Urology Coding and Reimbursement Podcast

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

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

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. PRS Coding and Reimburse...

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...

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. Free Kidney Stone Coding Calculator Download Now PRS Billing and Other Services - Book a Call with Mark Painter or  Marianne Desciose Click Here to Get More Infor...

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. Free Kidney Stone Coding Calculator Download Now 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 Pi...

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 urol...

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...

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. Free Kidney Stone Coding Calculator Download Now PRS Billin...

 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. Th...

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, documentati...

 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 uro...

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 ha...

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. Free Kidney Sto...

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...

 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 pers...

 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 Download Now PRS Billing and Other Services - Book a Call with Mark Painter or  Marianne Desciose Click Here to Get More Inf...

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...

J anuary 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. Free Kidney Stone Coding Calculator...

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 Download Now Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA Register Now for the Urology Advanced Coding and Reimbursement...

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 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...

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 Click Here for Information and Registration Event Details Location : New Orleans: January 31-February 1, 2025, at Harrah's Time : Friday 8...

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 Click Here for Information and Registration Event Details Location : New Orleans: January 31-February 1, 2025, at Harrah&apo...

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, 202...

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 yo...