Urology Coding and Reimbursement Podcast

May 22, 2026

In this episode, Scott, Mark, and Dr. Ray Painter revisit ureteral stent removal and replacement coding after listener feedback highlighted the need for additional clarification on when cystoscopic codes versus fluoroscopic exchange codes apply. The discussion then shifts to emerging RAC audits targeting prostate artery embolization (PAE) claims involving CPT codes 37242 and 37243, emphasizing the importance of detailed documentation and medical necessity support. The episode wraps with a deep dive into Medicare’s medically unlikely edit (MUE) for add-on code 55715 for additional prostate biopsy lesions—exploring why the edit conflicts with CPT guidance, how practices should report multiple lesions, and why appeals may be necessary to receive proper reimbursement.

 PRS Coding and Reimbursement Hub

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Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

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   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

May 15, 2026

In this special live episode from the AUA Annual Meeting in Washington, D.C., Scott, Mark, and Ray Painter share highlights from the AUA Innovation Nexus program, where emerging companies, investors, and industry leaders are working to bring new urology technologies to market  . The discussion focuses on the growing importance of reimbursement strategy early in product development, the operational and financial realities practices must consider before adopting new technology, and why collaboration between innovators, physicians, and practice teams is critical for success. The episode also explores how efficiency, workflow, and return on investment increasingly drive whether promising technologies ultimately make it into everyday urology practice.

 PRS Coding and Reimbursement Hub

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Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

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PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

May 8, 2026

In this episode, Scott, Mark, and Dr. Ray Painter discuss the growing wave of innovation in urology and why reimbursement strategy must be part of the conversation from day one. Ahead of the AUA Innovation Nexus meeting in Washington, D.C., the team explores how new technologies move from concept to clinical adoption—and the reimbursement hurdles that can slow that process down. The discussion covers coding, coverage, payer adoption, workflow planning, AI-driven practice tools, and the importance of building a realistic business plan before introducing new technology into a practice. The key takeaway: exciting technology alone is not enough—successful adoption requires clinical value, operational readiness, and a clear reimbursement strategy.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

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Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

May 1, 2026

In this episode, Scott, Mark, and Dr. Ray Painter break down key differences between ureteral stent removal and replacement codes—50385, 50387, and 50688—highlighting how anatomy, access (internal vs. external), and the requirement for radiologic supervision drive proper code selection. They also tackle a growing issue with ICD-10 coding for bladder cancer, where the correct use of “history of” codes during BCG maintenance therapy is leading to unexpected payer denials. The discussion explores when to follow strict coding guidelines versus when payer-specific rules may require strategic adjustments. The takeaway: understanding both the technical details of coding and the realities of payer behavior is essential to avoiding denials and protecting revenue.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

April 24, 2026

In this episode, Scott, Mark, and Dr. Ray Painter break down the latest guidance on HCPCS code C9761 and the growing confusion around what qualifies for payment under this new technology APC. They walk through key interpretations from the AHA, AMA, and MACs, highlighting the critical distinction between steerable ureteral catheters, scopes, and access sheaths—and why that difference can determine whether a case is paid or denied. The discussion emphasizes the importance of precise physician documentation, understanding device labeling, and verifying payer-specific policies before billing. The takeaway: while new technology offers higher reimbursement potential, it also introduces real risk—making clarity, compliance, and payer alignment essential.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

April 17, 2026

In this episode, Scott, Mark, and Dr. John Lin tackle a deceptively simple question: does it make sense to perform more complex procedures—like Optilume and other minimally invasive treatments—in the office setting? The discussion breaks down the three critical pillars every practice must evaluate—clinical fit, financial viability, and operational execution—while highlighting key factors such as reimbursement, equipment costs, anesthesia logistics, staffing, and workflow efficiency. They also explore opportunity cost, geographic variability, and how in-office procedures can improve both patient experience and physician productivity when done right. The takeaway: success requires a fully developed plan—because bringing procedures in-house is never just a simple yes or no decision.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

April 10, 2026 

In this episode, Scott and Mark Painter break down the rapidly evolving and increasingly uncertain landscape surrounding UTI PCR testing, following heightened scrutiny from the OIG and a surge in payer denials—particularly for CPT code 87798. They discuss confusion around MUE limits, shifting interpretations from MACs, and the growing use of N35 denials triggering documentation requests. The episode outlines how practices should respond, including when to appeal, how to support medical necessity, and the risks of prematurely changing billing behavior without clear guidance. The key takeaway: stay disciplined, document thoroughly, and play the long game as policies continue to evolve.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

April 3, 2026 

In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where interpretation is driving real-world coding challenges: when a prostate biopsy truly qualifies as a stereotactic template-guided saturation biopsy (55706), and whether diagnostic cystoscopy meets moderate risk under E/M guidelines. The discussion breaks down what differentiates saturation biopsy from standard transperineal approaches, including the importance of 3D templating and full-gland sampling, and why payer expectations may not align with physician interpretation. They also revisit the E/M risk table, reinforcing why cystoscopy is generally considered moderate risk—even if not explicitly stated in current guidelines. The key takeaway: as coding becomes more nuanced, balancing guideline interpretation with payer expectations is critical to staying compliant and getting paid correctly.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

March 27, 2026 

In this episode, Scott, Mark, and Dr. John Lin dive into the challenges of navigating Medicare Advantage (Part C) plans—what happens when you’re out of network, why reimbursement can feel like a “surgical lottery,” and how to decide whether to participate at all. Prompted by a real-world scenario involving UnitedHealthcare narrowing its network, the discussion explores out-of-network billing strategies, patient responsibility, contract pitfalls, and the risks of unpredictable payments. The team also breaks down the key differences between traditional Medicare and Medicare Advantage, highlighting how payer incentives, network restrictions, and administrative burden impact both practices and patients. The takeaway: know your numbers, know your leverage, and be intentional about the payers you choose to work with.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/ 

March 20, 2026 

In this episode, Scott, Mark, and Dr. Ray Painter break down a new UnitedHealthcare policy that could impact payment for professional components of diagnostic services—including urodynamics and other PCTC-coded procedures—and what practices must document to avoid denials. The discussion outlines the need for clearly separated diagnostic reports with findings and impressions, as payers increase prepayment scrutiny.   The key takeaway: as payer oversight intensifies, precise, structured documentation—and understanding how rules are applied—is essential to getting paid.

 PRS Coding and Reimbursement Hub

Access the Hub

Botox LCD Alert

Download the Alert

Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

         https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/