Urology Coding and Reimbursement Podcast

March 8, 2024

Mark, Scott, and Ray discuss questions that came into the PRS Network.

1. Hello all, I have a CPT coding question,
2. Indications = Urinary Obstruction // Post-Op DX = Obstruction of neck of Urinary Bladder 
3. Resectoscope per urethra into the bladder under direct vision. There was moderate trabeculations with no evidence of mass or stones. The bladder neck was noted to be elevated as seen on prior clinic cystoscopy. This was causing obstruction of the bladder outlet without significant prostatic hypertrophy.
4. The bipolar resectoscope was used with the plasma button attachment to perform a TUIP at 5 o'clock, vaporizing the bladder neck fibers until the bladder neck was able to open properly and drain appropriately. Electrocautery was used for any small bleeding vessels and hemostasis was adequate at the end of the procedure.
5. The recommended Code is: 52450, but the Coder is recommending Code: 52500.
6. We're also taking Codes: 52276 & 52214 into consideration.... Please advise on what you recommend with the Rationale. Any assistance is greatly appreciated.
7. I completed a  tapered ureteral reimplant  50783 on the left and a standard Non tapered ureteral reimplant on the right 50780 - does adding LT and RT modifiers allow both codes to be billed as follows:
   50783 LT
   50780.51.RT  
   does adding R /L mods  address the bundling issue?
   
   Coders noting that 50783 includes 50780 -- however this is  2 different sides and can't bill bilateral tapered 50783.50, as only tapered one side, and bilateral reimplant 50780.50 is undercoded for the additional time and complexity of ureteral tapering 
8. Has anyone billed for bladder injection of Lipiodol before? I have a provider who resected a large bladder tumor, then injected Lipidol in and around the resection site to aid with the patient's radiation planning for invasive bladder cancer. I was thinking this may be included in the 52240, but the office is suggesting unlisted code 53899 benchmarked to 52287 or 52283. Thoughts?

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March 1, 2024

Hosts Scott, Mark, and Ray discuss the upcoming MIPS submission deadline of April 1st and address common questions about MIPS submissions.

Registration is open for the Documentation for Coding and Reimbursement for APPs Course - Starts 3/11/24

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   The Thriving Urology Practice Facebook group.

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   Join the discussion:

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February 23, 2024

Mark, Scott, and Ray discuss questions that came into the PRS Network: 

1. Regarding the most recent podcast episode on shard/split visits: Medicare's policy states that only one practitioner must have face-to-face time with the patient. In our practice the physician documents an addendum on the APP's note with the medical decision making portion of the visit. Per the episode, the physician must demonstrate involvement during the visit (not afterwards) in order to bill under the physician's NPI. Is there a guideline that states the physician must document their portion in real-time as the visit with the APP takes place? If they document the MDM portion of the visit in its entirety, isn't that enough to bill for the "substantive portion of MDM" as required by Medicare?
2. For 52001, we commonly use this code for cysto and clot evacuation for gross hematuria under general anesthesia requiring rigid scope. Are physicians allowed to use this code for cystoscopy and irrigation of a clot with a syringe under local procedure or should they use 52000 + 57000?
3. For 52281, does passage of the cystoscopy to dilate a narrowing in the urethra or meatus count? Or it is only meant to be used for cases where the meatus is cut or dilators or DVIU are used?

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The Thriving Urology Practice Facebook group.

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February 16, 2024

Ray and Scott discuss the importance of documentation for reimbursement.

They emphasize the need to communicate effectively through documentation with billers, computers, and AI systems to ensure accurate coding and payment for services provided. They also mention the significance of using the right words in documentation to justify the level of service, multiple procedures, and modifier usage in order to obtain appropriate reimbursement. Additionally, they talk about the upcoming "Documentation for Reimbursement Challenge" that aims to help urologists and APPs improve their documentation skills for maximum reimbursement.

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The Thriving Urology Practice Facebook group.

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 February 9, 2024

Ray, Mark, and Scott discuss questions that came in about split or shared Visits.

Our questions are:

 When our doctors cover hospital patients, we often have Physician Assistants in the hospital rounding on new and follow up patients. Recently there is an Incident-to policy change, but I don’t think that applies to the hospital PAs since hospital charges cannot be billed incident-to. Regardless, what do you think of the following:

1. Are our physicians able to bill for those visits at 100 percent?
2. If yes, could they still bill via supervisory role to the PAs (i.e., the PA see the patient and discuss the patient’s case with the on call physician. The physician then formulates a follow up plan and communicate it directly to the PA without physically seeing the patient)? Or do the physicians have to physically see the patient to be able to bill?
3. Are physicians able to bill for procedures done by the PAs at the hospital?

Thank you so much for your assistance and guidance on this matter.

G2211 Guidance Document [free download]

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February 2, 2024

Ray, Mark, and Scott answer and discuss the following questions:

1. The seminar this past week was great. I have one question that I asked during the seminar but still not sure of the correct answer. For an initial hospital consultation, I have been using 99223 and generally 99232 for follow up visits. Is this correct.
2. Seeking clarification for the best way to code:
3. Ureteroneocystostomy; anastomosis of single ureter to bladder with vesico-psoas hitch
4. --Robotic approach
5. is it an unlisted code or 50948? Thank you in advance :)
6. I've received several questions recently on whether or not certain procedures can be performed in office by an APP alone (51720, 95972, Eligard/Firmagon injections etc.). Most codes as long as they are not surgical can be performed by an APP since they are a qualified healthcare provider, correct? Not sure where I can find info on this. I did check state statutes but found nothing specific about which procedures. Thanks!
7. If a patient comes in for routine SPT change or lupron injection, and provider states return in a week or month for next change or injection, is that enough for a modifier -25 to billed?
8. For the 99459 we have a gynurologist she does pelvic exams on almost all her patients unsupervised can we still add this code to her visits? Thank you

G2211 Guidance Document [free download]

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The Thriving Urology Practice Facebook group.

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January 19, 2024

Scott and Mark discuss the topics of G2211 and code 99459. They clarify some common questions and confusion surrounding these codes, provide guidance on their appropriate use, and share updates on their experience with Medicare, Medicare Advantage plans, and private payers. They also talk about code 99459 and the importance of documenting the presence or absence of a chaperone during a female pelvic exam.

G2211 Guidance Document [free download]

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___

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January 12, 2024

Scott and Dr. Ray Painter discuss the top issues impacting urologists and their practices.

G2211 Guidance Document [free download]

Click Here for the Link to Download the Guidance Document 

Urology Advanced Coding and Reimbursement Seminar

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New Orleans, January 26 & 27, 2024
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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 Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.

The Thriving Urology Practice Facebook group.

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Join the discussion:

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January 5, 2024

Mark, Scott, and Dr. Ray Painter discuss the new G2211 code.  How it should be used, examples, provide scenarios, and share questions about using the code.

G2211 Guidance Document

Click Here to get free Download Link  (available January 8th, 2024)

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More information and Registration) 

New Orleans, January 26 & 27, 2024
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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 Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.

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December 29, 2023

Mark, Scott, and Dr. Lin discuss topics from the Thriving Urology Practice Facebook Group:

1. There is still no CPT code for extricating the penis from a foreign body, right?
   Guy used a 2.5 pound weight plate as a penis ring. Took an ortho saw to remove it.
   Medtronic Midas Rex handheld device with a circular Diamond bit saw was used to cut the plate at 3 and
   9 o’clock positions. 2 separate Medtronic Midas Rex devices had to be used due to heat generation.
   Complete transection of the plate was performed. Penis was protected from the heat and the blade to
   effect a successful extrication.
2. How do we bridge the gap between those urologists and APPs who are practicing
   happily and getting paid for everything they do, not spinning their wheels, not burning
   out, vs. those who continue to suffer?

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More Information and Registration) 

New Orleans, January 26 & 27, 2024
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

Reserve your spot and save!

 Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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Join the discussion:

Urology Coding and Reimbursement Group - Join for free, ask your questions, and share your wisdom.

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