Urology Coding and Reimbursement Podcast

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. 50% discount on all Urology Coding Courses Register now Urology Coding Course for Urologists and APPs Urology Coding Course for Coders / Billers and Admins. Specia...

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 pushin...

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...

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...

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! Doe...

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.   Urology Advanced Coding and Reimbursement Seminar REGISTRATION OPEN Live In-Person Events Information and Registration Las Vegas, December 3-4, 2021 New Orleans, January 28-29, 2022 Join the discussion: Urology Coding...

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" anesthe...

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 Recording of the 2022 CMS Proposed Rules and the Impact on Urology Practices webi...

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 Recording of the 2022 CMS Proposed Rules and the Impact on Urology Practices webinar is now available. Go here to view the recording and slides now... Recording/Slides   Urology Advanced Cod...

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 Urology Advanced Coding and Reimbursement Seminar REGISTRATION OPEN Live In-Person Events Information a...

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/   Need help with implementing QPP?  Mark and his consultants can guide you: Schedule a ca...

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: https://www.facebook.com/groups/ThrivingPr...

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. Optimizer Series   Important Revenue Cycle Management (RCM) Metrics;   How to use them to identify and fix...

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?   OPTIMIZER SERIES PART 2   Online Cours...

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 a...

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.   REGISTRATION OPEN Urology Advanced Coding and Reimbursement Seminar - Live In-Person Events Information and Registration Las Vegas, December 3...

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 A...

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 t...

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. _____________________________________________________________________ Join the discussion: Urology Coding and Reimbursement Group - Join for free and ask your questions, and shar...

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...

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 TUR...

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.   Join...

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.    Join the discussion: Urology Coding and Reimbursement Group - Join for free and ask your quest...

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...

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 s...