Urology Coding and Reimbursement Podcast

 May 26, 2023 

Mark, Ray, and Scott discuss 4 questions that came into the Urology Coding and Reimbursement Group.

1. I'm trying to understand the Multiple Procedure Payment Reduction (MPPR) rules for OPPS/ASC payments for endoscopic procedures. Do I use the standard 100%/50%/50% discounting rules for OPPS/ASC payments, or do I use the special rules that apply to the professional fees for endoscopic procedures?
   
   
2. InterStim Procedure Discontinued:
   Pt had an attempted Insertion of Interstim Procedure Stage 1 (INSERTION PERCUTANEOUS STIMULATOR ELECTRODE).  However, procedure was stopped because surgeon was unable to visualize the sacrum completely.  He did try and pass a needle in the area where the S3 foramen should have been but that was unsuccessful.  Procedure was stopped and all needles were removed.  
   
   Medicaid is denying 64561/53 stating they want the anatomical modifier, however I am unable to determine from the op notes what side he planned on placing the electrodes.
   
   After reviewing this I am now wondering if 64561/53 would even be correct since he did not truly start the procedure.
   
   I would love to know your thoughts on this.
   
   
3. No Surprises Act question: 
   Do we have to provide a good faith estimate for the new patient visit too?  Or just for higher dollar services like surgery? 
   
   So if a self-pay new patient comes in and there is no surgery or any other services needed just the new patient visit.  Do we need to provide this patient with a good faith estimate for the visit? 
   
   
4. Hi, 
   When ureteral surgery (pyeloplasty, ureteroureterostomy, etc) is performed and a stent is placed at the end of surgery to promote healing is it separately billable (52332)? or is this an inherent part of the surgery on the ureter? 
   I have conflicting resources but the most recent (2018) states it is not separately billed if placed in the same ureter to promote healing.  And if it was placed in the opposite ureter, for example for hydronephrosis, this might be a billable service? Thank you!

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

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 May 19, 2023 

Mark, Ray, and Scott talk about a question Dr. John Lin asked on a recent Noridian Mac Call about billing a Modifier -78 with POS 11 (hear the recording on the Thriving Urology Facebook Group).  Also, they answer 3 questions that came into the Urology Coding and Reimbursement Group.

1. Robot-assisted Laparoscopic Evaluation of LEFT Distal Ureter:
2. How would you code this? dr put 50949.
3.  Hello,
4. We have a question for your regarding ADT injections/visits for:
5. Eligard injection- HCPCS: J9217
   Camcevi injection-HCPCS: J1952
6. We have recently hired an experienced NP to launch an Advanced Prostate Clinic. For our pts on ADT therapy, can they be seen by our NP and bill a level 3 or 4 office visit as she will be discussing bone health, sexual health, and incontinence issues?
7. What are other clinics doing nationwide for this type of visit and what is appropriate/recommended? Please let me know if there is any additional information I can provide.
8. I really enjoy your webinars, thank you so much for providing this service!
9. [To clarify, this would be for an E/M and therapeutic injection (ADT) in the same visit? ]
10. Thank you,
11. Riley
12. Is there a cpt code for removal of a urethral stone using forceps, no cysto involved?  Every code I see is for cysto with removal. Can we bill a 52310 with a modifier 52 for reduced services? Or should we use unlisted code 53899?  
    
    Thank you!

PRS Network Monthly Webinar Series Recordings:
Maximizing Income and Efficiencies for Urology Practices

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Registration Now Open: 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

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.

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 

 May 5, 2023 

Mark, Ray, and Scott share some general observations from last week's 2023 AUA Annual Meeting in Chicago and Mark gives a quick update on the implications of the PHE ending.

PRS Network Monthly Webinar Series Recordings:
Maximizing Income and Efficiencies for Urology Practices

Register for Entire Webinar Series - Free*

Registration Now Open: 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

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.

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 

April 28, 2023 

Mark, Ray, and Scott talk about coding for urology drug installation.  They use coding for Jelmyto, Mitomycin, BCG as examples.

Jelmyto Billing and Coding Guide

Click here to download

Registration Now Open: 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

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.

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 

 April 21, 2023 

Mark, Ray, and Scott talk about Reimbursement for New technology.  With the 2023 AUA Annual meeting in Chicago coming up they thought it would be a good time to discuss this topic.   Companies often use the AUA meeting to introduce new medical devices, new drugs, and other new medical technology.

Registration Now Open: 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

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.

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 

April 14, 2023

Mark, Ray, and Scott revisit coding for Optilume and provide an update, and also discuss two questions about robotic prostatectomy coding.

1.  Can you share your thoughts on billing 51990 & 55866?  I saw your post in 2018 however wanted to see if you have the same stance in regards to not billing 51990 when performed without incontinence. 
2. When coding a robotic radical prostatectomy with BPLND- 55866 states it includes use of robot so S2900 should not be billed but since 38571 is done as well does that support reporting the S2900?

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April 7, 2023

Larry Kemp joins Mark, Ray, and Scott as a special guest to delve into Integrated Practice Wide RCM in this first part of a two-part series. In the episode, Larry offers his expert insights on what you need to do to make your Pre-service Work effective and efficient.

Schedule a Call with Mark and/or Larry

Click the link to select the date and time below:

https://calendly.com/prsnetwork/call-prsnetwork-consulting?month=2023-04


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Available March 31, 2023

Mark, Ray, and Scott discuss FAQs: 

1. What codes should we capture for OPTILUME?  52276 w/0499T?  Or should we be looking at something else?
2. For an antegrade ureteroscopy done via an established nephrostomy- would you recommend coding 50951 or an unlisted 53899? 
3. When coding for torsion, is the proper coding of px captured with cpt code 54600, if torsion is repaired?  Laterality modifier would be appropriate if the torsion is unilateral, ie: LT or RT.  Correct? If the torsion is bilateral, modifier 50 would be appropriate? After discussing with my co-workers regarding Orchiopexy 54640 versus 54600, we were a bit unsure of the term within the procedure description: Reduction of torsion of testis, surgical, ""with or without fixation of contralateral testis"".  What is the  correct interpretation of fixation of the contralateral side? 

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Pricing and More Information

 The Thriving Urology Practice Facebook Group

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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 March 24, 2023

Mark, Ray, and Scott discuss FAQs: 

1. Would you consider interposition of peritoneal flaps separately billable with a Prostatectomy/lymphadenectomy? “The peritoneum at the dome of the bladder was folded over itself and anchored to the front sides of the bladder”. There is no guidance out there that I can find for coding, other than studies that show it is more of a prophylactic procedure to prevent lymphoceles. I am currently not coding for it but was wanting a second opinion. 
2. With the PHE ending on 5/11/2023, but telehealth being extended thru 12/31/2024, what is the ruling on using non HIPAA compliant platforms such as Facetime?  Will this exception being going away with the 1135 waiver ending ?
3. If a provider is only interested to do a post void residual (51798) and do not have a bladder scanner, can we use the ultrasound information (76857) as a post void residual and charge that way? Can you bill 76857 since the provider interprets the result of the post void residual?  Thank you. 

 Join The Urology Coding Compliance and Education Network and get started today!

Pricing and More Information

 The Thriving Urology Practice Facebook Group

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 

March 17, 2023

Ray and Scott discuss a question that came into the PRS Community: When your coder and EMR disagree, what do you do?

 Join The Urology Coding Compliance and Education Network and get started today!

Pricing and More Information

 The Thriving Urology Practice Facebook Group

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