Urology Coding and Reimbursement Podcast

Mark gives an update on the status of the Public Health Emergency (PHE). Mark, Ray, and Scott discuss FAQs:

1. Coding for a stent removal using a snare without radiologic guidance.
2. CPT code is for the i-Tind procedure
3. Can you code a consultation visit (non Medicare) for new patient office visit seen in the ER
4. Additional clarification on the 25 modifier.

Urology Advanced Coding and Reimbursement Seminar+ Bundle

Live Virtual Event
December 4th and 5th, 2020

Upcoming E&M 2021 Live Online Workshops

Dates (all times Eastern)

October 28, 2020 - 5:00 pm

Scott and Ray discuss the Urology Advanced Coding and Reimbursement Seminar.  Ray shares how it all began and why. They discuss how the Urology Advanced Coding Seminar is going to be different this year.  

Not only is it going to be a live virtual event but have added additional products and services to help practices prepare for 2021.

Mark, Ray, and Scott answer questions from the Urology Coding and Reimbursement group. Mark gives 

1)  Can urologist bill for Covid intake screenings? We hear from a  provider that when  patient walks in the door and we perform the  Covid intake screening ( we do these anyways), we can bill for this?
We would have to submit out Covid form, a medical form, and a SOAP note, these can be signed by an NP for submition to the insurance?

2)  Can a Urologist bill a 50590 and a 76000?  It says only if medically necessary. What would be considered medically necessary? 

3)  Can you explain in an office setting when you would only bill a 51702 for catheter change for management of chronic urinary retention pt VS including an E/M charge 99213 VS when to use a modifier 25? 

From my understanding there is no charge for a catheter removal and this is included in the E/M portion of the charge, so shouldn't every chronic catheter pt (for NGB, urinary retention) also have an E/M charge in addition to the 51702? 

Good news from the resolution act: regarding the Medicare repayment 

Mark, Ray, and Scott discuss the new ICD-10 codes that go into effect 10/1/20.  Make sure your Electronic Health Record and Practice Management System are up to date with the new codes.  Luckily there are not that many new codes and will not have a big impact on most urology practices.

Download a copy of the ICD-10 additions and changes here:

Urology ICD-10 Changes Effective 10-1-2020.pdf

Get a copy of the E&M 2021 Sneak Peek here:

Sneak Peek E&M 2021 Pocket Card

September 18, 2020

Scott shares the 3 simple steps PRS uses to create the PRS education projects.

We have, over the last 30 years, developed a system for creating education products. We used this tested and proven method to develop the upcoming E&M 2021 Live Online Workshop.

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 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

Join the discussion:

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