June 14, 2024

Mark, Scott, and Ray discuss topics that came into the PRS communities.

1. Can you bring this back up again as it relates to Audio only calls. Question i have is if you are just reviewing results that were ordered during a visit, this is essentially not a billable event. Isnt it considered double dipping because the review of the results and test order is included when ordered. Aside from the results, going over a treatment plan could be a billable event. Truly depends on what you are using this visit for. I have added an AMA sheet that will help with the different scenarios.
2. Please let me know your thoughts
3. Ordering a test is included in the category of test result(s) and the review of the test result is part of the encounter and not a subsequent encounter.”
   And, from the CPT Assistant, (AMA publication) November, 2020, page 5: “It is assumed that the physician or other QHP would review the results of the test ordered; therefore, the physician or other QHP would not receive dual credit toward MDM for service-level selection for both ordering and reviewing the test.”
5. Hi, a question please. Thank so much.
6. For Robotic assisted retroperitoneal lymph node dissection, Lap Resection of right gonadal vein/Spermatic cord stump.
7. I coded Robotic assisted retroperitoneal lymph node dissection with 38589 (benchmarked to 38780),
8. but I have a question for Lap Resection of right gonadal vein/Spermatic cord stump,
9. Should these be coded with two CPT codes: One to capture right gonadal vein resection and another one to capture Spermatic cord stump? VS these two are on the same location and should only be coded with one CPT code? Thank you!

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June 7, 2024

Mark and Scott discuss FAQs that came into the PRS communities.

1. Are you obligated to bill the new Category 3 CPT code for penile shockwave therapy, which we currently provide as a cash service? Specifically, do we have to use the Category 3 code when billing Medicare patients, even though there is no payment associated with it, and can we continue collecting cash without making it a Medicare billable service?
2. Is cystoscopy a moderate risk (level 4) procedure for medical decision making purposes absent other risk factors? Does it matter for MDM risk what discussion or thought process is documented? Or would that only be toward the medical necessity of the procedure?
3. CPT code 55250 says it is including postoperative semen examinations. So far we have done these in house but my physicians would like to no longer perform those and are currently looking into purchasing FELLOW kits to sell to the patients. We do not have any labs in town that perform post vas semen analysis. Any advice on what to do when patients refuse to purchase the kit?
4. If Trimix is a compounded drug wouldn't J7999 - Compounded drug, not otherwise classified be more appropriate to vs J3490?

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The Thriving Urology Practice Facebook group.

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May 31, 2024

Mark and Scott welcome Marianne Desciose to discuss what are the biggest issues right now in RCM.

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

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May 24, 2024

Mark, Ray, and Scott welcome Dr. Una Lee and Dr. John Lin to share their thoughts about their AUA IBL presentation "The Business of Urology – What I have Learned on How to be Clinically Productive"

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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.

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Join the discussion:

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May 17, 2024

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

1. Are there payers not paying for 99459?
2. Hello, the max units for J2704 is 80. I have searched and searched and can't figure out how to bill additional units if more than 80 units is administered. I have tried modifier 59 and my claim was still denied. Any help would be greatly appreciated.
3. Can we bill 13 units for 87798 for UTI PCR and Rectal swab PCR?
   Would charging 87801 be better for rectal swab PCR? VS 87798

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May 10, 2024

Mark and Scott discuss FAQs that came into the Urology Coding and Reimbursement Group.

1. MRI fusion biopsy update
2. Hi,
3. Can you please help us with the below questions.
4. 1. Pessary Insertion – does it require a physician to be onsite? What about Pessary cleaning?
   2. Urodynamics – we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?
   3. Biofeedback - we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?
5. Hi, a question regarding NCCI edit pls. When unbundling is not allowed between two CPT, due to an indicator "0", never billed together. If the secondary CPT has more work-RVU than primary CPT, i.e. 51705 (primary) wRVU 0.9; and 52000 (secondary) wRVU 1.53, Are there any rules that we must bill Primary 51705? VS Can we choose to bill 52000 instead, knowing that 52000 has more wRVU than 51705? Thank you,

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The Thriving Urology Practice Facebook group.

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April 26, 2024

Ray, Mark, and Scott discuss the upcoming AUA Annual meeting in San Antonio and what PRS plans to do there.

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April 19, 2024

Ray, Mark, and Scott discuss the nuances of communicating with payers and clearinghouses during the post-operative global period.

New Courses Available for Urologists and Urology APPs

Documentation for Reimbursement Challenge for Urologists​
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Certification for Urology Coders

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PRS Billing and Other Services

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The Thriving Urology Practice Facebook group.

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Join the discussion:

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