Urology Coding and Reimbursement Podcast

 March 28, 2025 

Scott, Mark, and Dr. Ray Painter discuss questions that came into the PRS Helpdesk. 

1. NGS sent a newsletter about the use of: cpt code G0463 as a primary code for G2211. Need more info if possible.
2. Do nurse practitioners get paid at 100% for procedures like a PNE when signing notes in NM by themselves?
3. a) Medicare NGS is denying CPT 52332 for bilateral stents with denial CO-151. This seems to be a constant problem with denials for frequency and/or bilateral stents.
   Has the policy been changed; I have not been able to find any changes regarding stents insertion or exchanges.
   Thanks
   b)Hi,
   Wondering if you can help me with this Medicare patients.
   NGS is denying the claim on several patients stating that this code has a frequency limit on 52332.
   NGS has a problem with both frequency and bilateral stents
   I have searched everywhere and find no information on this code for frequency limits per year or bilateral stents.
   Appreciate any help on this code.

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Marianne Desciose

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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/ 

March 21, 2025 

Scott, Mark, and Dr. Ray Painter break down the latest developments in telehealth policy and Medicare reimbursement. Mark shares the good news about the extension of telehealth flexibilities and the bad news regarding the unchanged (and still reduced) conversion factor. They also dive deep into the recent uptick in RAC audits, highlighting the procedures being targeted, documentation pitfalls to avoid, and best practices for navigating the audit and appeals process. 

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

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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.

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 14, 2025 

Scott, Mark, and Ray discuss three coding questions from the PRS Community and the Thriving Urology Practice Facebook group. 

1. My question is regarding G2211. Is there a time frame for the follow-up that needs to be dictated. My doctor has been putting return to clinic in a year in the notes and billing G2211. Wondering if this is ok, or if the follow up must be sooner?
2. Our new urologist started placing an amniotic tissue membrane graft around the urethral anastomosis during a laparoscopic robotic radical prostatectomy. Would this be included in the 55866 or is there a CPT code for this? I was looking at 15275 but not sure if that is correct either. I am a coder with questions.
3. Would you be so kind to give me your opinion on 50548 for robotic radical nephroureterectomy versus using 50545 for that surgery?

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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/ 

March 7, 2025 

Scott, Mark, and Ray discuss the latest updates (or lack thereof) on telehealth policies as the current extension nears expiration. They break down what practices should consider when scheduling telehealth visits, the potential impact of congressional actions, and how to prepare for possible changes.

The second topic dives into specialty designations within the same practice—what happens when different taxonomy classifications exist under the same tax ID, and how this affects new vs. established patient billing.

Free Kidney Stone Coding Calculator

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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/ 

February 28, 2025 

Scott, Mark, and Dr. Ray Painter break down the challenges of securing fair compensation for extra work performed in urology procedures when using modifier 22, unlisted codes, or Category III codes. They discuss effective strategies for communicating with payers and contract administrators, ensuring proper documentation, and negotiating fair work RVU adjustments.

Free Kidney Stone Coding Calculator

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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/ 

February 21, 2025 

Scott and Mark discuss questions from the PRS Network Community and the Thriving Urology Practice Facebook group.

1. Does anyone bill out a removal of testicular appendix separately from the hydrocelectomy? I have a new physician that is submitting 55040 and 54512.
2. After presenting Grand Rounds on billing/coding the question arose that our billing department is billing g G2211 with a modifier 25 and getting paid. That goes against what I learned and what I presented. 
3. Leveraging Provider Portals

Free Kidney Stone Coding Calculator

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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/ 

 February 14, 2025 

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

1. Our doctor's occasionally use the ESWL (Extracorporeal Shock Wave Lithotripsy) for bladder stones. Insurance requires a laterality modifier. I am not sure if we can bill for it or not. If we can bill for it, what is the correct way to do it?
2. Can you please clarify the relaxation of the in person requirement for supervision in 2025? As I read it and as I understand that you have explained it, this is a new rule stating essentially that if I am a physician supervising a nurse practitioner, the in person supervision is waived and I only need to be available via telecommunication. Am I interpreting this correctly? My coders are pushing back saying that this only applies to telehealth visits not in person visits for my supervisoion of a nurse practitioner.
3. Coding Challenging Stone Cases: Is there a CPT code I'm missing here? What financial incentive is there to use the suction/vacuum technology and perform FANS/DISS for larger stones? Just the 22-modifer? Seems like from a billing/time perspective, it's not worth tackling larger stones with either FANS or DISS. 
4. 
   Does the 22-modifier really make that much difference? Can you provide an example of generally what additional time (ie double/triple, etc) actually generates for additional RVUs? 

Free Kidney Stone Coding Calculator

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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/ 

 February 7, 2025 

Scott and Mark welcome back Dr. John Lin and Marianne Descoise to discuss some key takeaways from the Urology Advanced Coding and Reimbursement Seminar, which took place in New Orleans from January 31st to February 1st. 

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/ 

UCR 228: G0559 clarification, GC Modifier Explained, and G2211 documentation suggestion.

January 24, 2025 

Scott, Mark, and Dr. Ray Painter address questions submitted to the PRS Network.

1. I recently attended your Billing and Coding conference in Las Vegas this past December. 
   I need clarification on New CPT code G0559, can someone please contact me as soon as possible.
2. From a coding perspective, I have a question regarding the GC modifier for a teaching facility. Also, is there a difference between the coding perspective and the compliance side of the question?
   How crucial is adding the modifier GC to the encounter when a patient is seen by both the Resident and the Faculty member?
3. Appreciate any insight y'all can provide.
4. My coder is requiring me to add a statement for G2211 codes.
5. "E and M visit today is associated with current or anticipated ongoing medical care services related to a patient's single serious condition or complex condition."
   
   Is this necessary? Reading the CMS guidelines they say no. They are worried about "Bulletproof" Documentation. I am coding these with many of my follow up patient who have chronic BPH, OAB, ED and cancer. Thoughts on how to respond to them? 

Free Kidney Stone Coding Calculator

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

Click Here to Get More Information and Request a Quote

Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
New Orleans: January 31-February 1, 2025, at Harrah's

Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm

Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs

Click Here to Start Your Free Trial of AUACodingToday.com

January 17, 2025 

Scott, Mark, and Dr. Ray Painter are joined by special guest Marianne Desois, COO of PRS Managed Services, to dive into the growing issue of payer recoupments. They discuss the tactics payers use, common pitfalls practices face, and actionable strategies to identify and appeal recoupments effectively, helping you safeguard your revenue stream.

Free Kidney Stone Coding Calculator

Download Now

Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
New Orleans: January 31-February 1, 2025, at Harrah's

Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm

Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs

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/