Urology Coding and Reimbursement Podcast

July 29, 2022

Ray, Mark, and Scott discuss a question regarding injection codes and why it may be an excellent decision to bill the injection code even though you know it will probably be denied.

 Compliance Plans

Questions or need help, please send us an email: [email protected] 

  Join the discussion:

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

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July 22, 2022

Ray, Mark, and Scott discuss a question regarding antegrade ureteroscopy with laser lithotripsy to treat a ureteral stone and compliance plans.

 Compliance Plans

Questions or need help, please send us an email: [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 

July 15, 2022

Ray, Mark, and Scott discuss the 2023 CMS Proposed Rules and how they will impact Urology Practices.  Mark breaks down what's important to urology in the new proposed rules.

 Urologists’ Coding Workshop

July 23, 2022 - 10 am - 3 pm EST

Register Now

Special 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate).

"Beef Up" On your Urology Coding Knowledge

PRS Network Presentation Team

• Dr. John Lin
• Mark Painter
• Scott Painter
• Dr. Ray Painter

From the perspective of a practicing Urologist and experts In Urology Coding.

The majority of your income is from what you do in the clinic...

 Happy Coding!

  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 

July 8, 2022

Mark, Scott, and Ray clarify some concept nuances that may have been misinterpreted or misunderstood.

 Urologists’ Coding Workshop

July 23, 2022 - 10 am - 3 pm EST

Register Now

Special 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate).

"Beef Up" On your Urology Coding Knowledge

PRS Network Presentation Team

• Dr. John Lin
• Mark Painter
• Scott Painter
• Dr. Ray Painter

From the perspective of a practicing Urologist and experts In Urology Coding.

The majority of your income is from what you do in the clinic...

 Happy Coding!

  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 

July 1, 2022

Mark, Scott, and Ray discuss ICD-10 "Unspecified" codes and the increase in denials.

 Urologists’ Coding Workshop

July 23, 2022 - 10 am - 3 pm EST

Register Now

Special 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate).

"Beef Up" On your Urology Coding Knowledge

PRS Network Presentation Team

• Dr. John Lin
• Mark Painter
• Scott Painter
• Dr. Ray Painter

From the perspective of a practicing Urologist and experts In Urology Coding.

The majority of your income is from what you do in the clinic...

 Happy Coding!

  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 

June 24, 2022

Mark and Scott welcome Dr. John Lin to the podcast to discuss in detail Modifier -25.

Skyline Urology to Pay 1.85M to Settle False Claims Act Allegations of Medicare Overbilling 

https://www.justice.gov/opa/pr/skyline-urology-pay-185-million-settle-false-claims-act-allegations-medicare-overbilling 

Also Corporate Integrity Agreement 

OIG Audit Modifier 25

https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf

NCCI Policy Manual: https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare 

Chapter 7: GU System

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. 

Cigna:  

https://www.cmadocs.org/newsroom/news/view/ArticleId/49780/Cigna-to-require-medical-records-for-all-modifier-25-claims
Cigna’s Modifier Policies: https://static.cigna.com/assets/chcp/resourceLibrary/clinicalReimbursementPayment/medicalClinicalModifiersPolicies.html

Cigna’s Modifier 25 Policies:
https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf 

Horizon BCBS: Beginning on August 1, 2022

https://www.horizonblue.com/providers/news/news-legal-notices/claim-reimbursement-update-e-m-codes-appended-modifier-25 

BCBS of Massachusetts: Effective July 18, 2022, 

https://provider.bluecrossma.com/ProviderHome/portal/home/news/news/claims-coding-payment/all%20networks/!ut/p/z0/rZBNb8IwDIb_Sjj0OMUU6ODYsbVl0E1oApVcJtMGyEiTkkZl_PulaEP70G4c4_eJ_diU0YwyhY3YohVaoXTvFQteE38y7k6H8BwHywjms_5o6N8uAOYBfaTMAcswSO6ixIdhGkUwefLjcBHFPRj12w7i7XBgIWW5Vpa_W5pVRjei4IZU2liU5BwoS6RYGzQnDy5A7soGpavs0JSYu0wbFwi1JSUvRH4WrT0oUUhSc9OInJMv-NPuog8T_x7mD93kpRdNexAH17KrLaoCpVbcAzT5TjS8IIof63aAb9JxuqWsQru7EWqjafaT-WX598j_NJHS_bdHbfb1tRZpfTzIJYqydnzR3rnCU-lyt9n3gdWerQeymW1SO1iFnc4H0ChcIg!!/ 

June 17, 2022

Mark and Scott discuss the most popular topics of the first 100 episodes and why they were popular.

 ​NEW ONLINE WORKSHOP - Urologists’ Coding Workshop

Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).

"Beef Up" On General Coding Knowledge

PRS Network Presentation Team

• Dr. John Lin
• Mark Painter
• Scott Painter

From the perspective of a practicing Urologist and experts In Urology Coding.

The majority of your income is from what you do in the clinic...

It's a great idea to make your life as easy as possible. 

Mastering medical coding will ensure you reach the pinnacle of your game, so you can have time and energy for patient care and a happy life.

Join us for the Urologists’ Coding Workshop so we can help you get there!

Register Now

Happy Coding!

  Join the discussion:

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

June 10, 2022

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

 1) Can we bill for cpt 76377 or it is considered a Radiology procedure. My doctors want some direction if we can bill for this during prostate biopsy. Do you have any advice on this? Thank you so much!

2) We have a small path lab and pathologist will be out of town for a week and we are trying to figure out how to bill these charges while she is on vacation.
Since we are a small lab, what if we did not have a locum but just had the histo tech prepare the slides and we charge the technical (bill it under the pathologist who is in vacation) Avero charges the professional?

What would we miss out on from a billing standpoint for doing this?

Our pathologist is saying that lab does it all the time.

I would love to hear Mark’s opinion on this. 

3) I need some more education on billing for Biofeedback. Our office code for Pelvic floor therapy 91122, 51784, 97530, 97750 and 97032 They perform (Accessory Muscle Performance Measurements,
Anorectal Manometry, Pelvic Floor Muscle Simulation and EMC - Evaluation report with EMG leads). Is this correct billing for Biofeedback
Or this billing should be for the initial and then after we should bill 90912 and 90913 for all 4 tests performed for Pelvic Floor Therapy each time.
Thank you so much for all your recommendation and suggestions!   

 ​NEW ONLINE WORKSHOP - Urologists’ Coding Workshop

Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).

"Beef Up" On General Coding Knowledge

PRS Network Presentation Team

• Dr. John Lin
• Mark Painter
• Scott Painter

From the perspective of a practicing Urologist and experts In Urology Coding.

The majority of your income is from what you do in the clinic...

It's a great idea to make your life as easy as possible. 

Mastering medical coding will ensure you reach the pinnacle of your game, so you can have time and energy for patient care and a happy life.

Join us for the Urologists’ Coding Workshop so we can help you get there!

Register Now

Happy Coding!

  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 

Available June 3, 2022

Mark, Scott, and Ray discuss Mark's call with a payer making the argument that an E&M service can be billed with a Vasectomy on the same day.

 ​NEW ONLINE WORKSHOP - Urologists’ Coding Workshop

Special 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate).

"Beef Up" On General Coding Knowledge

PRS Network Presentation Team

• Dr. John Lin
• Mark Painter
• Scott Painter

From the perspective of a practicing Urologist and experts In Urology Coding.

The majority of your income is from what you do in the clinic...

It's a great idea to make your life as easy as possible. 

Mastering medical coding will ensure you reach the pinnacle of your game, so you can have time and energy for patient care and a happy life.

Join us for the Urologists’ Coding Workshop so we can help you get there!

Register Now

Happy Coding!

  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 27, 2022

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

1. Independent historian. For pediatric visits, I'm a little unclear what counts as an independent historian. I see the definition from CMS indicates "an individual (eg, parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patient who is unable to provide a complete or reliable history (eg, due to developmental stage, dementia, or psychosis) or because a confirmatory history is judged to be necessary."

Does a parent providing a history count as an independent historian for a baby? I can see an argument for no (i.e. "provides a history in addition" to the patient's history - baby provides no history) but also for yes (baby isn't able to provide history due to developmental stage). Curious your thoughts on this.

2. Newborn (post-hospitalization) circumcision consult. Trying to determine how this one is billed. Not talking about the routine circumcisions that happen right after birth (usually done by OB/pediatrics anyways) but rather about the ones referred to pediatric urology because the parents wanted a circumcision but peds / OB didn't think they should do it because of concern for something like penile torsion. 
- Risk: I presume would be level 4 (minor procedure with risk factors).
- Problem: I'm not sure about this one. I presume if something like penile torsion is noted on exam, this would be a level 4 problem (chronic not at treatment goal). What if it turns out the exam is normal? Is it still chronic not at treatment goal because the parents / patient desire circumcision? This seems to be the key question for whether this visit type would be a level 3 or 4. 
- Data: perhaps irrelevant if problem and risk are 4's, but perhaps a 3 (independent historian) or just a 2 (review of outside records).

3. This is a question posed by our ASC.
I appealed the insurance denial and they upheld the denial stating “Our review, with medical records, has determined that per published evidence-based coding literature the following diagnosis code(s) is not compatible with the procedure code(s) billed: T19.1XXD and 52310.” They state “the specific code combination listed above was denies based on published evidence-based coding literature. There is a more appropriate diagnosis code for the procedure billed per medical record documentation which states removal of ureteral stent, not a foreign body; please submit corrected claim.”

What more-appropriate diagnosis code is there? History was of UPJ stone with hydronephrosis, since resolved on one and ureteral stone, also resolved, on the other. Because the conditions were treated during surgery, the only reason the patient was coming back in was for removal of the ureteral stone and we’ve always used T19.1XXD w/out issue for that. Other possibilities I’m finding are Z46.6 (Encounter for fitting and adjustment of urinary device) or T83.192D (Other mechanical complication of indwelling ureteral stent, subsequent encounter) but they don’t feel appropriate.

4. Do you have experience with the code 0421T? I need to come up with RVU's to assign to the Temporary code 0421T. (Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed). I see other health systems with a definitive RVU number. Can you offer guidance on how to assign a RVU to this procedure?

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