Urology Coding and Reimbursement Podcast

UCR 036: Why Modifier -25 is so important and how it works with the EM 2021 Rules

January 29, 2021

Mark, Ray, and Scott discuss Modifier -25 and how it fits in with the new E&M 2021 Rules.  They discuss why Modifier -25 continues to be so important and give examples of what changes with the new guidelines.  You can save time by knowing the rules and how to use new guidelines.    Your defensible documentation should be much easier to produce.

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UCR 035: E&M 2021 Q&A: Other qualified health professional definition, Data - can I count note and PSAs in the note as separate data points? Is BCG with assessment a level 2 E/M? Prescription drug management clarification.

January 15, 2021

Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:

Question 1

It's now 2021 and I'm reviewing the coding seminar that I attended virtually in September. On the discussion of E&M coding based on time the phrase:

Distinct time spent by physician and "other qualified health professional" for the visit on the E/M encounter on the date of service

appeared on one of the slides. (The quotes and italics were added by myself.) What is the definition of "other qualified health professional?" Is that a nurse? Could that be a certificated medical assistant who takes time to track down a lab result or helps the patient fill out an IPSS score sheet?

Question 2

Regarding the 2021 E&M new rules, if I see a new patient for elevated psa and review the referring doctor's clinic note including three psa tests that are in that note does that count as four items in Element 2 of Medical Decision making?
For example, I review the note (one item), I review a unique psa from 2/4/2018 (second item), I review another psa from 3/5/2019 (third item), I review another psa from 6/2/2020 (fourth item). All the psa tests share a similar CPT code but they are from different dates and are unique tests. I reviewed them from the doctor's note and not directly from the Lab Corps documents. Did I get 4 items for Element 2?

Second question. For Element 2 do I just need to qualify for Category 1 or Category 2 or Category 3 or do I need to qualify in two out of three of the categories in Element 2?

Question 3

 Would it be considered legitimate to bill a level 2 E/M with BCG with assessment below? The reasoning is at the time of service, the decision to proceed is based on results of UA performed that day, & how well the patient did with prior treatment so they are evaluating and making a decision for the procedure on the same day even though it is scheduled in advance.
Would you consider it ok to bill for a level 2 E/M with a BCG?

"Bladder cancer Here for #6 out of 6 of BCG induction therapy which he has tolerated well. Urinalysis ordered today shows moderate pyuria and microscopic blood, no bacteria. This is consistent with his BCG treatments, no signs or symptoms of infection. He feels well with no urinary symptoms today. Proceeded with instillation of half dose BCG."

Question 4

 We have had a couple of questions from our providers that we’d like clarification on. They are as follows:

If you are continuing a medication on a patient but they don’t need refill is it acceptable to renew the med in urochart but not send to a pharmacy? This way you get credit for prescription drug management and still bill a level 4.

Is there a place where I can get clarification on the wall chart information like what classifies as a “minor risk” and “new interpretation of test” and “new ordering of test”.

I’ve watched several webinars and gone through power point slides, but I think examples are the most helpful.

For example, does a PVR count as a “review of unique test” or “order of unique test”?

If I review CT images and summarize my findings is that “independent interpretation test”? Is that true if it was performed at UA or ARA?

What is a minor surgery without risk? Where can I find a list of “risks”?

Element 2 explanations are giving me the most trouble.

UCR 034: 2021 last-minute changes, G2211 update, MRI fusion biopsy of prostate coding, and initial vs subsequent dilations

January 8, 2020

Mark, Ray, and Scott talk about the last-minute changes-  Congress passed a Covid Relief package that included a few impactful changes.

They also, discuss the changes with the new code G2211 which now cannot be Paid until 2024.

Finally, they answer 2 questions from the Urology Coding and Reimbursement Group:

1) How do I code for MRI fusion biopsy of the prostate?  Do I bill the unlisted 55899 and send in documentation?

and

2) CPT 53600 VS. CPT 53601 When are we able to rebill initial dilation again?
So, is there a time limit in between dilations that would justify initial dilation again or only when the patient is considered a new patient again?
The doctor I work for is wanting to know this answer.  Please advise

Urology Advanced Coding and Reimbursement Seminar - Virtual Live Event

January 29th and 30th, 2021

10am - 6pm EST each day

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Mark, Ray, and Scott talk about lessons learned from the first 33 episodes.  Also, they answer the question "what do you see as the biggest challenge (or opportunity) coming in 2021"?  Lastly, they discuss where the podcast is headed in the future.

Urology Advanced Coding and Reimbursement Seminar - Virtual Live Event

January 29th and 30th, 2021

10am - 6pm EST each day

Learn 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

Part 2 of 2 - The final Medicare rule was published on 12/2/2020.  Mark presents what has changed, what is important, and the impacts the new rules are going to have on your practice.  He also points out what you need to do to prepare your practice.

Last Chance to Learn the New E&M Rules in 2020

Live Workshop
December 21st, 2020

7pm - 10pm EST

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Join the discussion:

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

Part 1 of 2 - The final Medicare rule was published on 12/2/2020.  Mark presents what has changed, what is important, and the impacts the new rules are going to have on your practice.  He also points out what you need to do to prepare your practice.

Last Chance to Learn the New E&M Rules in 2020

Live Workshop
December 21st, 2020

7pm - 10pm EST

Learn More

Join the discussion:

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

November 24, 2020

Happy Thanksgiving!

Mark, Ray, and Scott discuss the Urology Advanced Coding and Reimbursement Seminar Agenda.  Mark explains what we have included and why.  Ray emphasizes that there are a lot of big changes this year that can lead to positive outcomes for urology practices.

Here is the Agenda for the Upcoming Virtual Live Event:

Friday 12/4/20
Time (EST)         |   Topic
10:00 AM |   Welcome 2021 - Back to the Future
10:30 AM |   Globals and Modifiers Part 1
11:00 AM |   Globals and Modifiers Part 2 OP note communication
12:00 PM |   Optimizing Patient Collections -Integrating system-wide solutions
1:00 PM |   Lunch: New Technology
2:00 PM |   Globals and Modifiers Procedural Scenarios
3:00 PM |   MIPS, MACRA, Medicare Updates
4:00 PM |   Operative Communications, Scheduling, Prior Auths - Break out share your processes
5:00 PM |   Compensation Trends - Private and Hospital-Based

Saturday 12/5/20
Time (EST) |  Topic
10:00 AM | Welcome 2021 - Back to the Future
10:30 AM | E&M 2021
11:00 AM | E&M 2021 Continued, Transition, New Documentation Hints
12:00 PM | Practice Operational Challenges and Lessons Learned
1:00 PM | Lunch: Online Reputation Mgmnt Presentation
2:00 PM | E&M 2021 Scenarios
3:00 PM | Telemedicine Optimization - Rules, In Practice
4:00 PM | Positioning the Practice for Sustainability - 2021 and beyond
5:00 PM | ICD-10 - Update. Examples ICD-10: Hematuria, Bladder Ca, BPH, CaP

Urology Advanced Coding and Reimbursement Seminar+ Bundle

Live Virtual Event
December 4th and 5th, 2020

10am - 6pm EST Each Day

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Join the discussion:

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

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November 17, 2020

Mark, Ray, and Scott discuss the 2nd wave of the pandemic and what that means to the urology practice. 

The first wave was dedicated to figuring out how to deal with the shutdowns/slowdowns and telehealth.  This next wave, if there is a slowdown there are some opportunities to use that time to streamline your practice.  Given the new Zoom skills we have all developed, there are opportunities to educate patients and leading to a higher return encounter.


Urology Advanced Coding and Reimbursement Seminar+ Bundle

Live Virtual Event
December 4th and 5th, 2020

10 am - 6 pm EST Each Day

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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

Mark, Ray, and Scott talk with Larry Kemp, FACHE about assessing your business practices, digging deep to identify the core problem, developing a road map, and then solving the root of the problem.  Larry points out that "Being Paid is Not the Same as Paid Accurately". 

You have to make sure you efficient in the things you can control in your practice.  It is hard to extract more income from payers unless you have leverage in that market.  But you do have options to limit exposure to the bad actors.

Urology Advanced Coding and Reimbursement Seminar+ Bundle

Live Virtual Event
December 4th and 5th, 2020

10 am - 6 pm EST Each Day

Learn 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

Mark, Ray, and Scott discuss some lessons and nuances that they learned during the discussion at the recent E&M 2021 workshops.  Mark shares the reasoning behind a vasectomy consult and what level it will probably fall with the new guidelines.  Also, he discusses the question - will all prostate cancer E&M visits be a level 4?

Ray shares why the new guidelines are going "back to the future".  Documenting using the new guidelines is going to be like it was before the original documentation guidelines introduced in the early 90s.

Why you should attend the Urology Advanced Coding and Reimbursement Seminar - Live Virtual Event.

Urology Advanced Coding and Reimbursement Seminar+ Bundle

Live Virtual Event
December 4th and 5th, 2020

10 am - 6 pm EST Each Day

Learn 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