fournier's gangrene

October 13, 2023 16:00 - 26 minutes - 18.4 MB

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...

UCR 165: Takeaways from recent national and regional Urology meetings

October 06, 2023 04:00 - 20 minutes - 13.9 MB

October 6, 2023  Ray, Mark, and Scott discuss important topics from recently attended national and regional Urology meetings. 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 Informat...

UCR 164: FAQs - Coding for insertion of an Estring; Trimix billing, what codes should you use?

October 04, 2023 22:00 - 21 minutes - 14.5 MB

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 rece...

UCR 163: FAQs - Hiring Certified Coders; Removal of foley, nurse visit or bladder irrigation? "Modifier Required"; Assistant Surgeon - preop / interop consult?

September 22, 2023 04:00 - 27 minutes - 18.7 MB

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)...

UCR 162: Targeted Probe and Educate (TPE) and Recovery Audit Contractor (RAC) Audits

September 15, 2023 18:00 - 37 minutes - 25.7 MB

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. 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 (C...

UCR 161: Shared split visit clarification and new rules; "Procedure to Provider" edits, PCR code denials

September 08, 2023 15:00 - 30 minutes - 20.7 MB

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 unders...

UCR 160: Exploring the Impact of ModMed: A Conversation with Dr. Eric Tygenhof

September 01, 2023 16:00 - 35 minutes - 24.4 MB

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. 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 C...

UCR 159: Agenda of the 2024 Urology Advanced Coding and Reimbursement Seminar

August 25, 2023 21:00 - 24 minutes - 16.8 MB

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 ...

UCR 158: Coding retrograde pyelogram w/ stent (52332 & 52005); remote physiologic monitoring coding (99457 & 99458); documentation for urodynamics code - 51729

August 18, 2023 16:00 - 34 minutes - 23.9 MB

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. C...

UCR 157: Chronic Care Management reimbursement; coding for scrotal lesion excisions

August 11, 2023 17:00 - 33 minutes - 22.9 MB

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 ar...

UCR 156: How to bill Urocuff in Medicare Advantage Plan; E/M service in global not related to surgery Modifier -24; and urologists billing moderate sedation in hospital

August 04, 2023 04:00 - 26 minutes - 18.3 MB

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 ...

UCR 155: Staff shortages, what can you do?

July 28, 2023 20:00 - 32 minutes - 22.1 MB

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 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 Ce...

UCR 154: Prior Authorizations and Prior Authorization Denials

July 21, 2023 19:00 - 28 minutes - 19.5 MB

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. 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...

UCR 153: 2024 CMS Proposed Rules and how they will impact urology - preliminary analysis

July 14, 2023 19:00 - 25 minutes - 17.3 MB

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 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, Codi...

UCR 152: E/M Medical Decision Making - Problem; visits with Elevated PSAs, and when does prostate cancer reach a level 5 problem?

July 07, 2023 16:00 - 36 minutes - 24.9 MB

 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 ...

UCR 151: FAQs with Dr. John Lin - Increasing 99214-25 denials, what can you do; TURBT and stent placement can this be unbundled?

June 29, 2023 11:00 - 49 minutes - 34 MB

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 t...

UCR 150: Integrated Practice Wide RCM, Part 2 - Point of Service Actions

June 21, 2023 20:00 - 41 minutes - 28.3 MB

 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 p...

UCR 149: Coding for prostatic artery embolization (PAE); Urocuff payment coverage, reports of diagnosis denials

June 16, 2023 04:00 - 32 minutes - 22.2 MB

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    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 Inform...

UCR 148: Coding for MRI fusion biopsy of the prostate; correcting a death date error

June 08, 2023 18:00 - 43 minutes - 29.7 MB

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 M...

UCR 147: Coding for 2 E/M services on the same date/patient; coding for services provided to a patient from an SNF in the office

June 02, 2023 16:00 - 24 minutes - 16.9 MB

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 m...

UCR 146: FAQs - OPPS/ASC multiple procedures; discontinued procedure denial; No Surprises Act - new patient visit; stent placement for promoting healing billable?

May 25, 2023 22:00 - 22 minutes - 15.3 MB

 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 Proc...

UCR 145: Complication modifier (-78) POS discussion; FAQs - laparoscopic evaluation ureter, E/M and therapeutic injection (ADT) in the same visit, code for stone removal using forceps - no cysto

May 19, 2023 12:00 - 34 minutes - 23.9 MB

 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...

UCR 144: Observations from the 2023 AUA Annual Meeting and a quick update on the implications of the PHE ending

May 05, 2023 16:00 - 30 minutes - 21.1 MB

 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.   PRS Network Monthly Webinar Series Recordings: Maximizing Income and Efficiencies for Urology Practices Register for Entire Webinar Series - Free* Registration Now Open: Urology Advanced Coding and Reimbursement Seminar Click Here to Register Now   Las Vegas, December 1&2, 2023 8 am - 4:30 pm Frida...

UCR 143: Coding for Urology Drug Instillation: Jelmyto, Mitomycin, BCG

April 27, 2023 17:00 - 24 minutes - 17.1 MB

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 Click here to download Registration Now Open: Urology Advanced Coding and Reimbursement Seminar Click Here to Register Now   Las Vegas, December 1&2, 2023 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday Reserve your spot and save! As a Urology Coding and Reimbursement Podcast listener, you get access to a disco...

UCR 142: Adopting New Technology and Getting Reimbursed

April 21, 2023 18:00 - 24 minutes - 17.1 MB

 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. Registration Now Open: Urology Advanced Coding and Reimbursement Seminar Click Here to Register Now   Las Vegas, December 1&2, 2023 8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturda...

UCR 141: Optilume coding update; robotic prostatectomy questions: can bill with urethral suspension? If performing with 38571 (BPLND) should you bill the S2900?

April 14, 2023 18:00 - 20 minutes - 14.1 MB

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...