Urology Coding and Reimbursement Podcast

August 15, 2025 

In this episode, Scott, Mark, Ray, and special guest Dr. John Lin dive deep into Medicare’s upcoming Wiser Program—set to begin in 2026—which brings prior authorization to traditional Medicare for select urology services. Learn which states are impacted, what procedures are targeted, and what steps urologists need to take to prepare. The team also discusses the growing use of steerable ureteral catheters and how facilities can (or can’t) use code C9761 for reimbursement. Get practical advice on documentation, appeal strategies, and how to advocate for your practice in this evolving regulatory landscape.

NCDs

Sacral Modulation NCD

Incontinence NCD

Impotence NCD

PRS Coding and Reimbursement Hub

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PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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

August 22, 2025 

In this special episode, Scott, Mark, and Ray welcome Dr. Marc Rose, a practicing urologist in Vero Beach, Florida, to share his journey of transitioning to a hybrid urology practice that combines traditional insurance with concierge medicine. Dr. Rose walks us through the burnout that led him to make a change, how he structured his new model, and the lessons he’s learned since making the leap. He explains how the practice operates day-to-day, how patients respond to concierge options, and the role his nurse practitioner and support team play. Whether you’re a urologist exploring alternative practice models or just curious about the benefits and challenges of concierge care, this episode offers valuable firsthand insight.

Contact Dr. Marc Rose

[email protected]

PRS Coding and Reimbursement Hub

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Free Kidney Stone Coding Calculator

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PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

August 8, 2025 

In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advantage plans, what it really means, and how to prepare your front desk and billing staff for potential patient coverage changes. Stay informed, stay proactive!

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

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PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

August 1, 2025 

In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Helpdesk. 

1. Pay er: Anthem BCBS
   State: NV
   Code/Codes: Tranurethral resection of bladder clot that was organized to facilitate removal
   Catagory: Other
2. Question: I'm looking for a CPT code for : transurethral resection of bladder clot that was organized t facilitate removal Pt was inpt and Dr tried to do a clot removal from the bladder, but was unsuccessful as the whole bladder was the clot. So he used a resectoscope to resect the clot into smaller pieces and then removed them with a ridid biopsy forceps. This procedure took over 2 hours. I need help with a CPT code that will accurately describe this procedure
3. Payer: N/A
   State: TX
   Code/Codes: N/A
   Catagory: Other
4. Question: Do you have info or prior podcast on billing for updated h/p prior to surgery if prior h/p done greater than 30 days before surgery? Appreciate help or directions to podcast if available. Sincerely, Irene McAleer, MD,JD,MBA [email protected] 948-610-9449 Sent from my iPhone
5. Payer: Mix
   State: Ohio
   Code/Codes: 57 vs. 25 modifier
   Catagory: Other
6. Question: When is best to use 25 vs. 57 same day procedure/OR - I thought anything requiring anesthesia would be OR procedure? Cysto/stent, cysto clot evaluation, etc would be 57 but is 25 more appropriate even if done in the OR?

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

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PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

© 2025 Physician Reimbursement Systems, Inc.

July 25, 2025 

In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Help Desk. 

1) Payor: Medicare
State: FL
Code/Codes: 52353-52 and 52332-59-51
Catagory: Kidney Stones

Question: If I have to abort a planned ureteroscopy and laser lithotripsy because the UO is too narrow to pass the ureteroscope so I place a stent. Can I bill the 52353-52 and 52332-59-51

2) Can you clarify what documentation is required to be able to code 51729? Is the length of the urethra required to be documented or is it just a possible element?

The AUA policy & Advocacy brief for Urodynamcis shows the example documentation of the UPP as, “ Urethreal Pressue Profile: The maximum urethral pressue profile was 45 cm of water with a functional urethral lenght of 2.75 cm. At 200cc, coughing was iniitated. There was no demonstrable leak of urine at 117 cm of water with abdominal straining.”

My provider is only documenting: Leak point pressure testing: volume tested: 150mL, Stress Induced DO: Absent Valsalva Leak Point Pressure: No Leak.

Is that enough to capture 51729?

Thank you for your assistance!

3) Can you tell me the best way to document and correctly bill for prostate biopsy using 55700/76942 and 76872?  I am told we are no longer getting paid for those.

4) What is the best way to document and code for placement of fiduciary markers under US guidance?

Thanks in advance

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

July 18, 2025 

In this episode, Scott, Mark, and Ray Painter break down their first impressions of the 2026 proposed Medicare physician fee schedule. From conversion factor changes and telehealth updates to significant RVU and facility payment shifts, they explore what’s in store for urology and what it all means for your bottom line.

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

July 11, 2025 

In this special episode, Dr. Peter Bretan—president of the AACU—joins Scott, Mark, and Ray to share his journey from transplant surgeon to national urology advocate. He highlights the power of grassroots advocacy, the importance of local engagement, and AACU’s evolving mission to support all urology professionals.

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

June 27, 2025 

Scott, Mark, and Ray discuss how new FDA rulings—like the recent update for Rezūm—impact coverage, coding, and reimbursement. They walk through the layers of medical necessity, CPT codes, payer policies, and documentation strategies needed to ensure payment.

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

June 20, 2025 

In this episode, Ray, Mark, and Scott answer questions that came into the PRS Helpdesk and give an update on Telehealth and where it stands.

1. Patient with BPH and bladder stones.  When treating both the BPH (N40.0) and bladder stones (N21.0) during the same surgery, is it appropriate to bill both 52649 {Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete…….)} & 52317 and/or 52318 [Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; …..]. There are no CCI edits in Coding today, so it appears they can be billed together.   Please explain why or why not?  
2. New to urology and would appreciate some knowledge in male fertility and general urology

PRS Coding and Reimbursement Hub

Access the Hub

Free Kidney Stone Coding Calculator

Download Now

PRS Coding Courses

For Urologist

For APPs

For Coders, Billers, and Admins

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/ 

© 2025 Physician Reimbursement Systems, Inc.

June 13, 2025 

In this episode, Ray, Mark, and Scott discuss recent denial issues from Aetna and Humana and offer some possible solutions. They also revisit a question covered in Episode #234: billing for amniotic tissue grafts during prostatectomy procedures, outlining strategies to address denials effectively.

PRS Coding and Reimbursement Hub

Access the Hub

Jelmyto Coding and Reimbursement Page

Upper Track Urothelial Cancer (UTUC) Coding and Reimbursement Page

Free Kidney Stone Coding Calculator

Download Now

PRS Billing and Other Services - Book a Call with Mark Painter or 
Marianne Desciose

Click Here to Get More Information and Request a Quote

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/