Urology Coding and Reimbursement Podcast

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 discuss...

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 targ...

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...

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 sm...

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...

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 enviro...

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-admin...

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 51...

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 t...

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...

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 au...

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 diagnos...

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...

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 stee...

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 cen...

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 ma...

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 droppi...

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...

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...

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. PRS Coding and Reimbursement Hub Access the Hub   Free Kidney S...

J uly 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. PRS Coding and Reimbursement Hub Access the Hub   Free Kidney Stone...

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. PRS Coding and Reimbursement Hub Access the Hub   Free Kidney Stone Coding Calculator Download Now PRS Coding Courses For Urol...

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 postope...

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. PRS Coding and Reimbursement Hub Access the Hub Jelmyto Coding and Reimbursement Page...

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 cus...