September 27, 2024

Ray and Scott welcome guest Marianne Desciose to discuss Prior Authorizations, Pre Certifications, and Eligibility.

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

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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars

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Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

Join the discussion:

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September 20, 2024

Mark, Ray, and Scott welcome guest Dr. John Lin to share a discussion with a Medical Director and his team from a large payer about what level an undesired fertility, pre-vasectomy, obesity counseling visit should be and the documentation required for reimbursement.

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

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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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

September 13, 2024

Mark, Ray, and Scott discuss questions from the PRS Community.

1. Hi, In your Urology Times article on July 30th, there is mention of a proposed change to the practice expense component of cystoscopy due to updates in the supply valuation by CPT RVU Update committee. It talks about "packs SA045, SA058 and SA042". What are these packs and can you explain further how this will impact the in-office RVU for CPT 52000?
   thanks
2. We are looking for some guidance regarding images and the accessibility. When coding procedures such as 50431 (images included in code) or 51600 or 51610 (images billed separately). Does the coder physically need to see the images before submitting charges? Or can charges be submitted if provider clearly documents images available? We know the images are readily available and are attempting to prevent additional work uploading to the chart for coder review. Should we consider having a written policy in place? Appreciate any advice or suggestions y'all may have.

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

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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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

September 6, 2024

Mark, Ray, and Scott address follow-up questions from the previous episode concerning the billability of ureteral stents during procedures. They clarify distinctions between inherent procedural components and separately billable services, emphasizing the importance of documentation.

The episode also reviews coding for G2211, where Mark adjusts his stance to include hypogonadism for long-term management. Additionally, the hosts discuss the supervision levels required for radiologic services and recommend AUACodingToday.com for efficient coding. Emphasizing up-to-date knowledge and precision in documentation, the episode closes with insights on adapting to evolving coding regulations.

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

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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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

August 30, 2024

Mark, Scott, and Ray talk about questions that came into the PRS Communities.

1. Hi, I have a coding question pls. Thanks so much.
   
   Our urologist performed HIFU a month ago. Pt. had come back for Dysuria postop complication, has been having dysuria for 2 weeks. Our urologist decided to perform Cystoscopy for this.
   
   Cystoscopy performed, but we did Not bring Pt. back to OR. So, it should Not be a billable service
   But then, Per NCCI, Diagnostic test and procedures may be paid as a separate service during global.
   
   Should we bill CPT 52000? and If so, will modifier be -58, since it did not occur in OR so -78 would not be an appropriate modifier?
   Please suggest, thank you!
2. Modifier 73 Question: Can this modifier be used when the patient is in the pre op area and he/she was given Dilaudid and another mediation and then prepped for surgery but then the patient decided they did not want to proceed because the pain medication made them feel better(Patient had a Kidney Stone). It seems resources were used and a block of time was scheduled for the facility. Wording can be a little different from our MAC, CPT, etc when some state the patient has to be taken to the operating room. Thanks for your time.
3. Hi, We are getting some pushback and would like to know when/if ureteral stents are billable intraoperatively. Our providers are placing a stent, performing pyeloplasty in the same ureter, and the stent is routinely removed one week later.
   Is this stent placement an inherent part of performing the primary procedure, or is this a billable service? Thank you!

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 Seminars - In-Person Seminars

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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

August 23, 2024

Mark, Scott, and Ray talk about two questions that came into the PRS Communities:

1. I have Optum requesting records on all of our clot evac cases where something in the bladder was fulgurated during the same session and after record review we fail the audit.
   Now compliance is very quick to say refund it, stop billing it, its bundled, etc.
   But we know a modifier is allowed so when is it allowed????
2. Everything I find online like AAPC says to bill both 52214 and 52001-59 but there is nothing recent and nothing concrete about what is considered distinct. I mean using a clot evacuator is different than using a loop electrode. Below are the Optum rationales.
   So the urologist does a cysto on hematuria work up, and they wind up using an evacuator to remove huge amounts of clot burden. Then use a loop electrode to fulgurate some areas that look suspicious.
   Why is that service not considered distinct? Compliance says its incidental but they can't tell me when it wouldn't be incidental and I don't want to let optum take back money without an argument.
3. Hi, I would like to ask a coding question please. Thank you so much!
4. For Robot-assisted left partial nephrectomy and Resection of a left renal hilar lymph node, Do we code any additional CPT to capture renal hilar lymph node, in addition to partial nephrectomy 50543?
5. Pathology report had a separate report for Renal hilar lymph node dissection, which was negative for carcinoma. And for partial nephrectomy, path showed Renal cell carcinoma.

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

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Urology Advanced Coding and Reimbursement Seminars - In-Person Seminars

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Special Early Bird code: 25UACRS732

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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

August 16, 2024

Mark, Scott, and Ray talk about G2211 and 99459 updates and two CPT description questions that came into the PRS Communities:

1. I have received a denial for px 50545 stating the adrenal gland was not removed, therefore, 50545 is not supported. PX description: Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy). I recall reading a PRS article regarding what constitutes a a radical nephrectomy (of course, currently I can not find my reference). But if I recall correctly, the main criteria for radical is the removal of the Gerota's facia. The nodes, adrenal and fatty tissue were not the determining factor, and did not have to be removed to classify as radical 50545. Can y'all please help direct me to the correct understanding? Does the adrenal gland have to be removed in a radical nephrectomy? Thanks for any input y'all can provide.
   
   
2. The CPT book does not define limited vs complete for penile duplex scans the way it does for other vascular studies. How do we choose between 93980 and 93981, and what do we look for in documentation to determine whether it is complete or limited If it is not a follow up? I have never had a provider perform this procedure before and want to make sure i am understanding the codes correctly. Thank you!

AMA Paranthetical Link

https://cpt-international.ama-assn.org/cpt-implementation-guide-component-2-primer

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 Seminars - In-Person Seminars

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Special Early Bird code: 25UACRS732

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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

August 9, 2024

Mark and Scott discuss the 2025 Proposed CMS Rules.

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 Seminars - In-Person Seminars

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Special Early Bird code: 25UACRS732

Click Here for Information and Registration

Event Details

Location:
Las Vegas: December 6-7, 2024, at Horseshoe
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

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