Urology Coding and Reimbursement Podcast

March 10, 2023

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

1.  We want to do a prehab clinic for patients to improve conditions before surgery. They would be using a PT/Dietician to help improve post op complications. The reason we are contacting you is we are trying to find out the best coding scenario for this. What would you suggest regarding CPT/DX? Would we be able to do an E/M with coding such as muscle weakness etc.?
2. We are having an issue with BCBS Medicare advantage claiming we are using 51701 inappropriately.  I was not aware there were other codes for passing a straight catheter, but it was brought to our attention that we should be using P9612.  Have you guys run into this before? any guidance you can offer in clarification of the use of 51701.  When i was looking into this P9612 is also implying taking the urine sample from an indwelling SPT or foley, not necessarily the act of placing the disposable straight catheter in the patient to collect the sample.  
3.  
4. Have you guys seen this?  what are your thoughts on 51701 vs P9612.  This is my first time seeing this.

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© 2023 Physician Reimbursement Systems, Inc.

March 3, 2023

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

1. Do you have any suggestions for CPT code for the penis stuck in the foreign object /plastic bottle on penis/per op repor "tonge depressor w KY jelly placed under mouth of the botle dorsal aspect of penis, cast cutter utilized to make two adjacentcuts in mouth of bottle"
   Should I bill for unlisted 55899, but what crosswalk apply?
   Thank you so much!
2. Group visits - can you bill for the time spent in a group visit with patients?

 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.

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February 24, 2023

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

1.  I listened to the most recent podcast episode regarding the updated PCNL codes and I'm still confused on why we can't bill 50436 or 50437 with 50080/50081? Dilation was deleted from the code description and I attended an AUA webinar in Dec 2022 that said the dilation could be reported separately. What's changed?
   
   
2. Good morning, Does 50548 include laparoscopic bladder cuff, or would the bladder cuff be separately billable with 51999? Bladder cuff is not mentioned in the code descriptor.
   
   
3. It was discussed at New Orleans seminar that retrograde pyelogram (74420) was not appropriate to report with stent exchanges/ureteroscopic procedures (as it is considered included as part of the guidance for these procedures). Is this direction based on CPT guidance or is there another reference? 

 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 

February 17, 2023

Mark, Ray, and Scott welcome back Dr. John Lin to discuss telehealth in 2023 and learn about the new changes.  Dr. John Lin shares his best practices based learned from over 4000 audio and video telehealth encounters.

The telehealth platform that Dr. John Lin uses:  https://doxy.me/ 

Get The Urology Plan - Documentation, Coding, and Billing Compliance and start 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 

 February 10, 2023

Mark, Ray, and Scott discuss questions and current topics.

1. "Good afternoon,
   Our practice has a lot of mid-level physicians.  The question has arose about “direct'  supervision and provider being immediately available.   I provided the below-
   How does Medicare define direct physician supervision?
   
   Direct supervision: The physician or AP providing supervision must be “immediately available” and “interruptible” to provide assistance and direction throughout the performance of the procedure; however, he or she does not need to be present in the room when the procedure is performed.
   
   One of the mid levels shared this:  In the office but not immediately available.  Remind physicians that they should not perform procedures while supervising incident-to visits.  The supervising physician must be able to drop what they are doing right away, even if the physician is performing a relatively simple procedure such as a trigger point injections, that would break the requirement that the physician be ready if the non-physician practitioner needs help or guidance.
   
   Now I am getting all kinds of questions.
   
   The rule above is only pertaining to “incident to” situations correct?  if the APP is listing a supervising provider for the day for insurance purposes only: such as the insurances that don't recognize /credential mid-levels (UHC for instance) would/should you follow the same rule as above?  How are other practices handling this?
   
   
2. Hello  *Independent Interpretation of test*
   
   If we own the CT and US machines can our providers still get credit for interpreting films done in our office? We do bill these studies global once the radiologists does his reading.
   
   
3. Our office has purchased equipment to start doing creatinine tests (82565) on contrast CT patients in the office.  Is this billable? And what codes would we bill?  What are the documentation requirements?
4. If I bill only for CPT 51798 and 51741. Can only the MA /technician being the signer or does it need to be MD as a billing provider.
   
   Thank you!

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Pricing and More Information

 The Thriving Urology Practice Facebook Group

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Dr. John Lin's interview with Dr. Sarabeth Martin

 https://youtu.be/_N2NfWBiAqA

 Urology Advanced Coding and Reimbursement Seminar  - Registration Open

New Orleans, LA - January 27-28, 2023

Register Now

 Please submit scenarios you would like us to cover to [email protected]

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 

  February 3, 2023

Mark, Ray, and Scott discuss questions and current topics.

1. CODE 50081 - Our providers are interpreting the use of imaging guidance i.e. fluoroscopy to create the tract and imaging guidance to remove the stones. Not for the imaging to position of the neph tube at the end of the case - Can you confirm?
2. Establishing access with PCNL procedure was discussed and CPT codes 50436/50437 were suggested to report for the access created with PCNL when Urologist performs this. However, I have seen AUGS guidance which suggests 50432-52 (since tube is include in PCNL) would be appropriate to report when access is created by Urologist for PCNL procedure. Which is correct? 50436/37 state "existing tract" in CPT verbiage which is confusing.
3. Urodynamics:
   I have a denial from the insurance company for 51741. They are stating that they are following the International Incontinence Society guidelines that the pressure flow void volume should be >150ml. Not sure on where this information is from. I did not think that it had to meet certain standards.
4. Does anyone have guidance on the billing pricing for 0421T? Medicare doesn't have a fee schedule, but that doesn't mean they won't pay it if billed.
   Thanks for your help!
5. Can I bill CPT 0421T with the modifier 22 if supported in medical records?
6. So, if our physician(s) orders the CT, but it is performed at an outside entity, would they be able to count the review and interpretation of that CT? Also, if the ordering physician does review and interpret the CT, then refers the patient to one of their partners for a procedure/surgery and that physician documents they have reviewed and interpreted, who or how would that be counted?

Purchase the PRS Urology Documentation, Coding, and Billing Plan and start implementing it today!

Pricing and More Information

 The Thriving Urology Practice Facebook Group

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

Dr. John Lin's interview with Dr. Sarabeth Martin

 https://youtu.be/_N2NfWBiAqA

 Urology Advanced Coding and Reimbursement Seminar  - Registration Open

New Orleans, LA - January 27-28, 2023

Register Now

 Please submit scenarios you would like us to cover to [email protected]

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 

 January 20, 2023

Ray, Mark, and Scott discuss what a Urology Documentation, Coding, and Billing Plan should include and what PRS has put together for you to efficiently and cost-effectively implement a plan.

Purchase the PRS Urology Documentation, Coding, and Billing Plan and start implementing it today!

Pricing and More Information

 The Thriving Urology Practice Facebook Group

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

Dr. John Lin's interview with Dr. Sarabeth Martin

 https://youtu.be/_N2NfWBiAqA

 Urology Advanced Coding and Reimbursement Seminar  - Registration Open

New Orleans, LA - January 27-28, 2023

Register Now

 Please submit scenarios you would like us to cover to [email protected]

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 

 January 13, 2023

Ray and Scott discuss the top 3 reasons why you should have a good documentation, coding, and billing plan:   1) money   2) time   3) peace of mind 

 The Thriving Urology Practice Facebook Group

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

Dr. John Lin's interview with Dr. Sarabeth Martin

 https://youtu.be/_N2NfWBiAqA

 Urology Advanced Coding and Reimbursement Seminar  - Registration Open

New Orleans, LA - January 27-28, 2023

Register Now

 Please submit scenarios you would like us to cover to [email protected]

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 

© 2023 Physician Reimbursement Systems, Inc.

January 6, 2023

Mark, Ray, and Scott discuss the new law's impact on urology.   CMS released updated national Medicare physician payment files that incorporate the changes in the Consolidated Appropriations Act of 2023. Specifically, Congress reduced the 4.5% cut to Medicare physician payment by increasing the 2023 conversion factor by 2.5%. The updated 2023 Medicare physician payment schedule conversion factor will be $33.8872. The previously finalized conversion factor was $33.0607. The 2022 conversion factor was $34.6062.

Also, they have a discussion about the CCI Modifier -25 guidelines:

"If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. In general, E&M services performed on the same date of service as a minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25."

Want to talk with Larry Kemp, FACHE?

Please email us at [email protected]

 Urology Advanced Coding and Reimbursement Seminar  - Registration Open

New Orleans, LA - January 27-28, 2023

Register Now

 Please submit scenarios you would like us to cover to [email protected]

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 23, 2022

Mark, Ray, and Scott welcome Larry Kemp, FACHE to discuss compensation plans and how to approach in 2023.

Want to talk with Larry Kemp, FACHE?

Please email us at [email protected]

 Urology Advanced Coding and Reimbursement Seminar  - Registration Open

New Orleans, LA - January 27-28, 2023

Register Now

 Please submit scenarios you would like us to cover to [email protected]

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