Urology Coding and Reimbursement Podcast

May 20, 2022

Mark, Scott, and Ray talk about the recent AUA Annual meeting in New Orleans.

 Also, we had a question come in about using the same data in medical decision making in two different encounters.  Can you count the same category 1 data twice?

 ​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 6, 2022

Mark, Scott, and Ray discuss a question about a scenario regarding coding the most comprehensive code:

Scenario 6 module 9, Cystectomy, with continent diversion, bilateral pelvic lymphadenectomy and prostatectomy. I captured both 55845 and 51596 and I also looked at the possibility of 51575 (Cystectomy with bilat lymphadenectomy, 50825 continent diversion including intestine anastomosis, and 55840 proctectomy. Do I not choose the 50825 (along with other codes) because of the intestine anastomosis? I tend to overthink px coding, am I over coding or under coding? What would y'all suggest to help, when I get lost in the "forest"? :) Thank you, Rhonda

Mark, Scott, and Ray talk about past AUA Annual Meetings and look forward to the upcoming meeting in May 2022.

 ​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 

April 29, 2022

Mark, Scott, and Ray discuss two current topics:

1)  Letter of notification from CMS/Qlarant, a provider was selected for prepayment claim review. We have received two record requests from them on urine PCR code 87798.

 2)  United Health Care proposing a plan to encourage e-consults for urology providers.

 ​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 April 22, 2022

Mark, Scott, and Ray answer questions

1)I have been asked if it is appropriate to bill for "misfired" Urolift implants?

2)  I know Jon's opinion on this, but was wondering what the Painters think....chief complaint--do you have to be more detailed than stating "follow up"?

 ​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 - Take advantage of VIP special pricing (the guaranteed lowest price) Ends soon.

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 April 14, 2022

Mark, Scott, and Ray answer questions

1) If a patient is being set up for a telemedicine visit with an MD in the MD's secondary clinic and the MD is in his/her primary clinic.  Do we bill under the primary clinic with a place of service 02? Also, should documentation support where the patient is located?

2)  How should I code for Bladder Interstitial Fiducial Marker placements in a female patient? The markers are placed cystoscopically and are used to guide radiation therapy for bladder cancer. For male patients we were using 55876, but that is being rejected for female patients. Is there an unlisted code for cysto procedures that we can use. or any other equivalent code?
3) Is CPT 64646 correct to bill for Botox injection to pelvic floor. In description of the procedure my dr. states “ the entire length
Of the levator musculature was injected on either side. Injected 100 units on each side with spinal needle.
CPT 64646 is correct to bill?

 ​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 - Take advantage of VIP special pricing (the guaranteed lowest price) Ends soon.

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 April 8, 2022

Mark, Scott, and Ray answer questions

1) My clinic is trying out the app through Emano Flow that tracks a patients urine flow for 14 days and then the Urologist goes over the results with the patient when the trial is finished. My clinic is very confused on whether or not each individual day needs an interpretation written by the doctor in order to bill a uroflow (51741) on a particular day?

2)  [9:05]  I am working on an appeal letter to Regence Blue Shield for in Interstim device.  In their criteria for coverage, the covered diagnoses for this type of treatment are: a. Urge Incontinence (N39.41), b. Non-obstructive urinary retention (R33.8), c. Overactive bladder (N32.81) and d. Urgency-Frequency syndrome (??).  For D, I could use the symptom codes of R39.15 and R35.0.........but is there anything else that might be better?  The documentation states the female patient has Fowler's Syndrome, but there isn't an ICD-10 for that either!  Suggestions???

3) If a Medicare has a TURP 52601 and then two months later has a bladder scan in the office 51700 should Medicare pay for that bladder scan?

4) What is the difference betweent simple prostatectomy codes 55821 and 55831.  What is the best way to code for Robot-assisted laparoscopic simple prostatectomy on a Medicare patient?  And, same question for a commercially insured patient?

UTI – PCR UPDATE

The following Medicare Administrative Contractors (MAC) aka Carriers, have issued a proposed multi-jurisdictional Local Coverage Decision (LCD) for Multiplex Nucleic Acid Amplification Test (NAAT) PANELS FOR INFECTIOUS DISEASE Testing, Wisconsin Physician Services Insurance Corporation, CGS Administrators, LLC., Noridian Healthcare Services, LLC., and Palmetto GBA.

Each has also issued an associated Local Coverage Article (LCA) with coding instructions and limitations on coverage. Each of these states participate in the MolDX program administered by Palmetto GBA. The coverage change takes effect April 17, 2022 in all states within each jurisdiction...

​[READ MORE]​

 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 1, 2022

Mark, Scott, and Ray discuss an update on the MolDx guidelines for PCR billing set to take effect on April 17th, 2022.  They also talk about Modifier -22; should you use it and what it takes.

UTI – PCR UPDATE

The following Medicare Administrative Contractors (MAC) aka Carriers, have issued a proposed multi-jurisdictional Local Coverage Decision (LCD) for Multiplex Nucleic Acid Amplification Test (NAAT) PANELS FOR INFECTIOUS DISEASE Testing, Wisconsin Physician Services Insurance Corporation, CGS Administrators, LLC., Noridian Healthcare Services, LLC., and Palmetto GBA.

Each has also issued an associated Local Coverage Article (LCA) with coding instructions and limitations on coverage. Each of these states participate in the MolDX program administered by Palmetto GBA. The coverage change takes effect April 17, 2022 in all states within each jurisdiction...

​[READ MORE]​

  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 25, 2022

Mark and Scott discuss the new MolDx guidelines for PCR billing set to take effect on April 17th, 2022.

 Urology Coding Course Spring Registration Is Open!

​Urology Coding Course for Urologists/QHPs  [Register Now]​
 

​Urology Coding Course for Coders/Billers/Admins  [Register Now]

Join the discussion:

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

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Mark, Ray, and Scott discuss comments and questions from PRS Forums: PRS Community and Urology Coding and Reimbursement Group:

1)  Re: RE: New Podcast Episode: -TC and -26 modifiers - Urodynamics billing: split or global? (3/11/22)

If the UDS tests are done on Monday and the ordering doc isn’t in the clinic, but there is a supervising doc, I know we would bill for the TC under the supervising doc.

If the ordering/interpreting doc doesn’t even see the tests until 2 days later, you’re saying in today’s podcast that we bill the global service with Wednesday’s date and not Monday’s date??

OR because of the MLN article SE17023 Revised 2/1/2019, we can chose which date to use, that we could bill the global charges with Monday’s date and the interpreting docs name…..even though he wasn’t in the clinic on Monday?

I think we should bill everything under the interpreting doc on the date the service was rendered, even if he isn’t in house, based on the 2019 MLN, and not on the date he interprets it.

2)  I am asking for more info and cpt help on VUDS

3) Anterior exenteration question.

I have several different opinions about how to code this surgery. My two urologists operated together. The bladder was removed, the uterus, vagina, tubes and ovaries, pelvic lymph nodes, and ileal conduit created. so we start with 51597 with the wording for pelvic exenteration (my surgeons don't feel we qualify because we didn't remove the colon). The AUA recommendation I received was to use the 51597 with 50820. not sure i agree with that. the CPT book in its description says and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof.
I guess im not sure what the and/or means. Is the colectomy part necessary to perform the 51597? My doctors think we should piecemeal the coding which im not a fan of.  Appreciate some advice here. Hoping there is some clarification from experts!!

4) I have started coding for a group of Urologists that bill for their prophylactic antibiotic injections separately from the procedure performed in the office.

For example: the patient comes in for a planned cystoscopy w/ Botox injection. The codes that the provider wants billed are the botox codes 52287 and J0585 and the injection of antibiotics 96372 and J0696. They will also bill them with cysto's , prostate biopsies, and other minor office procedures. I thought that I understood that prophylactic antibiotics were inherent to the office procedure, but my providers are adamant that they can be reported separately. I've tried it their way and I'm getting denials all over the place. Could you help me with this? Are my providers wrong, or my payers? Thank you!!!  

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March 11, 2022

Mark, Ray, and Scott discuss -TC and -26 billing for urodynamics.  There was a rule change in 2019 that updated how urodynamics should be billed in regards to the -TC and -26.  Prior to that rule change, we recommended split billing but now recommend the global billing.

Below is the question that prompted this discussion:

Can we bill a TC and 26 modifiers on same day for the 51728, 51741, 51784, 51797?  TC under direct supervision provider and 26 for interpretation from ordering provider on same day?  My understanding is if we want to split it out, we bill the TC the day of the procedure and the 26 out the day it was interpreted or otherwise we would bill the whole global under the interpreting provider?

Med Learn Matters Article That was Referenced in the Podcast

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17023.pdf

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