Mark provides an overview of Telehealth utility now and post Public Health Emergency.  He shares 3 opportunities to explore using Telehealth, if you are not doing so already.

1.) Basic Telehealth - Synchronous Audio Visual

2.) Communication Technology Based Services (CTBS)

3.) Remote Monitoring Services

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

Upcoming E&M 2021 Live Online Workshops

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Dates (all times Eastern)

September 18, 2020 - 5:00 pm 

September 26, 2020 - 10:00 am

October 8, 2020 - 6:00 pm

October 28, 2020 - 5:00 pm

Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement Group

1. Scenario:
   New patient being seen via telemedicine for the first visit. Dr. has ER reports and a CT with finding of "a nodular mass-like extension from the left posterior aspect of the prostate into the seminal vesicle and an impression of "Probable prostate cancer extending into the left seminal vesicle". A PSA was done and came back at 950.0 ng/mL. At the time of the Trusp/Bx, Dr coded D40.0, Neoplasm uncertain behavior of prostate. The physical findings at the biopsy were "Large, nodular hypoecoic mass left base & mid-gland of prostate". I think Dr. was trying to show that he didn't have pathology to prove malignant neoplasm and since there isn't an "Unspecified neoplasm" for prostate, I think he should just code what he knows for sure.....nodular prostate and elevated PSA......possibly also use N42.9 Disorder of prostate, unspecified which means anything from an abnormal prostate on exam to cancer. Could N42.9 be used as the "neoplasm of prostate, unspecified behavior"??
2. Hi, dr did a laparoscopic radical nephroureterectomy for ureteral cancinoma and also a repair of a lumbar hernia
   i came up with 50548 for the nephroureterectomy but am unsure of the hernia  
   thanks
3. Can you clear up when to use modifier -57 and modifier -25?
   
   Is -57 for clinic AND hospital consults? Does the surgery you are planning for the same day have to be a surgery with 90d global? what if it's just ureteroscopy? Does putting in a catheter after an ER consult need a -57 modifier?
   
   Is -25 used for separate E/M ONLY if they have a separate procedure? (for instance come in for cysto but then mention a genital wart that is then removed) Or can you add -25 for a totally unrelated problem that requires medicine or counseling but no procedure (for instance come in for cysto and then mention ED and discuss options/prescribe viagra) 

Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement Group

1. Can CPT code 50386 be done in the office?  The provider wants to remove the stents without cysto  whenever possible as he says it is more comfortable for the pt and less risk of infection.   Does this still need ultrasound guidance to do in the office?  Haven't done one of these before in the office.    Please advise.  Thank you. 
2. Good morning, new to ASC billing for my Urologist.  My doctor performed a TRUS/BX at an ASC and I am billing the facility charge.  For the facility, can I bill CPT 55700 with 76872, 76942, 96372 & J1580.  I have searched on line but unable to find anything relevant.  Please advise
3. Help please.
   Pt had gross hematuria and BPH. Would CPT 52214 be correct or 52601-52?....the resectoscope has me questioning my code choice.....  "...........cystoscope was removed and a 26Fr resectoscope was inserted. Using the bipolar rollerball the entire prostatic fossa was fulgurated. Hemostasis was attained. The resectoscope was removed and a 20fr 3-way catheter was inserted." Doc said TURP but think I'd need him to re-phrase his op note.....no?
   Thank you

Mark, Ray and Scott discuss the 7 steps your practice needs to take to ensure a smooth transition to the new E&M rules in 2021.

1. Choose a transition captain 
2. Update Compliance Plan
3.  Train the team
4. Update Processes
5.  EHR Template Update, Testing and Training
6.  Estimate Financial Impact
7.  Schedule Ongoing Training and Review

Upcoming E&M 2021 Live Online Workshops

Learn More

Dates (all times Eastern)

September 18, 2020 - 5:00 pm 

September 26, 2020 - 10:00 am

October 1, 2020 - 6:00 pm

October 2, 2020 - 5:00 pm

Mark outlines the proposed rule and the 8 items that will have the most impact on the Urology practice.

1. Final rule posting late this year
2. Conversion factor decreasing by 10.6%
3. E&M 2021 changes being adopted and will include increased RVUs for the E&M codes
4. RVUs for non-facility codes increasing enough to offset conversion factor decrease
5. RVUs for facility procedures are all decreasing
6. ASC payments are set to increase
7. MIPs has a couple of changes but they are not major changes to the current program
8. Telehealth is going to continue with the same rules during the Public Health Emergency.  Once the PHE is over then covered codes will change and be separated into 3 categories of covered codes

Mark, Ray and Scott discuss answer and discuss questions asked on the Urology Coding and Reimbursement Group.

Can you bill a consultation (99245) when one of our providers is sending his pt to another provider in the same group to discuss doing a RALP.  Ins  plan UMR/UHC.   I don't think you can since they are under the same Tax ID #.   The provider that did the consult says you can for a non CMS plan.  Please advise.    Thanks

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Mark, Ray and Scott discuss how to find the right codes or solutions by asking questions.  The problem is that if you don't ask the right questions you may get the wrong solution.  

Often times in coding and reimbursement the answers are not clear.  There is a lot of "gray" and involves finding the right solution based on all the information you have.

For PA and NP phone call only visits, what codes should be used?  Additionally, can phone only codes be billed as incident to for established patients?

Good morning! 
Can 52281 needing to be performed during global period of 52601 because of developed N35.811 meatal stenosis and increased self- catherizations be billed with a modifier? I am looking and the EncoderPro.com service I have through my employer says: "A modifier is not allowed to override this relationship". 
Thanks again!

Mark and Ray present the current CMS and CPT rules and how those rules affect coding for multiple stones.   As most are well aware, the rules are not always black and white and in this instance, the rules leave plenty of room for interpretation.  Mark and Ray present the current rules and lay out a case for a fair interpretation based on work performed.

Larry talks about how teamwork is one of the most important aspects of an efficient office.  Learn about one of the best ways to train your office.  Larry has helped many urology practices and over the years developed and tested systems and strategies to help practices of all sizes.