Urology Coding and Reimbursement Podcast
242 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.
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Episodes
UCR 192: Payer Communication - reporting services that are not payable during a global period
April 22, 2024 20:00 - 16 minutes - 11.6 MBApril 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 Certif...
UCR 191: FAQs - G2211 age restrictions; void trial fail coding; gemcitabine instillation coding; and scrotoplasty simple v. complicated
April 12, 2024 18:00 - 23 minutes - 15.9 MBApril 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. 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 perfor...
UCR 190: Enhancing Urology Practice Efficiency - New Training Courses Explained
April 03, 2024 19:00 - 27 minutes - 18.6 MBApril 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 nece...
UCR 189: Urology Practice Business and Leadership Insights with Dr. David J. Ellis
March 28, 2024 23:00 - 42 minutes - 29.2 MBMarch 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: https://www.facebook.com/groups/ThrivingPractic...
UCR 188: Change Health cyberattack updates, G2211 developments, FAQs - Urodynamics authorization, taxonomy multi-specialty practice
March 21, 2024 23:00 - 29 minutes - 20.6 MBMarch 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 MBMarch 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 MBMarch 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 MBMarch 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 MBMarch 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 MBFebruary 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 MBFebruary 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 MBFebruary 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 MBFebruary 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 MBJanuary 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 MBJanuary 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 MBJanuary 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 MBDecember 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 MBDecember 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 MBDecember 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 MBDecember 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 MBDecember 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 MBNovember 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 MBNovember 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 MBNovember 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 MBNovember 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 MBNovember 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 MBOctober 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 MBOctober 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 MBOctober 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 MBOctober 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 MBSeptember 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 MBSeptember 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 MBSeptember 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 MBSeptember 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 MBSeptember 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 MBAugust 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 MBAugust 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 MBAugust 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 MBAugust 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 MBJuly 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 MBJuly 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 MBJuly 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 MBJuly 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 MBJune 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 MBJune 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 MBJune 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 MBJune 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 MBJune 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 MBMay 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 MBMay 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...