Urology Coding and Reimbursement Podcast

October 30, 2026

In this episode, Scott, Mark, and Dr. Ray Painter break down the AI discussion from the AUA Western Section meeting, where Mark updated attendees on Medicare changes and joined a panel on artificial intelligence in urology. Practices are already using ambient scribes, patient education tools, document consolidation, scheduling, and revenue cycle applications—but Mark cautions that standard consumer AI tools like ChatGPT and Claude are not HIPAA compliant, so practices need to confirm vendor compliance, business associate agreements, and contractual protections before any patient data goes in. AI is not a standard software purchase: it learns and drifts, so every implementation needs vetting up front and ongoing monitoring. The team also covers the AMA's work on CPT coding for AI, CMS's view of software as a different resource model than physician work, who carries liability when AI informs a clinical decision, and the patchwork of state regulation emerging while the federal government stays hands off. Mark and Ray raise the reimbursement concern directly: with CMS already applying an efficiency adjustment to work RVUs, separate payment for AI could end up reducing what physicians are paid for the services AI makes easier. The key takeaway: pick good partners, vet and monitor every AI tool, and keep both patient care and the business of the practice in view while policy catches up. Headed to LUGPA in Chicago? Join PRS for a happy hour on November 4.

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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/

October 23, 2026

In this episode, Scott, Mark, and Dr. Ray Painter take on two questions that came in over the past week. First, quantitative urinalysis: the expanded, stack-coded urine test panels that some practices are starting to use in place of a standard UA. Mark explains why that pattern looks a lot like the early days of PCR testing, why payers are already issuing diagnosis-based medical necessity denials, and why every practice should write protocols for when a quantitative UA is ordered instead of a standard UA—with documentation that supports the reason for the test on that patient. The team also clarifies that meeting a payer's criteria means accurately documenting the patient's actual condition, never adjusting a diagnosis to get paid. Second, modifier 58 on a stent removal: Mark walks through the global surgery package and the three circumstances modifier 58 covers, and explains why a cystoscopic stent removal that was planned at the time of the original stone procedure is a staged procedure that can be reported with modifier 58 on the second procedure—as long as the plan is documented in the pre-operative or operative note. The key takeaway: written protocols, clear communication with the billing team, and documentation that supports medical necessity are what hold up when the payer reviews the record.

PRS Coding and Reimbursement Hub
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PRS Urology Coding and Reimbursement Seminar
Information and Registration

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/

October 16, 2026

In this episode, Scott, Mark, and Dr. Ray Painter share what they heard at the October meeting of the Urology Pharma and Tech Pioneer (UPTP) group—a monthly forum where urology practices from around the country compare notes on new technology, payer behavior, and office workflows. They discuss XIAFLEX acquisition costs now running above ASP plus six and how practices are moving away from buy-and-bill toward specialty pharmacy or other acquisition options, with a reminder that some states, such as New Jersey, restrict in-office dispensing. They review payer-specific payment problems with INLEXZO and ZUSDURI, early Medicare claim sampling, UPIC and RAC record requests, and Anthem prior authorization questions around prostatic artery embolization, and denials for PCR, quantitative urinalysis, and routine dipstick UA. The conversation also covers Altaviva, eCoin, biosimilars, appeal turnaround times of 90 to 120 days, and payers' growing use of AI in claims processing. The key takeaway: documentation and communication—inside the practice and across the urology community—are the foundation for getting paid in an environment that is changing MAC by MAC and payer by payer.

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

PRS Coding and Reimbursement Hub
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PRS Urology Coding and Reimbursement Seminar
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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/

October 9, 2026

In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where the details payers are watching can make or break payment. First, they look at why billing for injected and instilled drugs has become more complex: biosimilars that carry their own Q codes and NDCs, compounded drugs such as interferon being used during the BCG shortage, and rising acquisition costs that Medicare's ASP-based payment has not caught up with. Mark explains why the code and NDC on the claim must match the exact drug given, why most MAC policies call for an unlisted code for compounded drugs with pharmacy labeling and invoices as backup, and why practices should confirm coverage and pricing before the drug is administered. The team then turns to double denials—what to do when a correctly coded claim is denied again after the documentation has been reviewed. Using same-day stone cases as examples, they discuss adding a cover letter that explains medical necessity and context at the second-level appeal, when peer review or an ALJ appeal may be worth pursuing, and how to allocate limited resources as denials and audits continue to escalate. The key takeaway: build the internal team and processes to get the drug details right up front, and stay persistent on appeals when the documentation supports the work that was performed.

PRS Coding and Reimbursement Hub
Access the Hub

PRS Urology Coding and Reimbursement Seminar
Information and Registration

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 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.

 PRS Coding and Reimbursement Hub

Access the Hub

PRS Urology Coding and Reimbursement Seminar

Information and Registration 

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 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.

 PRS Coding and Reimbursement Hub

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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/ 

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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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/ 

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

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 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/