UCR 131: FAQs: New PCNL code clarification, urodynamics clinical denial, 0421T (Transurethral waterjet ablation of prostate) valuation and -22 usage, and outside CT and Category 2 E/M Data

  February 3, 2023

Mark, Ray, and Scott discuss questions and current topics.

UCR 130: What should a Urology Documentation, Coding, and Billing Plan include, and how to implement a plan efficiently and cost-effectively [Part 2]

 January 20, 2023

Ray, Mark, and Scott discuss what a Urology Documentation, Coding, and Billing Plan should include and what PRS has put together for you to efficiently and cost-effectively implement a plan.

UCR 129: Why Having a Urology Documentation, Coding, and Billing Plan is so important

 January 13, 2023

Ray and Scott discuss the top 3 reasons why you should have a good documentation, coding, and billing plan:   1) money   2) time   3) peace of mind 

UCR 128: How the new law impacts urology reimbursement in 2023; Modifier 25 - "unrelated to the decision to perform procedure" discussion

 January 6, 2023

Mark, Ray, and Scott discuss the new law's impact on urology.   Also, they have a discussion about the CCI Modifier -25 guidelines.

UCR 127: Physician Compensation Plan - 2023 Overview with Larry Kemp

December 23, 2022

Mark, Ray, and Scott welcome Larry Kemp, FACHE to discuss compensation plans and how to approach in 2023.

UCR 126: Important takeaways from the Las Vegas Seminar - December 2022

December 16, 2022

Ray and Scott discuss some highlights from the Urology Advanced Coding and Reimbursement Seminar.  They revisit the 2023 changes impacting urology, talk about the importance of coding and billing being a "team sport", and why the attendee interaction is so important.

UCR 125: Ambulatory Surgery Centers in Urology - Discussion with ASC expert Chris Setzler

December 9, 2022

Mark, Ray, and Scott welcome Ambulatory Surgery Center expert Chris Setzler and discuss ASCs in Urology.  Chris shares insights from lessons learned in Urology ASC build-outs.

UCR 124: Live from the Urology Advanced Coding and Reimbursement Seminar, what we are excited about the two-day event 

December 1, 2022

Mark, Ray, Scott, and Dr. John Lin discuss why they are excited about the Urology Advanced Coding and Reimbursement Seminar in Las Vegas December 2 and 3, 2022

UCR 123: Thanksgiving episode; can you get paid for E&M for groin dissection counseling during penectomy global?

Available November 25, 2022

Mark, Ray, and Scott wish all a Happy Thanksgiving and answer a question about getting paid for E&M for groin dissection counseling during a penectomy global. 

UCR 122: PCNL coding question; how to code it today and how it will change in 2023

November 18, 2022

Mark, Ray, and Scott discuss a PCNL question and how it should be coded under today's rules, and how this will change based on the new description revisions of the PCNL  codes for 2023.

UCR 121: CMS Final Rule 2023 - Analysis and Summary 

November 11, 2022

Mark presents the summary of the newly released CMS 2023 Final Rule.

UCR 120: What's important in urology coding and reimbursement right now [Part 2] - the Day 2 agenda of the Urology Advanced Coding and Reimbursement Seminar

November 04, 2022

Mark and Scott discuss the Day 2 agenda for the Urology Coding and Reimbursement Seminar what we included and why it's important right now.

UCR 119: What's important in urology coding and reimbursement right now [Part 1] - the Day 1 agenda of the Urology Advanced Coding and Reimbursement Seminar 

October 28, 2022

Mark and Scott discuss the Day 1 agenda for the Urology Coding and Reimbursement Seminar what we included and why it's important right now.

UCR 118: Billing for a Pre-Op clinic visit; Use of a snare to remove a stent, what about code 50386?; PHE Extended

October 21, 2022

Mark, Ray, and Scott welcome back special guest Dr. John Lin.  They discuss two questions that came into the Thriving Urology Facebook Group.  Can you bill for a Pre-Op clinic visit? Use of a snare to remove a stent, what about code 50386?; PHE Extended

UCR 117: How Dr. Lin almost lost over $8k due to documentation/appeal snafu

October 14, 2022

Mark, Ray, and Scott welcome special guest Dr. John Lin.  Dr. Lin shares how he almost lost over $8k due to documentation/appeal snafu and how he finally won it at the ALJ level.

UCR 116: Urology Coding Month Week 2 - ICD-10: urology review, payer denials based on diagnosis code notes and instructions, and other tips

October 7, 2022

Mark, Ray, and Scott discuss ICD-10 in week 2 of Urology Coding Month (October).  Mark gives the ICD-10 overview as it pertains to urology and shares current denial trends.

UCR 115: Urology Coding Month Kickoff; why knowing rules and learning new rules is so important; new 2023 CPT codes in urology

September 30, 2022

Mark, Ray, and Scott kickoff the Urology Coding Month (October) with a discussion of rules and why its so important to know what they are and how to apply them.  Also, as an example they discuss a few of the new 2023 CPT codes for urology.

 UCR 114: FAQs - New vs established patient; What services can nurses/MAs provide with no QHP present; Provenge billing clarification

Available September 23, 2022

Mark, Ray, and Scott discuss questions and current topics.

 UCR 113: Pediatric Urology Coding - non-palpable testis(UDT); surgery for possible chordee in boy.

September 16, 2022

Mark, Ray, and Scott discuss Pediatric Urology Coding and some of its nuances.  Also, they answer 2 pediatric urology coding questions.

UCR 112: Why it's so hard to get paid correctly for all services provided

September 9, 2022

Ray and Scott discuss why it is so hard to get paid accurately for all the services provided.

UCR 111: How to code, when surgery includes open and laparoscopic; Unspecified diagnoses denial recap

September 2, 2022

Mark, Ray, and Scott discuss what you should do when you have a surgery that includes both open and laparoscopic approaches.  Also, Mark recaps the Monthly Webinar "How to avoid unspecified diagnosis denials".

UCR 110: Coding guidance from manufacturers; CMS 2023 proposed rule: Discarded Drug Rebate

August 26, 2022

Mark, Ray, and Scott discuss the reliability of a manufacturer's coding guidance and also the Discarded Drug Rebate that is in the CMS proposed rule for 2023.

UCR 109: FAQs - Modifier Sequencing follow-up; Unbundling never allowed, but should be paid; Trimix injection training; and Bladder neck contracture codes

August 19, 2022

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

UCR 108: Modifier Sequencing: the orders in which you should order modifiers on a claim

August 12, 2022

Mark, Ray, and Scott discuss how modifiers should be ordered.  Mark shares what modifier sequencing is, why modifier sequencing is important, and provides examples of how to order modifiers on a claim.

UCR 107: Questions - Coding for TURBT with the removal of half a tumor; does medicare pay for repeat Urolift procedures?

August 5, 2022

Ray, Mark, and Scott discuss two questions that came into the Urology Coding and Reimbursement Group about billing a TURBT even though the whole tumor was not removed also they discuss coverage of repeat Urolift procedures.

UCR 106: Injections codes, why you may want to bill even if you know it's probably going to be denied 

July 29, 2022

Ray, Mark, and Scott discuss a question regarding injection codes and why it may be an excellent decision to bill the injection code even though you know it will probably be denied.

UCR 105: Laser ureteral stone through nephrostomy tube; Compliance plans

July 22, 2022

Ray, Mark, and Scott discuss a question regarding antegrade ureteroscopy with laser lithotripsy to treat a ureteral stone and compliance plans.

UCR 104: 2023 CMS Proposed Rules and how they will impact the Urology Practices

July 15, 2022

Ray, Mark, and Scott discuss the 2023 CMS Proposed Rules and how they will impact Urology Practices.  Mark breaks down what's important to urology in the new proposed rules.

UCR 103: Clarifications - 99211 in addition to office procedure; when can you bill an E&M in the post-op period, Modifier -24

July 8, 2022

Mark, Scott, and Ray clarify some concept nuances that may have been misinterpreted or misunderstood.

UCR 102: "Unspecified" ICD-10 Code Denials

July 1, 2022

Mark, Scott, and Ray discuss ICD-10 "Unspecified" codes and the increase in denials.

UCR 101: Modifier 25 - deep dive

June 24, 2022

Mark and Scott welcome Dr. John Lin to the podcast to discuss in detail Modifier -25.

UCR 100: Some of the most popular topics in the first 100 episodes and why they were popular

June 17, 2022

Mark and Scott discuss the most popular topics of the first 100 episodes and why they were popular.

UCR 099: Can urologists bill MRI fusion biopsy; billing pathology during pathologist's absence; and biofeedback and pelvic floor therapy billing?

June 10, 2022

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

UCR 098: E&M Level 3 with a Vasectomy on the same day

Available June 3, 2022

Mark, Scott, and Ray discuss Mark's call with a payer making the argument that a Level 3 E&M service can be billed with a Vasectomy on the same day with a Modifier.

UCR 097: Independent historian, newborn (post-hospitalization) circumcision consult, stent removal diagnosis, and temporary code 0421T

Available May 27, 2022

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

UCR 096: AUA Annual Meeting Recap; E/M 2021 Data Clarification

May 20, 2022

Mark, Scott, and Ray talk about the recent AUA Annual meeting in New Orleans.

 Also, we had a question come in about using the same data in medical decision making in two different encounters.  Can you count the same category 1 data twice?

UCR 095: Correct Coding - Cystectomy, with continent diversion, bilateral pelvic lymphadenectomy, and prostatectomy; AUA Annual Meeting May 2022

May 6, 2022

Mark, Scott, and Ray discuss a question about a scenario regarding selecting coding the most comprehensive code.

Mark, Scott, and Ray talk about past AUA Annual Meetings and look forward to the upcoming meeting in May 2022.

UCR 094: Prepayment claim review request and a new proposal from United Health Care to urology practices

April 29, 2022

Mark, Scott, and Ray discuss two current topics:

1)  Letter of notification from CMS/Qlarant, a provider was selected for prepayment claim review. We have received two record requests from them on urine PCR code 87798.

 2)  United Health Care proposing a plan to encourage e-consults for urology providers.

UCR 093: FAQs - Telemedicine POS, Bladder Interstitial Fiducial Marker, and Botox injection to pelvic floor.

April 22, 2022

Mark, Scott, and Ray answer questions

UCR 092: FAQs - Telemedicine POS, Bladder Interstitial Fiducial Marker, and Botox injection to pelvic floor.

April 15, 2022

Mark, Scott, and Ray answer questions

UCR 091: FAQs - Remote uroflow; Interstim covered diagnoses issue; TURP and bladder scan during global; Robot-assisted laparoscopic prostatectomy

April 8, 2022

Mark, Scott, and Ray answer FAQs

UCR 090: UTI – PCR UPDATE Part 2, Modifier -22

April 1, 2022

Mark, Scott, and Ray discuss an update on the MolDx guidelines for PCR billing set to take effect April 17th, 2022.  They also talk about Modifier -22; should you use it and what it takes.

UCR 089:  New MolDx guidelines for PCR billing - Part 1

March 25, 2022

Mark and Scott discuss the new MolDx guidelines for PCR billing set to take effect on April 17th, 2022.

UCR 088: Clarification -TC and -26 modifiers [#87]; FAQs - VUDS, Anterior Exenteration, and Prophylactic Antibiotic Injections

March 18, 2022

Mark, Ray, and Scott discuss comments and questions from PRS Forums: PRS Community and Urology Coding and Reimbursement Group.

UCR 087: -TC and -26 modifiers - Urodynamics billing: split or global?

March 11, 2022

Mark, Ray, and Scott discuss -TC and -26 billing for urodynamics.  There was a rule change in 2019 that updated how urodynamics should be billed in regards to the -TC and -26.  Prior to that rule change, we recommended split billing but now recommend the global billing.

CR 086: How to Tell if You Need More Urology Coding Training and How to Get It

March 3, 2022

Scott and Ray discuss the upcoming free webinar [March 10th, 2022]:

UCR 085: Research pathways  - coding services that may not have a clear answer - Pelvic Wave coding

February 22, 2022

Mark, Scott, and Ray discuss how to answer the question below and how to approach answering similar questions: 

UCR 084: Data and Reports - Overview of why data is so important and a preview of the upcoming free data webinar

February 11, 2022

Mark, Scott, and Ray discuss why data is so important and how you can learn more in the upcoming Free Webinar: 

Essential Coding and Billing Data and Reports for Urology Practices Workshop (2/17/22)

More information and registration 

UCR 083: Contracts - What can you do if payments are lower than expenses; No Surprises Act FAQs

February 4, 2022

Mark, Scott, and Ray discuss contracts and answer questions about the No Surprises Act. 

UCR 082: No Surprises Act

January 21, 2022

Mark, Scott, and special guest Dr. John Lin discuss the No Surprises Act.   Mark provides an overview of the act and the three discuss how will the act is going to impact urologists and urology practices.

UCR 081: New Modifiers 2022 and Urodynamics Coding 

January 14, 2022

Mark, Ray, and Scott discuss the new modifiers and urodynamics coding

UCR 080: Urology Advanced Coding and Reimbursement Seminar - Now Virtual, QPP New Reporting Change, and PRS 2022 Event Calendar Preview

January 6, 2022

 Mark, Ray, and Scott discuss the change of the Urology Advanced Coding and Reimbursement Seminar from in-person to online.  Mark provides an update on the QPP reporting that was just announced.  The PRS 2022 event calendar is previewed. 

UCR 079: FAQs - Disease v. personal history; modifier -24; data ordered prior to 1st visit - new or established

December 21, 2021

Ray and Scott discuss and answer questions from the PRS Communities.

UCR 078: Highlights Day 2- Urology Advanced Coding and Reimbursement Seminar - Las Vegas, Dec 2021

December 13, 2021

Ray and Scott discuss the highlights of the Seminar and share some of the takeaways for each session.

UCR 077: Highlights Day 1- Urology Advanced Coding and Reimbursement Seminar - Las Vegas, Dec 2021

December 9, 2021

Ray and Scott discuss the highlights of the Seminar and share some of the takeaways for each session.

UCR 076: Urolift ASC Payment Correction; Agenda Overview - 2022 Urology Advanced Coding and Reimbursement Seminar

December 1, 2021

Mark, Ray, and Scott discuss a correction to the preliminary analysis of the 2022 payment changes to the ASC payment for Urolift.  They also discuss the final agenda of the upcoming 2022 Urology Advanced Coding and Reimbursement Seminar (December 3rd - 4th, 2021 Las Vegas and January 28th - 29th, 2022 in New Orleans)

UCR 075: E&M 2021 - Common Questions and Clarifications

November 15, 2021

Mark, Ray, and Scott discuss some E&M 2021 FAQs.

UCR 074: CMS Final Rule 2022 - Preliminary Analysis and Summary

November 5, 2021

Mark presents the preliminary summary of the newly released CMS 2022 Final Rule

UCR 073: PHE Extension; Telehealth Update and Urology Coding Month 

October 22, 2021

Mark, Ray, and Scott discuss the PHE, telehealth place of service update, and urology Coding Month finale.

UCR 072: Implantable Penile Prosthesis Questions; "Incident To" (PTNS example)

October 15, 2021

Mark, Ray, and Scott revisit a question from Episode 068 about an Implantable Penile Prosthesis. Also, they discuss several additional IPP questions.  Finally, they had a question about PTNS that sparked an "Incident To" clarification discussion.

UCR 071: 2022 New and Revised CPT and ICD-10 Codes for Urology

October 12, 2021

Mark, Ray, and Scott discuss the new Urology CPT and ICD-10 Codes.

UCR 070: UCR 070: Global surgical package and global days

October 1, 2021

Ray, Mark, and Scott discuss the global surgical package and the global days. Understanding these concepts is critical to understanding the basics of coding.

UCR 069: Should Urologists/APPs do their own coding?

September 28, 2021

Ray, Mark, and Scott discuss the question: Should Urologists/APPs do their own coding?  This was a recent topic in the monthly webinar for PRS Network customers that we also wanted to share with the podcast listeners.

UCR 068: FAQs; Staged Procedure, IPP codes, Chordee/Hypospadias codes; QW;

September 21, 2021

Mark and Scott discuss questions from the Urology Coding and Reimbursement Group 

UCR 067: What is your Urology Coding Score? The average denial rate of Urology claims is 17% - we can do better!

September 7, 2021

Ray, Mark, and Scott discuss Ray's quest of helping Urology be the best coding specialty.  They discuss the free Urology Coding Score Quiz and how it can help identify your coding needs.

Click Here to Take the Free Quiz Now

PRS Network has declared October as "Urology Coding Month" and is offering a 50% discount to the Urology Coding Course for Urologists and APPs and the Urology Coding Course for Coders / Billers and Admins.

UCR 066: FAQs - Code for Renal Pelvic Washings CORRECTION; Physical Exam: necessity and documentation; Vasectomy initial visit E&M level in 2021

August 27, 2021

Mark, Ray, and Scott discuss questions from the Urology Coding and Reimbursement Group 

UCR 065: FAQs - Rezum (53854) reimbursement; CPT 55866 denial; CPT 74425 when it's not billed with 50690; code for Renal Pelvic Washings

August 20, 2021

Mark and Scott discuss questions from the Urology Coding and Reimbursement Group 

UCR 064: RAC Audits (Recovery Audits) - What happens and how to handle it when you get an audit request

August 17, 2021

Ray, Mark, and Scott discuss Recovery Audits.  Mark shares what you need to look for and how you need to react.  He also shares some current common audit requests.

UCR 063: FAQs; 51728 and 51729 differentiation, Criteria for 45990, F/U visit and provider did a PVR can use -25

August 10, 2021

Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group 

UCR 062: Physician Compensation Overview: Private Practice and Hospital System

August 3, 2021

Ray, Mark, and Scott welcome Larry Kemp to discuss urologist compensation and key concerns we see working directly with physician groups nationwide.

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...

Read More

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:

1. Coding for a stent removal using a snare without radiologic guidance.
2. CPT code is for the i-Tind procedure
3. Can you code a consultation visit (non Medicare) for new patient office visit seen in the ER
4. 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?

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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

1. 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"......
2. 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

1. 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. 
2. 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.

1. Choose a transition captain 
2. Update Compliance Plan
3.  Train the team
4. Update Processes
5.  EHR Template Update, Testing and Training
6.  Estimate Financial Impact
7.  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.

1. Final rule posting late this year
2. Conversion factor decreasing by 10.6%
3. E&M 2021 changes being adopted and will include increased RVUs for the E&M codes
4. RVUs for non-facility codes increasing enough to offset conversion factor decrease
5. RVUs for facility procedures are all decreasing
6. ASC payments are set to increase
7. MIPs has a couple of changes but they are not major changes to the current program
8. 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

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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.