Urology Coding and Reimbursement Podcast

December 22, 2023

Mark, Ray, and Scott answer questions from the PRS Urology Coding Community:

1. I have multiple providers who want to bill 55867 & 51860 for the same procedure. While there’s isn’t an NCCI Edit for these codes, you can see that the procedure description includes both the making of an incision in the bladder wall and then later the suture repair. Coding guidelines dictate that since you could not perform the main surgical procedure without the minor one, then the minor is bundled into the major. As a coder I don't feel that there is support for separate reimbursement when the two codes are routinely billed together. Their contention is that there are 2 ways to do a simple prostatectomy. The first is through the capsule of the prostate gland without a bladder incision. The simple prostatectomy code has traditionally encompassed the first way of not making a bladder incision and if an incision was made then a cystorrhaphy was billed. With the addition of the new code specifically for the simple prostatectomy, I would like some direction on how these codes should be billed.
2. Have you been able to lookup what the reimbursement will be for the new CPT code 99459 for female pelvic exam?
3. Can 51741 and/or 51798 be billed twice on the same day?
   For example, if a patient does the first urofow and the volume is not adequate and then we have him drink and come back later for a second uroflow. 
4. When billing 51700 for voiding trial post-op after prostatectomy (90 day global), is a modifier needed ? Such as modifier 58

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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The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

Join the discussion:

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

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 December 15, 2023

Mark, Ray, and Scott welcome Dr. Richard Pelman to discuss the importance of State Urology Societies and why you should participate.

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

December 8, 2023

Mark, Ray, and Scott welcome Dr. John Lin to discuss the 2024 Urology Coding and Reimbursement Seminar and share their thoughts about the 2024 Urology Coding and Reimbursement Seminar in Las Vegas, on December 1st and 2nd, 2023.

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

December 1, 2023

Mark, Ray, and Scott welcome Dr. Jonathan Rubenstein to discuss the big CMS changes for urology in 2024 and how to implement them.

 
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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

November 22, 2023

Mark, Ray, and Scott discuss Part B drugs and how a practice can compare clinically similar drugs.

Telehealth Resource Centers

https://telehealthresourcecenter.org/

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More information and Registration) 

Las Vegas, December 1 & 2, 2023
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

 Mark Painter and PRS Consulting

Schedule a call with Mark Painter or Larry Kemp / PRS Consulting

November 17, 2023

Mark, Ray, and Scott have a conversation with Dr. Finkelstein about Telehealth in Urology.

Dr. Finkelstein's expertise illuminates key considerations for urologists seeking to harness the potential of telemedicine, offering a roadmap for successful implementation. This episode equips listeners with invaluable knowledge to navigate and leverage telehealth for enhanced patient outcomes and practice efficiency in urology.

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More information and Registration) 

Las Vegas, December 1 & 2, 2023
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

 Mark Painter and PRS Consulting

Schedule a call with Mark Painter or Larry Kemp / PRS Consulting

November 10, 2023

Mark presents the summary of the newly released CMS 2024 Final Rule.

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More Information and Registration) 

Las Vegas, December 1 & 2, 2023
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

Mark Painter and PRS Consulting

Schedule a call with Mark Painter or Larry Kemp / PRS Consulting

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 Billing Fellowship - Urology (DCB-FS)

 For Coders, Billers, and Admins
(Click Here for Pricing, More Information, and Registration)

Documentation, Coding, and Billing Specialist Certification (DCB-SC)
Documentation, Coding, and Billing Master Certification (DCB-MC)

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More information and Registration) 

Las Vegas, December 1 & 2, 2023
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

October 27, 2023 

Mark and Scott welcome back John Lin to answer more questions that have come into the Thriving Urology Practice Facebook Group. 

1. Can I bill for a modifier- 25 if the E&M service was provided in the procedure room where the patient had a cystoscopy?
2. BCBS is not paying N52.9 for office visit E&M. What is the replacement code?
    

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 - Urology (DCB-FS)

 For Coders, Billers, and Admins
(Click Here for Pricing, More Information, and Registration)

Documentation, Coding, and Billing Specialist Certification (DCB-SC)
Documentation, Coding, and Billing Master Certification (DCB-MC)

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More information and Registration) 

Las Vegas, December 1 & 2, 2023
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com

October 20, 2023 

Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group.

1. 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
2.  This is in regards to Optilume, cat III code 0499T.  I know there will be a cat I code of 52284 that will take effect 1/1/2024, so we sent one claim in with the cat III code of 0499T.  Medicare denied it and the claim adjustment code given was PR-173.  Balance is the patient's responsibility due to the fact that 'service/equipment was not prescribed by a physician".  Does this mean we need to write a script for the drug on the balloon??  It just doesn't make sense to me......... 

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 - Urology (DCB-FS)

 For Coders, Billers, and Admins
(Click Here for Pricing, More Information, and Registration)

Documentation, Coding, and Billing Specialist Certification (DCB-SC)
Documentation, Coding, and Billing Master Certification (DCB-MC)

Urology Advanced Coding and Reimbursement Seminar

(Click Here for More information and Registration) 

Las Vegas, December 1 & 2, 2023
8 am - 4:30 pm Friday, 8 am - 3:30 pm Saturday

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:

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

Join the discussion:

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

Click Here to Start Your Free Trial of AUACodingToday.com