Urology Coding and Reimbursement Podcast

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. 

Brent shares what most Urologists are missing on their website.  Do you explain what you do?  Have pictures related to your practice? Have a clear call to action?  Learn some simple changes you can make to your website to help attract your ideal patient.

Should you have video on your website?  How important are testimonials?  Get the answers to all these questions and more as Brent discusses what's important for today's urology website.

Join the discussion:

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

In this episode, Mark interviews cybersecurity expert Jeffery Daigrepont, from the Coker Group.

Jeffery shares some items you should consider to protect your practice.  Did you realize that one of the most important tools is cybersecurity insurance and most out of the box policies don't cover a common cyber breach potential?


Also, most practices don't know that many breaches occur because of individuals actions within the practice.  These actions are not intentional but can lead to significant issues.

Join the discussion:

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

Mark, Scott, and Ray talk modifier -25.  In addition to a general overview of the definition, they give several urology specific examples.

Modifier -25 definition: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.

Join the discussion:

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

UCR 008: RVUs - Overview and How They Can Help You

Mark discusses RVUs and why they are important to the urology practice.  Not only are they important for reimbursement but they can also be used as a tool to assess practice productivity and efficiency.

Learn why not understanding the RVU basics could be costing you in many aspects of your practice.

UCR 007: Voice Recognition in Today's Practice with Brad Sclar

Scott talks with voice recognition expert Brad Sclar.  Learn how Brad, who has a Doctorate of Musical Arts, got involved with healthcare. Find out if voice recognition belongs in today's practice.  Why the dictation software and algorithms on your phone and computer just don't cut it in the medical profession.

Questions for Brad? Interested in Dragon Naturally Speaking?

Click Here