April 12, 2024

Mark and Scott discuss questions that have come into the PRS communities:

1. Hi is there any documentation, regarding the age limit for G2211 or 99459?
   
   Our MD think that they only apply to patients over 65 years old.  Is this true or is there documentation stating we can use them on patients under 65 years old.  
2. If a patient fails a Trial of void, and a catheter is placed, would the 51700 be coded or just 51702? Should it matter if pass its fail? The service was still performed. And the 51702 is a component of the 51700.
3. What are the codes that I use for gemcitibine bladder installation in the office. I know I would use 51720 would be the cpt code but how do i bill for the medicine?
4. For Scrotoplasty, complicated (CPT 55180), Does it need to be performed with either Graft of Flap, to call for "complicated"? I am trying to differentiate between 55175 (scrotoplasty, simple) and 55180 (scrotoplasty, complicated), thank you!

New Courses Available for Urologists and Urology APPs

Documentation for Reimbursement Challenge for Urologists​
Use Special Discount Code:DRC5624 and Save 36%

 ​Documentation for Coding and Reimbursement for APPs​
Use Special Discount Code: DCRA5624 and Save 36%

Certification for Urology Coders

Documentation, Coding, and Billing Certification Course for Urology Coders
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   The Thriving Urology Practice Facebook group.

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April 5, 2024

Mark, Scott, and Ray discuss why PRS developed two new courses, one for Urologists and one for APPs

 These courses aim to tackle the challenges practices face with documentation for reimbursement and efficient use of Electronic Health Records (EHR), emphasizing the importance of a unified team approach to stay updated on coding, billing, and documentation. They also discuss the critical role of Advanced Practice Providers (APPs) in urology, their billing nuances, and the necessity of continuous education to ensure financial health and combat provider burnout. The discussion wraps up with insights into the evolving landscape of medical coding and billing, stressing on AI's role in audits and the need for precise documentation. Links to further details about the courses can be found below.

New Courses Available

Documentation for Reimbursement Challenge for Urologists​
Use Special Discount Code: DRC5624 and Save 36%  (ends 5/6/24)

 ​Documentation for Coding and Reimbursement for APPs​
Use Special Discount Code: DCRA5624 and Save 36%  (ends 5/6/24)

Certification for Urology Coders

Documentation, Coding, and Billing Certification Course for Urology Coders
Use Special Discount Code: DCBSC5624 and Save 36%  (ends 5/6/24)

PRS Billing and Other Services

Click Here to Get More Information and Request a Quote

   The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

   Join the discussion:

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

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March 28, 2024

Mark, Scott, and Ray welcome Dr. David J. Ellis to discuss the evolution of urology practice, leadership strategies, the role of organizations like LUGPA, AUA, and AACU, and the importance of communication and education in the field.

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   The Thriving Urology Practice Facebook group.

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   Join the discussion:

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March 22, 2024

Mark, Scott, and Ray discuss the Change Health cyberattack, G2211 developments and questions that came into the PRS Network.

1. We have been receiving denials for our Urodynamics appointments because authorization was obtained under a provider that differs from the provider that signed off on the note day of services. For non-medicare plans (and plans that do not adhere to 100% of medicare guidelines) are we able to have a provider that is not on-site at the time of the UDS appointment sign off on the note?
2. We are a multi-specialty practice that all share one TIN. If we send an established patient to be seen by a provider that practices under a different taxonomy, can this provider then bill under a new patient encounter? For example, Urology refered to Urogynecology or if Oncology referred to Urology? Additionally, can these pts be seen by differing specialties, at different office locations on the same day?
3.  

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   The Thriving Urology Practice Facebook group.

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   Join the discussion:

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March 15, 2024

Mark, Scott, and Ray discuss questions that came into the PRS Network.

1. Hello,
   What is the recommendation on documentation for new code 99459? Our practice is wanting to create a template for this procedure code. I know documenting a chaperon is key. Thank you
2. Hello,
   I need help.
   I am having issues with multiple insurance companies denying diagnosis code N30.10 stating it is an invalid code. Anyone else experiencing this issue? Any indication on what the issue is?
   I looked in the ICD10 code book and it states it is a billable code.
   Thank you
3. Hi I have a coding question for peds urology.
   Can CPT 51701 be used for a urine capture for UAs? Since this is peds our payor mix does not include medicare. I was under the impression that for commerical payors 51701 cannot be used for urine capture and that it would bundle into the E/M service.
   Also, shouldn't we be able to code 81001-81003 for the UA? The provider is only coding an E/M service with 51701.
   Thanks!

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   The Thriving Urology Practice Facebook group.

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March 8, 2024

Mark, Scott, and Ray discuss questions that came into the PRS Network.

1. Hello all, I have a CPT coding question,
2. Indications = Urinary Obstruction // Post-Op DX = Obstruction of neck of Urinary Bladder 
3. Resectoscope per urethra into the bladder under direct vision. There was moderate trabeculations with no evidence of mass or stones. The bladder neck was noted to be elevated as seen on prior clinic cystoscopy. This was causing obstruction of the bladder outlet without significant prostatic hypertrophy.
4. The bipolar resectoscope was used with the plasma button attachment to perform a TUIP at 5 o'clock, vaporizing the bladder neck fibers until the bladder neck was able to open properly and drain appropriately. Electrocautery was used for any small bleeding vessels and hemostasis was adequate at the end of the procedure.
5. The recommended Code is: 52450, but the Coder is recommending Code: 52500.
6. We're also taking Codes: 52276 & 52214 into consideration.... Please advise on what you recommend with the Rationale. Any assistance is greatly appreciated.
7. I completed a  tapered ureteral reimplant  50783 on the left and a standard Non tapered ureteral reimplant on the right 50780 - does adding LT and RT modifiers allow both codes to be billed as follows:
   50783 LT
   50780.51.RT  
   does adding R /L mods  address the bundling issue?
   
   Coders noting that 50783 includes 50780 -- however this is  2 different sides and can't bill bilateral tapered 50783.50, as only tapered one side, and bilateral reimplant 50780.50 is undercoded for the additional time and complexity of ureteral tapering 
8. Has anyone billed for bladder injection of Lipiodol before? I have a provider who resected a large bladder tumor, then injected Lipidol in and around the resection site to aid with the patient's radiation planning for invasive bladder cancer. I was thinking this may be included in the 52240, but the office is suggesting unlisted code 53899 benchmarked to 52287 or 52283. Thoughts?

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   The Thriving Urology Practice Facebook group.

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   Join the discussion:

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March 1, 2024

Hosts Scott, Mark, and Ray discuss the upcoming MIPS submission deadline of April 1st and address common questions about MIPS submissions.

Registration is open for the Documentation for Coding and Reimbursement for APPs Course - Starts 3/11/24

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PRS Billing and Other Services

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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/ 

   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

February 23, 2024

Mark, Scott, and Ray discuss questions that came into the PRS Network: 

1. Regarding the most recent podcast episode on shard/split visits: Medicare's policy states that only one practitioner must have face-to-face time with the patient. In our practice the physician documents an addendum on the APP's note with the medical decision making portion of the visit. Per the episode, the physician must demonstrate involvement during the visit (not afterwards) in order to bill under the physician's NPI. Is there a guideline that states the physician must document their portion in real-time as the visit with the APP takes place? If they document the MDM portion of the visit in its entirety, isn't that enough to bill for the "substantive portion of MDM" as required by Medicare?
2. For 52001, we commonly use this code for cysto and clot evacuation for gross hematuria under general anesthesia requiring rigid scope. Are physicians allowed to use this code for cystoscopy and irrigation of a clot with a syringe under local procedure or should they use 52000 + 57000?
3. For 52281, does passage of the cystoscopy to dilate a narrowing in the urethra or meatus count? Or it is only meant to be used for cases where the meatus is cut or dilators or DVIU are used?

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The Thriving Urology Practice Facebook group.

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Join the discussion:

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February 16, 2024

Ray and Scott discuss the importance of documentation for reimbursement.

They emphasize the need to communicate effectively through documentation with billers, computers, and AI systems to ensure accurate coding and payment for services provided. They also mention the significance of using the right words in documentation to justify the level of service, multiple procedures, and modifier usage in order to obtain appropriate reimbursement. Additionally, they talk about the upcoming "Documentation for Reimbursement Challenge" that aims to help urologists and APPs improve their documentation skills for maximum reimbursement.

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The Thriving Urology Practice Facebook group.

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 February 9, 2024

Ray, Mark, and Scott discuss questions that came in about split or shared Visits.

Our questions are:

 When our doctors cover hospital patients, we often have Physician Assistants in the hospital rounding on new and follow up patients. Recently there is an Incident-to policy change, but I don’t think that applies to the hospital PAs since hospital charges cannot be billed incident-to. Regardless, what do you think of the following:

1. Are our physicians able to bill for those visits at 100 percent?
2. If yes, could they still bill via supervisory role to the PAs (i.e., the PA see the patient and discuss the patient’s case with the on call physician. The physician then formulates a follow up plan and communicate it directly to the PA without physically seeing the patient)? Or do the physicians have to physically see the patient to be able to bill?
3. Are physicians able to bill for procedures done by the PAs at the hospital?

Thank you so much for your assistance and guidance on this matter.

G2211 Guidance Document [free download]

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Join the discussion:

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