Urology Coding and Reimbursement Podcast

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 Billin...

O ctober 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 ca...

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 w...

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&apo...

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 -...

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...

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 re...

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 ) Documentati...

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 t...

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,...

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 - Brid...

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...

A ugust 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...

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...

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 Pri...

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)  ...

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, a...

 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...

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 Ci...

 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 appl...

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 Fellowshi...

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...

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 c...

 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 endosc...

 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....