Urology Coding and Reimbursement Podcast

1. June 6, 2025 

In this episode, Ray, Mark, and Scott welcome back Dr. John Lin to discuss topics brought up on the Thriving Urology Practice Facebook Group.

1) Just got a call from ER. 19 year-old cannot get an erection...

2) This notice came from the hospital last week regarding change in financial protocol about scheduled / elective surgical procedures.

Increased Patient Responsibility:

As is customary in the Phoenix market and in-line with other providers, we will move the down payment requirement to 50%. We will be increasing the required patient payment for deductibles and co-pays prior to the day of surgery from 20% to 50% of the estimated patient liability.

3) Our office will be beginning PAE {prostatic artery embolization) for BPH in the near future. This will be performed in the office, POS 11 by an interventional radiologist, who will manage the sedation and the performance of the procedure. We have not had to bill for conscious sedation in the office before. I was hoping to get some guidance on what codes should be investigated for the anesthesia portion (administration, meds, etc.) so we can better prepare ourselves for what is to come.

Bonus Topic

I received an email from a surgery center recently which stated the following: 

Recently, we have been using a larger number of disposable ureteroscopes which are very costly to the Center. In order to capture the code C9761 for reimbursement of the disposable flexible ureteroscopes, we need your dictation to reflect the usage of that scope and that suction/aspiration was used. 

A vendor’s representative has provided a few examples from other physicians that have resulted in successful reimbursement of these scopes. Below are the examples. 

• The op report documents a steerable and suction/aspiration was used. It says "A disposable single use flexible scope with steerable and suction/aspiration was used to improve stone-free rate."
• The op report documents only a scope using a suction feature. It says "A disposable flexible ureteroscope utilizing a suction feature was utilized for the procedure."

   If you are not already, please have your dictation reflect that you are using a disposable flexible ureteroscope with suction so that we can bill for reimbursement. As always, we appreciate your help with cost containment and appropriate reimbursement for the Center. Please let me know if have any questions or concerns

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 Pract

May 30, 2025 

In this episode, Mark and Scott address upcoming significant changes to the prostate biopsy codes and provide guidance on correctly applying modifiers 25 and 59 when billing procedure 51798 and an E/M service. They also discuss coding considerations for the emerging practice of robotic-assisted vasectomies.

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/ 

May 23, 2025 

Scott, Mark, and Ray answer listener questions on coding for remote uroflowmetry, defining high-complexity MDM, and dealing with low Medicare Advantage reimbursements. They discuss CPT code options, provide examples of immediate-risk diagnoses, and offer strategies for contract negotiations. 

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/ 

May 16, 2025 

Scott and Mark switch roles to introduce the new PRS Coding and Reimbursement Hub, featuring Jelmyto as an example. The Hub helps practices simplify workflow, coding, and reimbursement processes. Scott explains how the Hub provides clear, trusted guidance, enabling urology practices to streamline reimbursement, reduce confusion, and accelerate patient access.

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/ 

May 9, 2025 

In this episode, Scott, Mark, and Ray answer questions that came into the PRS Helpdesk.

1. One of my specialties is pedsurology and there is just not much guidance for surgery coding.
   Is it appropriate to use 54360 (plastic operation on penis to correct angulation) for correction of penile torsion?
   I found an article from AAPC dated 2005 that stated to use 14040 for penile torsion repair when performed with a MAGPI hypospadias repair (54322).
   What if the penile torsion repair is not performed with another procedure or at least without a hypospadias repair?
2. If Medical technologists (Medical assistants trained to perform Urodynamics) can perform this test why are Medical assistants not permitted by CMS to perform catheter insertion and removal in non regulated sites of services? (I have seen MAs in non regulated spaces perform catheter changes, bladder instillations--etc---how are practices able to get away with having MAs incorporated in their work flow as such?)
3. In regulated sites of service (Hospital based clinics) what documentation should be used to ensure proper billing when an MA performs 51798 (bladder scan) (incident to billing for a hospital-employed physician).

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/ 

May 2, 2025 

In this episode, Scott, Mark, and Ray share highlights from the AUA 2025 Annual Meeting in Las Vegas, discussing exciting new technologies, reimbursement challenges, key conversations, and updates from the urology community.

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/ 

April 25, 2025 

Scott, Mark, and Ray discuss the pressures of Urology practice in 2025. They talk about what you need to be aware of and why you need to plan for the future.

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/ 

April 18, 2025 

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

1. For the past 8 months, I have been in an employed position with a county hospital system that provides inpatient and ambulatory services. Their coding consultants (acsteam.net) are telling the hospital that foley catheter insertions, bladder irrigations, and a list of other procedures commonly performed in urology clinics cannot be billed if they are not performed personally by the physician according to CMS. They reference a list of procedures from CMS and state that these services cannot be billed when performed by ancillary staff regardless of the level of supervision. They use https://www.cms.gov/status-indicators as their source citing the section on PC or TC indicators. Can this be true? Is it possible that this consultant is giving advice from a hospital perspective and not aware of differences between the ambulatory setting? The urology clinic I am working in is not a department of the hospital. It is freestanding. I have never worked in a clinic that did not bill for these services performed by ancillary staff with physician supervision.
2. I look forward to your response.
3. Good afternoon, my question is regarding "Incident to" required documentation. When we attended your seminar this past December, on Day 2, the new "Incident to Rule" was discuss. Can you please help clarify the new rule? My notes are not clear.
   We are in the process of CMS Review -"Targeted Probe and Educate Round 1". The letter states we were chosen for review because of being in the 60th percentile for our jurisdiction for code 99214.
   Our practice has the challenge of servicing and underprivilege community and estimated population of 590,142. We have 7 Urologist, 4 Apps and 1 Radiation Oncologist in our practice. Hence our volume is overwhelming.
   Earlier this year we submitted a batch of approximately forty records. Today we received a notification request "Incident to documentation: needed 2 previous office visits done by MD to support physician/supervising provider's initiation and continued involvement in treatment, and documentation to support direct supervision met.
   I appreciate any assistance with clarifying the “Incident to” rule.
   Thank you in advance for your assistance.
4. Doctor did a stent pull in the ASC but not with Cysto scope. How would we go about billing this?

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/ 

© 2025 Physician Reimbursement Systems, Inc.

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April 11, 2025 

Scott and Mark discuss questions that came into the PRS Helpdesk:

1. Hello, Some years ago we were using the SRS urocuff. Can you tell me what the current codes are? I know this has been mentioned at the seminars- cannot find the slide :( Thanks
2. How are groups coding for the new Revi procedure for urge incontinence, urgency of urination, for both professional and facility fees. Is it best to use a 0817T or a 64581 w/ crosswalk? Cannot find a lot of information about this. Any feedback or suggestions would be greatly appreciated!
3. I would like your thoughts about the use of Pelvic Floor rehab CPT code 91122 in a urology practice.  The company UroVal Inc. is promoting this  procedure for urologists to perform in the office setting.
4. E/M question pls. Thank you!  For a follow up office visit, Pt has prostate cancer, and he is on "Active Surveillance".  For Problem Component of E/M, would you consider pCA on Active Surveillance is a Moderate VS a Low-level problem? (as opposed to personal history of pCA - Watchful Waiting).  I think it's a moderate level 4, but would like to hear your opinion, thank you!!

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/ 

April 4, 2025 

Scott and Mark discuss who can perform biofeedback services, clarify billing requirements, and explore practical scenarios involving incident-to billing. Mark and Scott break down key Medicare guidelines, share best practices for documentation, and offer tips for optimizing biofeedback delivery within your urology practice.

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/