Urology Coding and Reimbursement Podcast

September 25, 2026

In this episode, Scott, Mark, and Dr. Ray Painter break down the 2026 prostate biopsy coding changes and the documentation details that determine which code should be used. They review transrectal versus transperineal approaches, ultrasound-guided versus MRI-fusion biopsies, systematic versus targeted sampling, and when the add-on code for additional targeted lesions may apply. The team also discusses diagnosis coding, current denial trends, the risks of separately billing imaging guidance that is already built into the biopsy codes, and considerations for performing transperineal biopsies in the office. The key takeaway: prostate biopsy coding now depends heavily on approach, imaging method, targeting, and precise documentation—so getting the details right is essential for compliant reimbursement.

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   The Thriving Urology Practice Facebook group.

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September 11, 2026

 In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose take a closer look at the growing number of RAC audits, UPIC reviews, and medical record requests facing urology practices. They discuss current areas of scrutiny, including sacral neuromodulation, UTI PCR testing, newer technologies, and high-dollar procedures, while emphasizing the importance of meeting LCD, LCA, and payer documentation requirements before the claim ever goes out. The team also walks through how to respond when an audit arrives, including timelines, record selection, internal checklists, appeal strategy, and when legal or clinical support may be necessary. The key takeaway: getting paid is only half the battle—strong documentation, organized workflows, and a disciplined audit response process are essential to keeping the money you have already earned.

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Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

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For APPs

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Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

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   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

September 11, 2026

 In this episode, Scott and Mark Painter are joined by Dr. John Lin to tackle several practical coding and reimbursement questions from the urology community. They discuss whether there is a right number of CPT codes to include on a prior authorization, when catheter and other DME supply A-codes can—or cannot—be separately billed, and how those rules apply to Foley catheter changes and BCG instillations. The conversation also explores the growing use of AI for coding research and why an answer that sounds authoritative may still be wrong. The key takeaway: use AI as a tool, but understand the fundamentals, ask the right follow-up questions, and always verify important coding answers against primary sources.

 PRS Coding and Reimbursement Hub

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Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

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PRS Coding Courses

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For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

September 4, 2026

In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marinne DeSciose take a deeper look at the sharp increase in payer downcoding and the growing workload it creates for urology practices. They discuss how downcoded E/M claims can quietly reduce revenue, why these adjustments may not show up clearly in traditional AR reports, and how practices can build workflows to identify, review, and appeal them efficiently. The team also explores when the return on investment justifies the additional staff time, how provider documentation and audit performance should influence the appeal process, and why practices need ongoing monitoring even after a payer appears to stop downcoding. The key takeaway: downcoding is becoming a significant revenue-cycle issue, and practices need a deliberate strategy to decide when to fight, when to change workflows, and when a payer relationship may no longer be worth the effort.

 PRS Coding and Reimbursement Hub

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Botox LCD Alert

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Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

August 28, 2026

In this episode, Scott, Mark, and Dr. Ray Painter review where telehealth stands today and why it is becoming an essential part of the future of urology care. They discuss Medicare’s current rules for audio-visual and audio-only visits through 2027, documentation requirements, place-of-service rules, telehealth for hospitalized patients, and the importance of state licensure. The team also looks ahead to Medicare’s proposed 2027 group medical visit model and explores how telehealth can improve access, increase efficiency, support remote monitoring, and become a true line of business within a urology practice. The key takeaway: telehealth is no longer just a temporary convenience—it is becoming a foundational part of how practices will deliver care.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

August 21, 2026

In this episode, Scott, Mark, and Dr. Ray Painter revisit the coding and documentation requirements for cystoscopic bladder tumor treatment. They discuss why tumor size—not the size of the resection bed—drives code selection, how multiple tumors are handled, and why documenting the exact bladder location is increasingly important for diagnosis coding. The team also explains when to use malignant, uncertain, or unspecified neoplasm codes, why you should code based on what is known at the time of the procedure, and when a same-day bladder instillation may or may not be separately billable. The key takeaway: bladder tumor coding is highly detail-dependent, and accurate documentation of size, location, diagnosis, and any separately performed services is essential to support reimbursement

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

August 14, 2026

In this episode, Scott and Mark Painter revisit ABNs and the growing importance of collecting directly from patients as more financial responsibility shifts away from payers. They discuss when ABNs are appropriate, cash-pay options, co-pays, deductibles, co-insurance, surgical deposits, and the value of collecting before services are rendered. The conversation also explores how practice culture, staff training, front-desk policies, geography, and patient demographics can influence collection success. The key takeaway: strong patient collection processes are no longer optional—they are a critical part of protecting the financial health of a urology practice.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

August 7, 2026

In this episode, Scott, Mark, and Dr. Ray Painter answer three reimbursement questions involving common—but increasingly scrutinized—coding situations. First, they discuss when a urologist can separately bill the professional component of a radiologic service such as retrograde urography on the same day as an E/M service, including the documentation requirements and potential conflict when radiology also bills for the interpretation. Next, they examine a ureteroscopy denial caused by an inconsistent diagnosis code and explain how to properly distinguish kidney and ureteral stones with and without hydronephrosis. Finally, they tackle another modifier 25 denial and explain why simply citing NCCI rules in an appeal may not be enough—the documentation must clearly demonstrate the significant, separately identifiable E/M service that supports the modifier.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

July 31, 2026

In this episode, Scott, Mark, and Dr. Ray Painter answer three detailed listener questions. First, they discuss whether an E/M service can be billed when a urologist evaluates a patient on the hospital floor and then decides to take the patient to the operating room for stone treatment or stent placement. Next, they examine payer denials involving laparoscopic radical prostatectomy with bilateral pelvic lymphadenectomy and whether all listed lymph node groups must be removed to support code 55869. Finally, they explain how to report bladder stone removal performed through the same laparoscopic incision as a simple prostatectomy—and why the surgical approach may require an unlisted bladder procedure code.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

July 24, 2026

In this episode, Scott, Mark, and Dr. Ray Painter examine a major shift in Medicare’s approach to coding UTI PCR testing. The discussion explains why reimbursement may now depend on the number of testing kits, methodologies, or procedures used—not simply the number of organisms reported—and what practices should review with their laboratory partners. The team also addresses denials, RAC and UPIC audits, corrected claims, potential commercial payer takebacks, and the continuing uncertainty in MolDX states. They then review the proposed 2027 RVU changes affecting urology, including a significant increase for in-office bulking agent injections, potential reductions for urodynamics, and additional changes to prostate biopsy codes.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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