Urology Coding and Reimbursement Podcast

October 13, 2023 

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

1. 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?
2. Are 11006 and 97606 appropriate here for wound vac?
   
   OPERATION: Debridement of Fournier's gangrene.
   
   DRAINS: Wound VAC, 16-French Foley catheter.
   
   OPERATIVE TECHNIQUE: The patient was brought into the operating room, placed in supine position on the operating room table. After administration of IV antibiotics and anesthesia, the patient was repositioned in dorsal lithotomy position, prepped and draped in the usual sterile fashion. The wound measured approximately 30 cm x 14 cm and went from the left inguinal region through the left perineum and to the posterior left buttocks. Using a curettage, we proceeded with additional debridement of all the raw surfaces. Spot electrocautery was used as needed for hemostasis and the wound was irrigated copiously with antibiotic irrigation. The sharp debridement was done to the level of the dartos fascia and Colles fascia. Once we had finished the sharp debridement, we went ahead and decided to place a wound VAC. A black sponge was placed into the wound and then carefully placed using the sticky plastic and put it to suction. Given the location, it was a bit challenging but we were able to place the wound VAC to suction. Given that the wound extended near the posterior buttocks, it was near the anus which would likely be an issue for maintaining suction if the patient had a bowel movement. The patient tolerated the procedure well.

Mark Painter and PRS Consulting

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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
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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

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Use code: 24UACRS733

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October 6, 2023 

Ray, Mark, and Scott discuss important topics from recently attended national and regional Urology meetings.

Mark Painter and PRS Consulting

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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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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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September 29, 2023 

Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:

1. 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 device. 57170 is diaphragm or cervical cap fitting with instruction. In the AAPC post that is most recent (9/10/21) they said to use 57170 for the Estring. If 57170 is mostly to prevent pregnancy, I can't see how this would be appropriate for a woman in menopause.
2. Hello. I have a question regarding trimix billing. I know that there is not a HCPCS code since it is a compound drug. From my own research i have found conflicting information with some saying to bill each drug separately and others to bill unlisted J3490. In your opinion, what is the best practice for coding Trimix? Thank you!

Mark Painter and PRS Consulting

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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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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:

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September 22, 2023 

Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:

1. 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.
2. Patient has a nurse visit for removal of a foley catheter that was placed during a procedure with a 00-day global (i.e TURBT). Visit was 2 days after surgery. Documentation by nurse states; Pt in for foley cath removal. 10 ml sterile water removed from balloon, balloon deflated, foley cath removed. Pt tolerated well. Should we be billing a 99211 nurse visit, a 51700 for bladder irrigation or considered part of the surgical package and would not be billable?
3.  My question is what if I use a modifier that Coding Today indicates a modifier is required, and the insurance company still denies the second procedure with the modifer as included in the primary procedure, such as CPT's 52332 and 52005-59. Is this appealable?
4. To clarify the Assistant Surgeon, is this is completely separate from a pre op consult to place stents for ureteral identification or an intraop consult for cystoacopy or foley placement or to repair a bladder injury?

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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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

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)

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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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

September 8, 2023 

Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:

1. 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 to be based on time and feel should be billed as the APP doing the substantive work. Our understanding is that those changes (time based only) were delayed until 2024, so for remaining 2023 the physician can continue to be the billing provider as long as we are doing the MDM element as the “substantive portion.”
   Any further clarification available?
   (Also In that scenario, would it be conceivable to be the billing provider even in the absence face to fave encounter if the elements of MDM are met. Thoughts?)
2. Does anyone know where to find "Procedure to Provider" edits? We have a PCR lab in Illinois and two of the billed codes are being denied with CO B7 reason code.  This reason code indicates the provider is not eligible for

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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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

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, 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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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/ 

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 - Bridging the Gap
• Breakout Session A2 - Navigating Urologist Compensation and Practice Options

DAY 2

• Annual Update - Urology Coding and Reimbursement
• Mastering Modifiers and the Global Package
• Journey of a Urologist
• Ensuring Urology Coding Compliance
• Urology Coding Workshop
• Urology ICD-10 Coding 

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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (expires 8/31/23).

Use code: 24UACRS733

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

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):

1. 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?
2. Hello, I have a question regarding CPT code 99457 & 99458. I have a provider who is working with Starling pilot and wanted to start billing these codes. Can you please advise what are the guidelines for these codes? Thank you so much!
3. Hello, I have a question regarding urodynamics. I have a new provider selecting code 51729 but when reviewing his documentation I do not see an urethral pressure profile study. What should the documentation include to capture this code? Are there certain values we should be looking for?
4.  

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 to Register Now  

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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).

Use code: 24UACRS733

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 

August 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):

1. 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 our providers will be treating and managing the cancer but as for as the diabetes goes they are not treating this or managing it in any way. Would we still be able to use this in out CCM billing?
2. Hi, What CPT code set would you bill for Excision Scrotal Lesion(s)? (Path Report: Benign). Would you code with 11420-11426 or 11106-11107 or 54060 or something else? NOTE DETAILS: FINDING(s): Numerous scattered superficial skin lesions, In total 20cm skin removed. "We began by marking out the areas of concern with elliptical incisions. There were numerous lesions but they were spread out enough that we decided to do multiple separate incisions. After the lesions were marked the skin was anesthetized with 0.5% Macaine. Incisions were made sharply along the previous marked ellipse. The skin was then carefully dissected sharply from of the underlying dartos tissue. Hemostasis was achieved with bipolar cautery. This was repeated for all lesions."

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 to Register Now  

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!

As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).

Use code: 24UACRS733

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