co-hosted by: Mark, Scott and Dr. Ray Painter
Urology Coding and Reimbursement Podcast
The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.
UCR 061: The Increasing Role and Billing Issues of Advanced Practice Provider (APP)
July 23, 2021
Ray, Mark, and Scott discuss the Advanced Practice Provider (APP) and their increasing role. Also, they discuss how the 2022 CMS Proposed Rule has a change that will impact PAs.
UCR 060: 2022 CMS Proposed Rules and how they impact the Urology Practices
July 16, 2021
Ray, Mark, and Scott discuss the 2022 CMS Proposed Rules and how they impact the Urology Practices. Mark breaks down the proposed changes and how they will impact urology practices.
UCR 059: Why Bother with QPP (Quality Payment Program)?
July 9, 2021
Ray, Mark, and Scott try to answer the question "why bother with QPP?". Mark shares the reasons why the implementation of value-based medicine is important. In the discussion, they share the 4 main reasons why you should bother with QPP.
UCR 058: PCNL Revisited; Modifier -25 and LHRH injections; Billing for Multiple Bladder Biopsies
July 2, 2021
Ray, Mark, and Scott welcome back Dr. John Lin to clarify PCNL coding and answer some questions from the Thriving Urology Practice facebook group. Mark corrects information provided on a previous podcast.
UCR 057: Statistics and Target Metrics for Urology Practices
June 29, 2021
Ray, Mark, and Scott discuss some highlight statistics and metrics presented in the online course: "Important Revenue Cycle Management (RCM) Metrics; How to use them to identify and fix issues". What metrics should you be reviewing and how do you compare to others.
UCR 056: PCNL (Percutaneous Nephrolithonomy) coding; How to approach stone coding.
June 18, 2021
Ray, Mark, and Scott discuss PCNL coding. We have been getting more questions about PCNL coding. Mark explains PCNL coding and how you should code and bill. Also, they have a discussion about stone coding in general and Mark gives his approach to coding stones. What do you start with Location? Approach? Number of Stones? what's next?
UCR 055: E&M 2021 Guidelines - When it seems like a level 4 but MDM will only get you to a level 3, what can you do?
June 11, 2021
Ray, Mark, and Scott welcome Dr. John Lin to discuss Medical Decision Making. When it seems like a level 4 but MDM will only get you to a level 3, what can you do?
UCR 054: How to deal with providers that will not provide the documentation needed to get reimbursed
June 8, 2021
Ray, Mark, and Scott discuss the importance of physicians and other QHPs providing accurate documentation to communicate what they have done. Since the QHP is the only one able to communicate what services were provided during the encounter.
UCR 053: TURBT vs. Bladder fulguration and biopsy codes; AUACodingToday.com Bundling Matrix; Upcoming Seminars
May 28, 2021
Ray, Mark, and Scott welcome Dr. John Lin and discuss TURBT vs. Bladder fulguration and biopsy codes (52204 and 52224). The discussion is a deep dive into what circumstances the codes are used and how to differentiate in the documentation.
UCR 052: Payer's letters to physicians regarding their E&M billing levels relative to their "peers"
May 21, 2021
Ray, Mark, and Scott welcome Dr. John Lin to discuss payer's letters to physicians regarding their E&M billing levels relative to their "peers". Dr. Lin runs The Thriving Urology Practice facebook group and this topic has generated a lot of discussion.
UCR 051: Is patient care better with clinical pathways and good coding? Why and how the pathways are impacted by coding.
May 17, 2021
Ray, Mark, and Scott discuss clinical pathways and coding and how they impact patient care. They also discuss why accurate coding and documentation are important parts of clinical pathways and patient care.
UCR 050: Physician supervision, incident to, and IDTF; FAQs - 99221-99223 denials and takebacks; Biofeedback billing after prostate surgery; 2 surgeon surgery: colovesical fistula and robotic lap sigmoid colectomy coding.
May 11, 2021
Ray, Mark and Scott discuss physician supervision, incident to, and IDTF (Independent Diagnostic Testing Facility), also answer questions from the PRS Community and the Urology Coding and Reimbursement Group
FAQs
UCR 049: FAQs - Documentation for the administration of patient-supplied drugs; TURBT of multiple bladder tumors - can you "aggregate"; stone fragment removal, billing for Calyxo device; scrotal cyst code?
May 3, 2021
Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group
UCR 048: Documentation Support for Lab Tests; Coding for Laparoscopic and Robotic Procedures
April 23, 2021
Ray, Mark, and Scott discuss why you need to provide complete documentation for lab tests. Payers are starting to focus audits and takebacks on lab test reimbursement. Mark talks about how to document your test properly.
We receive frequent questions on Robotic procedures and the proper coding. Mark, Ray and Scott discuss the proper coding for Robotic and laparoscopic procedures.
UCR 047: How Much Coding Does a Urologist Really Need to Know, and Why?
April 20, 2021
Ray and Scott discuss the common question from urologists "Why do I need to learn coding? I have a team that does that". Over the years many Urologists have asked this question. Ray shares his thoughts on how much coding urologists need to know and why they need to know it.
UCR 046: The New Optimizer Series from PRS: Why it Was Developed and the First Part of the Series - "Optimizing Front Office and Critical Processes"
April 12, 2021
Mark, Ray, and Scott discuss the new PRS Network series: The Optimizer. Why they decided to develop the Optimizer Series and what they hope to help urology practices accomplish.
Also, they discuss part 1 of the series: Optimizing the Front Office and Critical Processes. Mark shares a story of 1 practice that lets $100,000 of uncollected AR walk through the door each month. They continue the discussion of how the series can help you focus on specific parts of your practice and optimize those functions.
UCR 045: Modifier Rules and other data in the National Physician Fee Schedule Relative Value File; where it is in AUACodingToday and how we made it easier to understand
April 3, 2021
Mark, Ray, and Scott had a question this week on whether or not you could use the bilateral modifier (-50) for code:
54351 - Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic
You may be surprised at the answer!
This prompted the discussion on data and where it comes from and how we have interpreted it and summarized it in AUACodingToday.com. The interpretation and summarization help make coding more efficient.
UCR 044: Payers - using hassle factor to delay payments, what you can do
March 26, 2021
Mark, Ray, and Scott discuss a problem with United Health Care and payment delays for higher-priced claims (ie Provenge, Urolift). What options do you have? What should you do?
UCR 043: FAQs - Bilateral Ureteroscopy Laser lithotripsy with stent; Urodynamics and Catheter; Cysto w/ sp Tube; Family history and risk; Documenting what was reviewed
March 19, 2021
Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:
UCR 042: How the New Technical Revisions to E&M 2021 Guidelines Impact Urology
March 12, 2021
Ray, Mark and Scott discuss technical revisions that the AMA released March 9th, 2021. The team breaks down what's different and what urology practices need to understand.
In addition to the details, they will also give urology examples so you understand the concepts.
UCR 041: Deductible Season: Impacts and How to Ensure Your Practice is Prepared
March 7, 2021
Ray, Mark and Scott discuss deductibles and the impact they have on urology practices. The importance of previsit planning and training to ensure a healthy practice.
UCR 040: "Incident to" billing; When to bill the 99211- Nurse Visit
February 26, 2021
Ray, Mark and Scott discuss incident to billing and when to bill the 99211 nurse visit.
UCR 039: FAQs, Multiple ESWLs, 55700 with 96372, vital sign collection requirements, 99441-99443 usage, 51702 and A4344
February 19, 2021
February 19, 2021
Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group
Question 1: 40 Seconds
Hello, one of our physicians has been doing multiple ESWL's (cpt 50590) on the same dos for treating more than one stone..i.e one kidney stone, one ureteral stone or bilateral stones..i have found info that says only one 50590 per dos and also to unbundle with an X modifier
any clarification much appreciated
thanks.....
UCR 038: What is the Urology QHPs Role in Coding and Billing
February 16, 2021
Ray and Scott discuss what a urology QHP should do and what they should not do. As we teach at PRS, you should always work at the top of your license. This does include some coding and billing. Ray and Scott discuss and give some examples of the role the QHPs.
UCR 037: E&M 2021 Risk - is prostate cancer with watchful waiting a level 2,3,4 or 5?
February 5, 2021
Mark, Ray, and Scott discuss Risk under the new E&M 2021 guidelines. Mark lays out a position that you can have a level 2, 3, 4, and 5 for watchful waiting for patients with prostate cancer. Your documentation is the key.
You need to provide the complete picture to include clinical and medical reimbursement perspectives.
UCR 036: Why Modifier -25 is so important and how it works with the EM 2021 Rules
January 29, 2021
Mark, Ray, and Scott discuss Modifier -25 and how it fits in with the new E&M 2021 Rules. They discuss why Modifier -25 continues to be so important and give examples of what changes with the new guidelines. You can save time by knowing the rules and how to use new guidelines. Your defensible documentation should be much easier to produce.
UCR 035: E&M 2021 Q&A: Other qualified health professional definition, Data - can I count note and PSAs in the note as separate data points? Is BCG with assessment a level 2 E/M? Prescription drug management clarification.
January 15, 2021
Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:
Question 1
It's now 2021 and I'm reviewing the coding seminar that I attended virtually in September. On the discussion of E&M coding based on time the phrase...
UCR 034: 2021 last-minute changes, G2211 update, MRI fusion biopsy of prostate coding, and initial vs subsequent dilations
January 8, 2020
Mark, Ray, and Scott talk about the last minute changes- Congress passed a Covid Relief package that included a few impactful changes.
They also, discuss the changes with the new code G2211 which now cannot be Paid until 2024.
Finally, they answer 2 questions from the Urology Coding and Reimbursement Group:
UCR 033: Lessons Learned from the First 33 Episodes; 2021 Biggest Challenges / Opportunities
December 21, 2020
Mark, Ray, and Scott talk about lessons learned from the first 33 episodes. Also, they answer the question "what do you see as the biggest challenge (or opportunity) coming in 2021"? Lastly, they discuss where the podcast is headed in the future.
UCR 032: 2021 Medicare Update Part 2 - Excerpt from our Urology Advanced Coding and Reimbursement Seminar - Virtual Live Event 12-4-20
December 15, 2020
The final Medicare rule was published on 12/2/2020. Mark presents what has changed, what is important, and the impacts the new rules are going to have on your practice. He also points out what you need to do to prepare your practice.
UCR 031: 2021 Medicare Update Part 1 - Excerpt from our Urology Advanced Coding and Reimbursement Seminar - Virtual Live Event 12-5-20
December 11, 2020
The final Medicare rule was published on 12/2/2020. Mark presents what has changed, what is important, and the impacts the new rules are going to have on your practice. He also points out what you need to do to prepare your practice.
UCR 030: Happy Thanksgiving! What we included in the agenda of the Urology Advanced Coding and Reimbursement Seminar and why
November 24, 2020
Happy Thanksgiving!
Mark, Ray, and Scott discuss the Urology Advanced Coding and Reimbursement Seminar Agenda. Mark explains what we have included and why. Ray emphasizes that there are a lot of big changes this year that can lead to positive outcomes for urology practices.
UCR 029: As the 2nd wave of pandemic looms, what can you do in your practice if there is another shutdown or slowdown
November 17, 2020
Mark, Ray, and Scott discuss the 2nd wave of the pandemic and what that means to the urology practice.
The first wave was dedicated to figuring out how to deal with the shutdowns/slowdowns and telehealth. This next wave, if there is a slowdown there are some opportunities to use that time to streamline your practice. Given the new Zoom skills we have all developed, there are opportunities to educate patients and leading to a higher return encounter.
UCR 028: Defining Poor Business Practices and Implementing Solutions
November 10, 2020
Mark, Ray, and Scott talk with Larry Kemp, FACHE about assessing your business practices, digging deep to identify the core problem, developing a road map, and then solving the root of the problem. Larry points out that "Being Paid is Not the Same as Paid Accurately".
You have to make sure you efficient in the things you can control in your practice. It is hard to extract more income from payers unless you have leverage in that market. But you do have options to limit exposure to the bad actors.
UCR 027: Lessons Learned from Our Workshops About the New E&M 2021 Guidelines; Vasectomy Consult - Level 2, 3, or 4? Prostate Cancer?
October 31, 2020
Mark, Ray, and Scott discuss some lessons and nuances that they learned during the discussion at the recent E&M 2021 workshops. Mark shares the reasoning behind a vasectomy consult and what level it will probably fall with the new guidelines. Also, he discusses the question - will all prostate cancer E&M visits be a level 4?
UCR 026: PHE Extension; FAQs - Urology Coding and Reimbursement Group
October 21, 2020
Mark gives an update on the status of the Public Health Emergency (PHE). Mark, Ray, and Scott discuss FAQs:
- Coding for a stent removal using a snare without radiologic guidance.
- CPT code is for the i-Tind procedure
- Can you code a consultation visit (non Medicare) for new patient office visit seen in the ER
- Additional clarification on the 25 modifier.
UCR 025: How the Urology Advanced Coding and Reimbursement Seminar came to be and how it looks different this year
October 17, 2020
Scott and Ray discuss the Urology Advanced Coding and Reimbursement Seminar. Ray shares how it all began and why. They discuss how the Urology Advanced Coding Seminar is going to be different this year.
Not only is it going to be a live virtual event but PRS has added additional products and services to help practices prepare for 2021.
UCR 024: Answers to questions asked on the PRS Community; News about advanced payment paybacks
October 2, 2020
Mark, Ray and Scott answer questions from the Urology Coding and Reimbursement group.
Can urologist bill for Covid intake screenings? We hear from a provider that when patient walks in the door and we perform the Covid intake screening ( we do these anyways), we can bill for this?
We would have to submit out Covid form, a medical form, and a SOAP note, these can be signed by an NP for submition to the insurance?
UCR 023 - New ICD-10 Codes for Urology - Active October 1st, 2020
September 28, 2020
Mark, Ray, and Scott discuss the new ICD-10 codes that go into effect 10/1/20. Make sure your Electronic Health Record and Practice Management System are up to date with the new codes. Luckily there are not that many new codes and will not have a big impact on most urology practices.
UCR 022: 3 Secrets PRS Uses to Develop Educational Products
September 18, 2020
Scott shares the 3 simple steps PRS uses to create the PRS education projects.
We have, over the last 30 years, developed a system for creating education products. We used this tested and proven method to develop the upcoming E&M 2021 Live Online Workshop.
UCR 21: 3 ways to consider incorporating telehealth in your practice now and after the Public Health Emergency
September 4 , 2020
Mark provides an overview of Telehealth utility now and post Public Health Emergency. He shares 3 opportunities to explore using Telehealth, if you are not doing so already.
1.) Basic Telehealth - Synchronous Audio Visual
2.) Communication Technology Based Services CTBS
3.) Remote Monitoring Services
UCR 20: FAQs - Question about D40.0, Neoplasm uncertain behavior of prostate? Modifier -57 v Modifier -25?
September 1, 2020
Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement Group
- Scenario:
New patient being seen via telemedicine for the first visit. Dr. has ER reports and a CT with finding of "a nodular mass-like extension from the left posterior aspect of the prostate into the seminal vesicle and an impression of "Probable prostate cancer extending into the left seminal vesicle"...... - Hi, dr did a laparoscopic radical nephroureterectomy for ureteral cancinoma and also a repair of a lumbar hernia
i came up with 50548 for the nephroureterectomy but am unsure of the hernia
thanks. Read More
UCR 19: FAQs - Can CPT code 50386 be done in the office? Can I bill CPT 55700 with 76872, 76942, 96372 & J1580?
August 24, 2020
Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement Group
- Can CPT code 50386 be done in the office? The provider wants to remove the stents without cysto whenever possible as he says it is more comfortable for the pt and less risk of infection. Does this still need ultrasound guidance to do in the office? Haven't done one of these before in the office. Please advise. Thank you.
- Good morning, new to ASC billing for my Urologist. My doctor performed a TRUS/BX at an ASC and I am billing the facility charge.... Read More
UCR 18: E&M 2021 Preparation Checklist - The 7 steps you need to take to ensure a smooth transition
August 14, 2020
Mark, Ray and Scott discuss the 7 steps your practice needs to take to ensure a smooth transition to the new E&M rules in 2021.
- Choose a transition captain
- Update Compliance Plan
- Train the team
- Update Processes
- EHR Template Update, Testing and Training
- Estimate Financial Impact
- Schedule Ongoing Training and Review
UCR 017: 2021 CMS Proposed Rules and how they impact the Urology Practices
August 6, 2020
Mark outlines the proposed rule and the 8 items that will have the most impact on the Urology practice.
- Final rule posting late this year
- Conversion factor decreasing by 10.6%
- E&M 2021 changes being adopted and will include increased RVUs for the E&M codes
- RVUs for non-facility codes increasing enough to offset conversion factor decrease
- RVUs for facility procedures are all decreasing
- ASC payments are set to increase
- MIPs has a couple of changes but they are not major changes to the current program
- Telehealth is going to continue with the same rules during the Public Health Emergency. Once the PHE is over then covered codes will change and be separated into 3 categories of covered codes
UCR 016: FAQs - Consultation billing? Can you bill catheters and leg bags with 51702? Auditing rules for telehealth? PCNL - 50080/81 and -52?
July 31, 2020
Mark, Ray and Scott discuss answer and discuss questions asked on the Urology Coding and Reimbursement Group.
Can you bill a consultation (99245) when one of our providers is sending his pt to another provider in the same group to discuss doing a RALP. Ins plan UMR/UHC. I don't think you can since they are under the same Tax ID #. The provider that did the consult says you can for a non CMS plan. Please advise. Thanks
UCR 015: How do you ask the right questions to find the right solution / code?
July 17, 2020
Mark, Ray and Scott discuss how to find the right codes or solutions by asking questions. The problem is that if you don't ask the right questions you may get the wrong solution.
Often times in coding and reimbursement the answers are not clear, there are a lot of "gray" areas. Finding the right solution based on all the information you have, is important. Then you need to double check by asking "does my answer make sense"?
UCR 014: FAQs - Telehealth Codes for PA/NP phone only visit? 52281 and 52601 during global, bundling question.
July 10, 2020
For PA and NP phone call only visits, what codes should be used? Additionally, can phone only codes be billed as incident to for established patients?
Good morning!
Can 52281 needing to be performed during global period of 52601 because of developed N35.811 meatal stenosis and increased self- catherizations be billed with a modifier? I am looking and the EncoderPro.com service I have through my employer says: "A modifier is not allowed to override this relationship".
Thanks again!
UCR 013: Kidney Stone Coding - a discussion about the CPT® and CMS rules and how they impact multiple stone billing in different locations.
Mark and Ray present the current CMS and CPT rules and how those rules affect coding for multiple stones. As most are well aware, the rules are not always black and white and in this instance the rules leave plenty of room for interpretation. Mark and Ray present the current rules and lay out a case for a fair interpretation based on work performed.
UCR 012: Maximizing income and efficiency begins with the front office, learn what to look for and how to adjust. Interview with Larry Kemp, FACHE
Larry talks about how teamwork is one of the most important aspects of an efficient office. Learn about one of the best ways to train your office. Larry has helped many urology practices and over the years developed and tested systems and strategies to help practices of all sizes.
How do you know when it is time to part ways with a team member? Is one employee dragging the performance of the rest of the group down?
UCR 011: The 5 most important things for Urologists to include on the home page of their website. Interview with Marketing Expert Brent Stutzman
Brent shares what most Urologists are missing on their website. Do you explain what you do? Have pictures related to your practice? Have a clear call to action? Learn some simple changes you can make to your website to help attract your ideal patient.
Should you have video on your website? How important are testimonials? Get the answers to all these questions and more as Brent discusses what is important for today's urology website.
UCR 010: Cybersecurity: Working from home/remotely? How to protect your network and your practice from cyber attacks and breaches
Cybersecurity: Working from home/remotely? How to protect your network and your practice from cyber attacks and breaches
In this episode, Mark interviews cybersecurity expert Jeffery Daigrepont, from the Coker Group.
Jeffery shares some items you should consider to protect your practice. Did you realize that one of the most important tools is cybersecurity insurance and most out of the box policies don't cover a common cyber breach potential?
Also, most practices don't know that many breaches occur because of individuals actions within the practice. These actions are not intentional but can lead to significant issues.
UCR 009: Modifier -25
Mark, Scott and Ray talk modifier -25. In addition to a general overview about the definition, they give several urology examples.
Modifier -25 definition: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.
UCR 008: RVUs - Overview and How They Can Help You
Mark discusses RVUs and why they are important to the urology practice. Not only are they important for reimbursement but they can also be used as a tool to assess practice productivity and efficiency.
Learn why not understanding the RVU basics could be costing you in many aspects of your practice.
UCR 007: Voice Recognition in Today's Practice with Brad Sclar
Scott talks with voice recognition expert Brad Sclar. Learn how Brad, who has a Doctorate of Musical Arts, got involved with healthcare. Find out if voice recognition belongs in today's practice. Why the dictation software and algorithms on your phone and computer just don't cut it in the medical profession.
UCR 006: How Dr. John Lin is "reopening" his urology practice as the pandemic restrictions are easing
Mark and Scott talk with Dr. John Lin, a solo practitioner from Gilbert, AZ in the Phoenix metropolitan area. Dr. Lin shares his strategies and the steps he is taking to "reopen" his practice.
Find out if he sees telehealth in his practice moving forward and if there are any efficiencies to be gained from what he has learned.
UCR 005: Do you know what you are not billing?
We hope you and your families are safe and healthy.
In this episode, Scott and Ray discuss two commonly overlooked billing mistakes that cost urology practices money. You can't find this on any report but yet it occurs in all practices unless you have the right system.
Ray outlines the simple but effective way to identify procedures performed, that may not have been billed. They also discuss a second issue, contractual denials, and outline a strategy to address them.
UCR 004: Telehealth/Telemedicine Shared Visits Clarification
We hope you and your families are safe and healthy.
In this episode, Mark clarifies the rules associated with Telehealth/Telemedicine shared visits. We have been getting questions regarding shared visits.
Mark answered a question on the recent webinar and his answer sparked additional discussions on this topic.
UCR 003: How to Document Telehealth/Telemedicine Visits and Comply with the New Rules
This is a replay of a webinar that aired Thursday, April 10th, 2020. Mark outlined how to properly document Telehealth/Telemedicine visits and select the appropriate level of service during the Public Health Emergency.
The rules were released and then adapted to the changed Telehealth environment. Mark also reviews the new rules and how to apply them in a Urology practice.
co-hosted by: Mark, Scott and Dr. Ray Painter
UCR 002: Telehealth/Telemedicine: New Rules in the Wake of the Coronavirus
Congress and the president gave Medicare some additional powers to relax the current restrictions surrounding payment for services provided via telephone, Video chat and through HIPAA secure technology for traditional Medicare. Additionally, Private insurance companies through both Medicare Advantage plans and standard commercial plans have been encouraged to expand telehealth services.
co-hosted by: Mark, Scott and Dr. Ray Painter