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Scott Painter And Dr. Ray Painter

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Urology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 236: NGS Updates on G0463 & G2211, APP Billing for Neuromodulation, and Bilateral Ureteral Stent [52332] Denials March 28, 2025 Scott, Mark, and Dr. Ray Painter discuss questions that came into the PRS Helpdesk. NGS sent a newsletter about the use of: cpt code G0463 as a primary code for G2211. Need more info if possible.Do nurse practitioners get paid at 100% for procedures like a PNE when signing notes in NM by themselves?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 abl...2025-03-2812 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 235: Telehealth Updates, Conversion Factor Disappointment, Medicaid Possible Cuts, and a Surge in RAC AuditsMarch 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. Free Kidney Stone Coding CalculatorDownload NowPRS Billing and Other Se...2025-03-2224 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 232: Work RVUs and Modifier 22, Unlisted Codes, Category III Codes - Navigating Payer Reporting and Administrator DiscussionsFebruary 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 CalculatorDownload NowPRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get Mo...2025-02-2825 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 228: G0559 Clarification, GC Modifier Explained, and G2211 Documentation SuggestionUCR 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.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.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 si...2025-01-2523 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 227: Understanding Recoupments – How to Protect Your Practice’s RevenueJanuary 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 CalculatorDownload NowUrology Advanced Coding and Reimbursement Seminar - New Orleans, LARegister Now for the Urology Advanced C...2025-01-1830 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 204: Urological Leadership & Advocacy: A Conversation with Dr. Willie UnderwoodJuly 26, 2024Scott, Mark, and Dr. Ray Painter interview Dr. Willie Underwood, a urologist with over 20 years of experience and a key figure in the American Medical Association's leadership. Dr. Underwood discusses the importance of physician involvement at state and national levels, the AMA's stance on telehealth advancements, and the necessity for collective action and financial contributions to influence healthcare policies. The conversation highlights how unified efforts and innovative solutions can transform the medical profession and improve health outcomes nationwide. Urology Advanced Coding and Reimbursement VIRTUAL SEMINAR2024-07-2629 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 203: Streamlining Billing Processes for Part B DrugsJuly 19, 2024Scott, Mark, and Dr. Ray Painter explore effective billing practices for Part B drugs, using Jelmyto as an example. They discuss challenges such as prior authorizations, correct dosing, and site-specific billing considerations, emphasizing the need for accurate documentation and communication within healthcare settings. The episode also highlights strategies to manage Medicare and private insurance requirements efficiently, focusing on setting up internal processes to safeguard against common billing errors and ensure compliance. Urology Advanced Coding and Reimbursement VIRTUAL SEMINARRegister Now for the Urology Advanced C...2024-07-1925 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 202: Prostatic needle biopsy coding; and bladder tumor resection and fulguration code selection with Dr. John LinJuly 12, 2024Scott, Mark, and Dr. Ray Painter are joined by Dr. John Lin.  In this episode, they answer two questions that came into the Thriving Urology Practice Facebook group:Pearl:We use 55700 for the MRI fusion prostate biopsy. The docs want to use 55706 instead when MRIfusion biopsy is done with the transperineal approach. Is that OK? Kimberly:Can someone please explain to me if codes 52214 and 52224 can be billed together? If yes, whatmodifier are you using? Also, how is code 52224 a component of 52214??? Th...2024-07-1241 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 201: Empowering Urologists - Interview with Dr. Eugene Rhee on Policy, Technology, and Future DirectionsJune 28, 2024Scott, Mark, and Dr. Ray Painter are joined by Dr. Eugene Rhee, a key figure in urology and healthcare policy. Dr. Rhee, who recently completed his term as Chair of the AUA Public Policy, shares his insights on the challenges facing urology, notably the supply-demand gap in the workforce, and the increasing importance of telemedicine. The discussion covers the impact of the pandemic on telehealth adoption, legislative efforts to sustain telehealth services, and the strategic role of advocacy in urology. Dr. Rhee also touches on his potential candidacy for the AUA Presidency...2024-06-2833 minIn The Thick of ItIn The Thick of It#34: Ray Blakney, Founder & CEO | Rayvensoft VenturesIn this episode of “In The Thick of It,” we're joined by Ray Blakney, a serial entrepreneur and co-founder of Rayvensoft Ventures, a holding company for multiple successful online businesses. Ray recounts his diverse upbringing, from his birth in the Philippines to his childhood in Turkey and eventual move to the United States. He shares his experiences in the Peace Corps, which led him to Mexico, where he met his wife and started a language school together.Throughout the episode, Ray discusses the challenges and triumphs of building and scaling various businesses, including an online language school, a ma...2024-05-131h 40Gwatney UnpluggedGwatney UnpluggedShawn Ray - Professional BodybuilderIn over 30 major bodybuilding competitions, Ray only failed once to place in the top five. Ray has appeared on more Flexible Magazine covers than any other bodybuilder in the history and also has also featured in many fitness and bodybuilding magazines worldwide. Ray was a co-host on Flex Magazine Workout on ESPN for 5 years as well as hosting bodybuilding competitions for ESPN as a commentator for 8 years. Ray is a prominent spokesman, master of ceremonies and expert commentator for IFBB Pro League & NPC shows, most notably the Mr. Olympia. He is currently the Editor in...2022-12-2130 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 111: How to code, when surgery includes open and laparoscopic; Unspecified diagnoses denial recapSeptember 2, 2022Mark, 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".Link to Monthly Webinar: "How to avoid unspecified diagnosis denials"Urology Advanced Coding and Reimbursement Seminar  - Registration OpenLas Vegas, NV - December 2-3, 2022New Orleans, LA - January 27-28, 2023Register Now 2022-09-0217 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 110: Coding guidance from manufacturers; CMS 2023 proposed rule: Discarded Drug RebateAugust 26, 2022Mark, Ray, and Scott discuss the reliability of a manufacturer's coding guidance and the Discarded Drug Rebate in the CMS proposed rule for 2023.Urology Advanced Coding and Reimbursement Seminar  - Registration OpenLas Vegas, NV - December 2-3, 2022New Orleans, LA - January 27-28, 2023Register Now  Compliance PlansQuestions or need help, please send us an email: info@prsnetwork.com ...2022-08-2623 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 109: FAQs - Modifier Sequencing follow-up; Unbundling never allowed, but should be paid; Trimix injection training; and Bladder neck contracture codesAugust 19, 2022Mark, Ray, and Scott discuss questions that came into the PRS community:I just listened to the podcast on Order of modifiers on a claim. Just one question. I've been taught that the global modifier doesn't apply to an assistant surgeon. So if the patient is in a global you wouldn't add the 78 or 79 modifier to their claim. It would only be added to the primary surgeon. I have been coding for over 20 years and never used a global modifier on an assistant claim with no denied claims. Correct me if...2022-08-1925 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 108: Modifier Sequencing: the orders in which you should order modifiers on a claimAugust 12, 2022Mark, 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.Urology Advanced Coding and Reimbursement Seminar  - Registration OpenLas Vegas, NV - December 2-3, 2022New Orleans, LA - January 27-28, 2023Register Now  Compliance PlansQuestions or need help, please send...2022-08-1233 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 107: Questions - Coding for TURBT with the removal of half a tumor; does medicare pay for repeat Urolift procedures?August 5, 2022Ray, Mark, and Scott discuss two questions that came into the Urology Coding and Reimbursement Gropou about billing a TURBT even though the whole tumor was not removed also they discuss coverage of repeat Urolift procedures.PRS Education Foundationhttps://www.prseducationfoundation.orgUrology Advanced Coding and Reimbursement Seminar  - Registration OpenLas Vegas, NV - December 2-3, 2022New Orleans, LA - January 27-28, 2023Register N...2022-08-0521 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 106: Injections codes, why you may want to bill even if you know it's probably going to be deniedJuly 29, 2022Ray, 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. Compliance PlansQuestions or need help, please send us an email: info@prsnetwork.com   Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wis...2022-07-2928 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 105: Laser ureteral stone through nephrostomy tube; Compliance plansJuly 22, 2022Ray, Mark, and Scott discuss a question regarding antegrade ureteroscopy with laser lithotripsy to treat a ureteral stone and compliance plans. Compliance PlansQuestions or need help, please send us an email: info@prsnetwork.com   Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Her...2022-07-2233 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 104: 2023 CMS Proposed Rules and how they will impact the Urology PracticesJuly 15, 2022Ray, 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. Urologists’ Coding WorkshopJuly 23, 2022 - 10 am - 3 pm ESTRegister NowSpecial 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate)."Beef Up" On your Urology Coding Knowledge2022-07-1540 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 103: Clarifications - 99211 in addition to office procedure; when can you bill an E&M in the post-op period, Modifier -24July 8, 2022Mark, Scott, and Ray clarify some concept nuances that may have been misinterpreted or misunderstood. Urologists’ Coding WorkshopJuly 23, 2022 - 10 am - 3 pm ESTRegister NowSpecial 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate)."Beef Up" On your Urology Coding KnowledgePRS Network Presentation TeamDr. John LinMark Pai...2022-07-0828 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 102: "Unspecified" ICD-10 Code DenialsJuly 1, 2022Mark, Scott, and Ray discuss ICD-10 "Unspecified" codes and the increase in denials. Urologists’ Coding WorkshopJuly 23, 2022 - 10 am - 3 pm ESTRegister NowSpecial 5-hour Zoom Workshop: intensive and interactive workshop for practicing urologists and APPs (coders, billers, and admins are welcome to participate)."Beef Up" On your Urology Coding KnowledgePRS Network Presentation TeamDr. John LinMark PainterScott PainterDr. Ray...2022-07-0123 minScott Horton Show - Just the InterviewsScott Horton Show - Just the InterviewsRay McGovern on the Russian Invasion: What He Missed and What It All MeansScott is joined by Ray McGovern to discuss the Russian invasion of Ukraine. Like many, McGovern was surprised that Putin chose to actually invade Ukraine. He explains why he had been confident Russia would not invade earlier this year and how his analysis of Russia’s goals has changed since then. Discussed on the show: “Did Obama Know ‘Russian Hacking’ Was a Fraud?” (Antiwar.com) “Some Lemmings Wear Wooden Shoes; and Factoring in China” (Antiwar.com Blog) The Doomsday Machine by Daniel Ellsberg 2018 Interview with McGovern about Russian Next-Gen Nuclear Weapons  Putin’s 2018 speech Ray McGovern is the co...2022-06-2257 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 099: Can urologists bill MRI fusion biopsy; billing pathology during the pathologist's absence; and biofeedback and pelvic floor therapy billing?June 10, 2022Mark, Scott, and Ray discuss questions that came into the PRS Community Forum 1) Can we bill for cpt 76377 or it is considered a Radiology procedure. My doctors want some direction if we can bill for this during prostate biopsy. Do you have any advice on this? Thank you so much!2) We have a small path lab and pathologist will be out of town for a week and we are trying to figure out how to bill these charges while she is on vacation.2022-06-0929 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 098: E&M Level 3 with a Vasectomy on the same dayAvailable June 3, 2022Mark, Scott, and Ray discuss Mark's call with a payer making the argument that an E&M service can be billed with a Vasectomy on the same day. ​NEW ONLINE WORKSHOP - Urologists’ Coding WorkshopSpecial 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate)."Beef Up" On General Coding KnowledgePRS Network Presentation TeamDr. John LinMark PainterScott PainterFrom...2022-06-0235 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 097: Independent historian, newborn (post-hospitalization) circumcision consult, stent removal diagnosis, and temporary code 0421TMay 27, 2022Mark, Scott, and Ray discuss questions that came into the PRS Community Forum.1. Independent historian. For pediatric visits, I'm a little unclear what counts as an independent historian. I see the definition from CMS indicates "an individual (eg, parent, guardian, surrogate, spouse, witness) who provides a history in addition to a history provided by the patient who is unable to provide a complete or reliable history (eg, due to developmental stage, dementia, or psychosis) or because a confirmatory history is judged to be necessary."Does a...2022-05-2724 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 096: AUA Annual Meeting Recap; E/M 2021 Data ClarificationMay 20, 2022Mark, 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? ​NEW ONLINE WORKSHOP - Urologists’ Coding WorkshopSpecial 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate)."Beef Up" On General Coding Knowledge2022-05-2128 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 095: Correct Coding - Cystectomy, with continent diversion, bilateral pelvic lymphadenectomy, and prostatectomy; AUA Annual Meeting May 2022May 6, 2022Mark, Scott, and Ray discuss a question about a scenario regarding coding the most comprehensive code:Scenario 6 module 9, Cystectomy, with continent diversion, bilateral pelvic lymphadenectomy and prostatectomy. I captured both 55845 and 51596 and I also looked at the possibility of 51575 (Cystectomy with bilat lymphadenectomy, 50825 continent diversion including intestine anastomosis, and 55840 proctectomy. Do I not choose the 50825 (along with other codes) because of the intestine anastomosis? I tend to overthink px coding, am I over coding or under coding? What would y'all suggest to help, when I get lost in the "forest"...2022-05-0628 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 094: Prepayment claim review request and a new proposal from United Health Care to urology practicesApril 29, 2022Mark, 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. ​NEW ONLINE WORKSHOP - Urologists’ Coding WorkshopSpecial 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate)."Beef Up" On G...2022-04-2933 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 093: FAQs - Billing for misfired Urolift implant and chief complaint documentationAvailable April 22, 2022Mark, Scott, and Ray answer questions1)I have been asked if it is appropriate to bill for "misfired" Urolift implants?2)  I know Jon's opinion on this, but was wondering what the Painters think....chief complaint--do you have to be more detailed than stating "follow up"? ​NEW ONLINE WORKSHOP - Urologists’ Coding WorkshopSpecial 5-hour virtual, intensive, and interactive workshop for practicing urologists and APPs (coders, billers and admins are welcome to participate)."Beef Up" On...2022-04-2221 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 092: FAQs - Telemedicine POS, Bladder Interstitial Fiducial Marker, and Botox injection to pelvic floor.Available April 14, 2022Mark, Scott, and Ray answer questions1) If a patient is being set up for a telemedicine visit with an MD in the MD's secondary clinic and the MD is in his/her primary clinic.  Do we bill under the primary clinic with a place of service 02? Also, should documentation support where the patient is located?2)  How should I code for Bladder Interstitial Fiducial Marker placements in a female patient? The markers are placed cystoscopically and are used to guide radiation therapy for bladder cancer. For male patients we...2022-04-1522 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 091: FAQs - Remote uroflow; Interstim covered diagnoses issue; TURP and bladder scan during global; Robot-assisted laparoscopic prostatectomyAvailable April 8, 2022Mark, Scott, and Ray answer questions1) My clinic is trying out the app through Emano Flow that tracks a patients urine flow for 14 days and then the Urologist goes over the results with the patient when the trial is finished. My clinic is very confused on whether or not each individual day needs an interpretation written by the doctor in order to bill a uroflow (51741) on a particular day?2)  [9:05]  I am working on an appeal letter to Regence Blue Shield for in Interstim device.  In their criteria for...2022-04-0826 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 090: UTI – PCR UPDATE Part 2, Modifier -22April 1, 2022Mark, Scott, and Ray discuss an update on the MolDx guidelines for PCR billing set to take effect on April 17th, 2022.  They also talk about Modifier -22; should you use it and what it takes.UTI – PCR UPDATEThe following Medicare Administrative Contractors (MAC) aka Carriers, have issued a proposed multi-jurisdictional Local Coverage Decision (LCD) for Multiplex Nucleic Acid Amplification Test (NAAT) PANELS FOR INFECTIOUS DISEASE Testing, Wisconsin Physician Services Insurance Corporation, CGS Administrators, LLC., Noridian Healthcare Services, LLC., and Palmetto GBA.E...2022-04-0122 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 088: Clarification -TC and -26 modifiers [#87]; FAQs - VUDS, Anterior Exenteration, and Prophylactic Antibiotic InjectionsMark, Ray, and Scott discuss comments and questions from PRS Forums: PRS Community and Urology Coding and Reimbursement Group:1)  Re: RE: New Podcast Episode: -TC and -26 modifiers - Urodynamics billing: split or global? (3/11/22)If the UDS tests are done on Monday and the ordering doc isn’t in the clinic, but there is a supervising doc, I know we would bill for the TC under the supervising doc.If the ordering/interpreting doc doesn’t even see the tests until 2 days later, you’re saying in today’s podcast that we bill t...2022-03-1827 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 087: -TC and -26 modifiers - Urodynamics billing: split or global?March 11, 2022Mark, 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.Below is the question that prompted this discussion:Can we bill a TC and 26 modifiers on same day for the 51728, 51741, 51784, 51797?  TC under direct supervision provider and 26 for interpretation from ordering provider on same day?  My understanding is if we want to split it o...2022-03-1119 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 086: How to Tell if You Need More Urology Coding Training and How to Get ItMarch 3, 2022Scott and Ray discuss the upcoming free webinar [March 10th, 2022]:How to Tell if You Need More Urology Coding Training and How to Get ItThey discuss why it is important to understand what you know.   Link to Register for the Free WebinarHow to Tell if You Need More Urology Coding Training and How to Get ItRegister Now PRS Education FoundationFree Urology Resident Tra...2022-03-0325 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 085: Research pathways - coding services that may not have a clear answer - Pelvic Wave codingFebruary 22, 2022Mark, Scott, and Ray discuss how to answer the question below and how to approach answering similar questions: What would be the appropriate CPT codes to bill for Pelvic Wave (pelvic floor PT)?Urology Advanced Coding and Reimbursement Seminar - The RecordingsREGISTRATION OPENInformation and Registration Urology E&M Workshop - RecordingsOver 5 Hours of UROLOGY E/M...2022-02-2220 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 084: Data and Reports - Overview of why data is so important and a preview of the upcoming free data webinarFebruary 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  Urology Advanced Coding and Reimbursement Seminar - The RecordingsREGISTRATION OPENInformation and Registration Urology E&M Workshop - Rec...2022-02-1126 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 083: Contracts - What can you do if payments are lower than expenses; No Surprises Act FAQsFebruary 4, 2022 Mark, Scott, and Ray discuss contracts and answer questions about the No Surprises Act.   Urology Advanced Coding and Reimbursement Seminar - The RecordingsREGISTRATION OPENInformation and Registration Urology E&M Workshop - RecordingsOver 5 Hours of UROLOGY E/M Training! Information and Registration Join the discussion:Urology Coding and Re...2022-02-0441 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 081: New Modifiers 2022 and Urodynamics CodingJanuary 14, 2022 Mark, Ray, and Scott discuss the new modifiers and urodynamics coding  Urology Advanced Coding and Reimbursement Seminar - Virtual EventREGISTRATION OPENLive Online EventInformation and RegistrationOnline - January 28-29, 2022 Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and shar...2022-01-1525 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 080: Urology Advanced Coding and Reimbursement Seminar - Now Virtual, QPP New Reporting Change, and PRS 2022 Event Calendar PreviewJanuary 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.  Urology Advanced Coding and Reimbursement Seminar - Virtual EventREGISTRATION OPENLive Online EvengtInformation and RegistrationOnline - January 28-29, 2022 2022-01-0713 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 079: FAQs - Disease v. personal history; modifier -24; data ordered prior to 1st visit - new or establishedDecember 21, 2021Ray and Scott discuss and answer questions from the PRS Communities.1) I have a question regarding BPH w/LUTS; if a patient is treated successfully with a TURP, no longer having any LUTS, would the diagnosis then be BPH w/o LUTS (N40.0) or would it be Personal Hx of disease of other male genital organs (Z87.438)2)  If a patient is in the office for the postop visit after prostatectomy, and the urologist moves on from going over postop care topics to cancer counseling(further testing/cancer surveillance/p...2021-12-2125 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 078: Highlights Day 2- Urology Advanced Coding and Reimbursement Seminar - Las Vegas, Dec 2021December 13, 2021Ray and Scott discuss the highlights of the Seminar and share some of the takeaways for each session.Urology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventInformation and RegistrationNew Orleans, January 28-29, 2022 Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom. Click Here to...2021-12-1321 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 077: Highlights Day 1- Urology Advanced Coding and Reimbursement Seminar - Las Vegas, Dec 2021December 9, 2021Ray and Scott discuss the highlights of the Seminar and share some of the takeaways for each session.Urology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventInformation and RegistrationNew Orleans, January 28-29, 2022 Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom. Click Here to...2021-12-1024 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 076: Urolift ASC Payment Correction; Agenda Overview - 2022 Urology Advanced Coding and Reimbursement SeminarDecember 1, 2021Mark, 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) Urology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventsInformation and RegistrationLas Vegas, December 3-4, 2021New Orleans, January 28-2...2021-12-0126 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 075: E&M 2021 - Common Questions and ClarificationsNovember 15, 2021Mark, Ray, and Scott discuss some E&M 2021 FAQs.Is pyuria and hematuria 2 points or one? If it appears to be clearing, would it still be considered “with exacerbation”?Can a problem be considered chronic if you expect the problem will last >1 year or it is only considered chronic if the problem has existed for >1 year? If Medicare does not cover Bladder Scans for UTI would we count itIf the provider documents that he reviewed "records from the ER...2021-11-1624 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 073: PHE Extension; Telehealth Update and Urology Coding MonthOctober 22, 2021Mark, Ray, and Scott discuss the PHE, telehealth place of service update, and urology Coding Month finale.Free E&M Training - 4 Sessions (30 minutes each)Session #1 - Why E&M 2021 is So Important [10/25/21 at 3-3:30 pm EST]Session #2 - Medical Decision Making 2.0: Problem, Risk and Data [10/27/21 at 2-2:30 pm EST]Session #3 - Time, Shortcut Tools, and Best Practices [10/28/21 at 1-1:30 pm EST]Session #4 - Case...2021-10-2227 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 072: Implantable Penile Prosthesis Questions; "Incident To" (PTNS example)October 15, 2021Mark, 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.Free E&M Training - 4 Sessions (30 minutes each)Session #1 - Why E&M 2021 is So Important [10/25/21 at 3-3:30 pm EST]Session #2 - Medical Decision Making 2.0: Problem, Risk and Data [10/27/21 at 2-2:30 pm EST]Session #3 - T...2021-10-1528 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 071: 2022 New and Revised CPT and ICD-10 Codes for UrologyOctober 12, 2021Mark, Ray, and Scott discuss the new Urology CPT and ICD-10 Codes.Urology ResidentsCoding and Documentation for Urology ResidentsMore Information and RegistrationUrology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventsInformation and RegistrationLas Vegas, December 3-4, 2021New Orleans, January 28-29, 2022 Join the discussion:Urology C...2021-10-1220 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 070: Global Surgical Package and Global Days ExplainedOctober 1, 2021Ray, Mark, and Scott discuss the global surgical package and the global days. Understanding these concepts is critical to understanding the basics of coding.Urology ResidentsCoding and Documentation for Urology ResidentsMore Information and RegistrationUrology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventsInformation and RegistrationLas Vegas, December 3-4, 2021New Orleans, January 28-29, 2022 2021-10-0121 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 069: Should Urologists/APPs do their own coding?September 28, 2021Ray, 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.50% discount on all Urology Coding CoursesRegister nowUrology Coding Course for Urologists and APPs Urology Coding Course for Coders / Billers and Admins.Special Offer Ends 10/1/21Urology R...2021-09-2822 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 067: What is your Urology Coding Score? The average denial rate of Urology claims is 17% - we can do better!September 7, 2021Ray, 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 NowPRS 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. Urology Advanced Coding and Reimbursement Seminar...2021-09-0725 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 066: FAQs - Code for Renal Pelvic Washings CORRECTION; Physical Exam: necessity and documentation; Vasectomy initial visit E&M level in 2021August 27, 2021Mark,  Ray, and Scott discuss questions from the Urology Coding and Reimbursement Group Question 1:  55 SecondsCORRECTION - Renal Pelvic Washings CPT Code - 52005Question 2 - minute 5:26I need something in writing from Dr. Ray painter for my Urologist.  I have this info from the AMA and Noridian both, but they want to hear it from you.  We are told by Noridian and also the AMA who is the author of the CPT book that an Exam is still needed....2021-08-2729 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 064: RAC Audits (Recovery Audits) - What happens and how to handle it when you get an audit requestAugust 17, 2021Ray, 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. Urology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventsInformation and RegistrationLas Vegas, December 3-4, 2021New Orleans, January 28-29, 2022Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.2021-08-1720 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 063: FAQs; 51728 and 51729 differentiation, Criteria for 45990, F/U visit and provider did a PVR can use -25August 9, 2021Ray, Mark, and Scott discuss questions from the Urology Coding and Reimbursement Group Question 1:  49 SecondsWhat documentation could I look for to differentiate 51728 and 51729. There is no clear mention of “urethral pressure  profile study” in UDS documentation.Question 2 - minute 10:22What are the criteria for billing 45990 - the CPT book lists "requiring" anesthesia. Can I bill 45990 since the DRE was done under anesthesia after a cystoureteroscopy Question 3 - 15:19If patient came in for f/u visit and provider did a p...2021-08-1027 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 062: Physician Compensation Overview: Private Practice and Hospital SystemAugust 3, 2021Ray, Mark, and Scott welcome Larry Kemp to discuss urologist compensation and key concerns we see working directly with physician groups nationwide.Change is needed and not easy, communicating concerns softly, using practice data as keystone alignedwith key goals and sustainability.Webinar RecordingRecording of the 2022 CMS Proposed Rules and the Impact on Urology Practices webinar is now available.Go here to view the recording and slides now...Recording/Slides2021-08-0426 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 061: The Increasing Role and Billing Issues of Advanced Practice Provider (APP)July 23, 2021Ray, 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.Webinar RecordingRecording of the 2022 CMS Proposed Rules and the Impact on Urology Practices webinar is now available.Go here to view the recording and slides now...Recording/Slides Urology Advanced Coding and Reimbursement Seminar2021-07-2329 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 060: 2022 CMS Proposed Rules and how they impact the Urology PracticesJuly 16, 2021Ray, 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.  FREE Webinar - July 22, 20212022 CMS Proposed Rules and how they impact the Urology PracticesUrology Advanced Coding and Reimbursement SeminarREGISTRATION OPENLive In-Person EventsInformation and RegistrationLas Vegas, December 3-4, 2021New Orleans, January 28-29, 20222021-07-1635 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 059: Why Bother with QPP (Quality Payment Program)?July 9, 2021Ray, 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. Read more about QPP at:https://qpp.cms.gov/ Need help with implementing QPP? Mark and his consultants can guide you:Schedule a call today! REGISTRATION OPENUrology Advanced Coding and Reimbursement Semina...2021-07-0936 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 058: PCNL Revisited; Modifier -25 and LHRH injections; Billing for Multiple Bladder BiopsiesJuly 2, 2021Ray, 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. Dr. Lin is the administrator of The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/   REGISTRATION OPENUrology Advanced Coding and Reimbursement Seminar - Live In-Person Events...2021-07-0344 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 057: Statistics and Target Metrics for Urology PracticesJune 29, 2021Ray, 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.Optimizer Series Important Revenue Cycle Management (RCM) Metrics;  How to use them to identify and fix issues Information and Order Form REGISTRATION OPEN2021-06-2925 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 056: PCNL (Percutaneous Nephrolithonomy) coding; How to approach stone coding.June 18, 2021Ray, 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? OPTIMIZER SERIES PART 2 Online Course from PRS Consulting - June 24th!Important Revenue Cycle Management (RCM) Metrics; How t...2021-06-1923 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 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, 2021Ray, 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?Question from Michael:I'm still having a hard time with less straight forward #MDM. I had a patient with left testicular pain x 3 mos. He fell from a ladder and had back pain with radicalar pain down into his leg and likely testis. GU exam is unremarkable. UA is normal. I have ordered an M...2021-06-1139 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 054: How to deal with providers that will not provide the documentation needed to get reimbursedJune 8, 2021Ray, 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. REGISTRATION OPENUrology Advanced Coding and Reimbursement Seminar - Live In-Person EventsInformation and RegistrationLas Vegas, December 3-4, 2021New Orleans, January 28-29, 2022Join the discussion:...2021-06-0930 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 053: TURBT vs. Bladder fulguration and biopsy codes; AUACodingToday.com Bundling Matrix; Upcoming SeminarsMay 28, 2021Ray, 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.They also share information about the "Bundling Matrix" on AUACodingToday.com (click for free trial)Finally, they discuss the Urology Advanced Coding and Reimbursement Seminar - Live In-Person Events (Information and Registration)Dr. Lin runs The Thriving Urology Practice Facebook group and this topic has generated a lot o...2021-05-2843 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 052: How to deal with payer's letters to physicians about E&M billing levels relative to "peers".May 21, 2021Ray, 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.  What does it mean if you are not withing the average range. The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ _____________________________________________________________________REGISTRATION OPENUrol...2021-05-2132 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 051: Is patient care better with clinical pathways and good coding? Why and how the pathways are impacted by coding.May 17, 2021Ray, 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._____________________________________________________________________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 _____________________________________________________________________2021-05-1725 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 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 3, 2021 Ray, Mark and ScottMay 11, 2021Ray, 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 GroupFAQs[14 minutes and 01 Seconds] Our Urology group bills inpatient hospital codes when we get called in for initial visit (99221-99223).  We have always been paid without issues and I have read Medicare guidelines stating this can be billed by each specialty.  In the past few months Aetna started denying these codes stating only one doctor, regardless of sp...2021-05-1133 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 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, 2021Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group FAQs [40 Seconds] Our patients bring in there own testosterone and we bill out the administration code 96372.. Is the NDC #  required to be documented? (We do document j code, dx , patient provided,amount given, Lot# and expiration.)[8 minutes and 57 Seconds] One of my physicians completed a TURBT of multiple bladder tumors but he never listed any size. Instead, he says "aggregate greater than 5cm." My understanding was that we cannot use...2021-05-0416 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 048: Documentation Support for Lab Tests; Coding for Laparoscopic and Robotic ProceduresApril 23, 2021Ray 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. Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom....2021-04-2328 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 047: How Much Coding Does a Urologist Really Need to Know, and Why?April 20, 2021Ray and Scott discuss the common question from urologists "Why do I need to learn to code? 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.  Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom. Click Here...2021-04-2024 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 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, 2021Mark, 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. Learn More about the Opti...2021-04-1225 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 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 understandApril 3, 2021Mark, 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; diagnosticYou 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.  Join the discussion:Urology Cod...2021-04-0329 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 044: Payers - using hassle factor to delay payments, what you can doMarch 26, 2021Mark, 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?Share your payer stories with usEmail:  info@prsnetwork.comor on the free Q&A forum Urology Coding and Reimbursement Group.Take the 30 Day Urology Coding and Billing Challenge and learn what a coder, biller, admin and other non-QHPs should know and nothing more....2021-03-2622 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 043: FAQs - Bilateral Ureteroscopy Laser lithotripsy with stent; Urodynamics and Catheter; Cysto w/ sp Tube; Family history and risk; Documenting what was reviewedMarch 19, 2021Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:Question 1 (:55)For bilateral Ureteroscopy Laser lithotripsy with stent placements can we bill 52353, 52332 (using N20.0 as diagnosis) & 52356 (using N20.1 as diagnosis)Question 2 (5:35)For Urodynamics- when patient has foley catheter in place prior to procedure and will need a foley catheter placed after the procedure can we bill for the foley catheter cpt 51702Question 3 (9:47)Can...2021-03-1933 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 042: How the New Technical Revisions to E&M 2021 Guidelines Impact UrologyMarch 12, 2021Ray, 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.Link to the CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes:EM 2021 Guidelines Technical Corrections 3-9-21March Edition of the Monthly Webinar Series, live March 18th, 2021 at 1 pm...2021-03-1249 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 041: Deductible Season: Impacts and How to Ensure Your Practice is PreparedMarch 7, 2021Ray, 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.Take the 30 Day Urology Coding and Billing Challenge and learn what a coder, biller, admin, and other non-QHPs should know and nothing more.Learn MoreJoin the discussion:Urology Coding and Reimbursement Group - Join for free and ask y...2021-03-0830 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 040: "Incident to" billing; When to bill the 99211- Nurse VisitUCR 040: "Incident to" billing; When to bill the 99211- Nurse VisitFebruary 26, 2021Ray, Mark and Scott discuss incident to billing and when to bill the 99211 nurse visit.   Take the 30 Day Urology Coding Challenge and learn what a QHP should know and nothing more.Learn MoreJoin the discussion:Urology Coding and Reimbursement Group - Join for fr...2021-02-2728 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 039: FAQs, Multiple ESWLs, 55700 with 96372, vital sign collection requirements, 99441-99443 usage, 51702 and A4344February 19, 2021Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group Question 1:  40 SecondsHello,  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 modifierany clarification much appreciatedthanksQuestion 2 - minute 5:03We are seeing denials from Cigna Medicare plans where they are denying 96372 as...2021-02-1930 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 038: What is the Urology QHPs Role in Coding and BillingFebruary 16, 2021Ray 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.Take the 30 Day Urology Coding Challenge and learn what a QHP should know and nothing more.Learn More2021-02-1527 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 037: E&M 2021 Risk - is prostate cancer with watchful waiting a level 2,3,4 or 5?February 5, 2021Mark, 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.Take the 30 Day "Code like Mark Painter" Challenge and finally master urology coding.Learn MoreJoin the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and...2021-02-0629 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 036: Why Modifier -25 is so important and how it works with the EM 2021 RulesUCR 036: Why Modifier -25 is so important and how it works with the EM 2021 RulesJanuary 29, 2021Mark, 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.2021-01-2930 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 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.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, 2021Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:Question 1It's now 2021 and I'm reviewing the coding seminar that I attended virtually in September. On the discussion of E&M coding...2021-01-1535 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 034: 2021 last-minute changes, G2211 update, MRI fusion biopsy of prostate coding, and initial vs subsequent dilationsUCR 034: 2021 last-minute changes, G2211 update, MRI fusion biopsy of prostate coding, and initial vs subsequent dilationsJanuary 8, 2020Mark, 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:1) How do I code for MRI fusion biopsy of the prostate?  Do I bi...2021-01-0834 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 033: Lessons Learned from the First 33 Episodes; 2021 Biggest Challenges / OpportunitiesMark, 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.Urology Advanced Coding and Reimbursement Seminar - Virtual Live EventJanuary 29th and 30th, 202110am - 6pm EST each dayLearn MoreJoin the discussion:Urology Coding and Reimbursement Group - Join fo...2020-12-2125 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 030: Happy Thanksgiving! What we included in the agenda of the Urology Advanced Coding and Reimbursement Seminar and WhyNovember 24, 2020Happy 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.Here is the Agenda for the Upcoming Virtual Live Event: Friday 12/4/20Time (EST)         |   Topic10:00 AM |   Welcome 2021 - Back to the Future10:30 AM |   Globals and Modifiers Part 111:00 AM |   Globals and Modifiers Part 2 OP note communication12:00 PM...2020-11-2418 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 029: As the 2nd wave of pandemic looms, what can you do in your practice if there is another shutdown or slowdownNovember 17, 2020Mark, 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.Urology Advanced Coding and Rei...2020-11-1723 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 028: Defining Poor Business Practices and Implementing SolutionsMark, 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.Urology Advanced Codi...2020-11-1039 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 027: Lessons Learned from Our Workshops About the New E&M 2021 Guidelines; Vasectomy Consult - Level 2, 3, or 4? Prostate Cancer?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?Ray shares why the new guidelines are going "back to the future".  Documenting using the new guidelines is going to be like it was before the original documentation guidelines introduced in the early 90s.Why you should attend the Uro...2020-10-3123 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 026: PHE Extension; FAQs - Urology Coding and Reimbursement GroupMark 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 procedureCan you code a consultation visit (non Medicare) for new patient office visit seen in the ERAdditional clarification on the 25 modifier.Urology Advanced Coding and Reimbursement Seminar+ BundleLive Virtual EventDecember 4th and 5th, 2020Upcoming E&M 2021 Live Online...2020-10-2121 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 025: How the Urology Advanced Coding and Reimbursement Seminar came to be and how it looks different this yearScott 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 have added additional products and services to help practices prepare for 2021.2020-10-1731 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 024: Answers to questions asked on the PRS Community; News about advanced payment paybacksMark, Ray, and Scott answer questions from the Urology Coding and Reimbursement group. Mark gives 1)  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?2)  Can a Urologist bill a 50590 and a 76000?  It says only if medically necessary. What would be considered medical...2020-10-0227 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 023 - New ICD-10 Codes for Urology - Active October 1st, 2020Mark, 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.Download a copy of the ICD-10 additions and changes here:Urology ICD-10 Changes Effective 10-1-2020.pdfGet a copy of the E&M 2021 Sneak Peek here:Sneak Peek E&M 2021 Pocket Card...2020-09-2816 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 20: FAQs - Question about D40.0, Neoplasm uncertain behavior of prostate? Modifier -57 v Modifier -25?Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement GroupScenario: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". A PSA was done and came back at 950.0 ng/mL. At the time of the Trusp/Bx, Dr coded D40.0, Neoplasm uncertain behavior of prostate. The physical findings at the biopsy were "Large, nodular...2020-09-0124 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 19: FAQs - Can CPT code 50386 be done in the office? Can I bill CPT 55700 with 76872, 76942, 96372 & J1580?Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement GroupCan 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.  For the facility...2020-08-2419 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 18: E&M 2021 Preparation Checklist - The 7 steps you need to take to ensure a smooth transitionMark, 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 teamUpdate Processes EHR Template Update, Testing and Training Estimate Financial Impact Schedule Ongoing Training and ReviewUpcoming E&M 2021 Live Online WorkshopsLearn MoreDates (all times Eastern)September 18, 2020 - 5:00 pm S...2020-08-1419 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 016: FAQs - Consultation billing? Can you bill catheters and leg bags with 51702? Auditing rules for telehealth? PCNL - 50080/81 and -52?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[more]2020-07-3127 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 015: How do you ask the right questions to find the right solution / code?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 is a lot of "gray" and involves finding the right solution based on all the information you have.2020-07-1820 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 009: Modifier -25Mark, Scott, and Ray talk modifier -25.  In addition to a general overview of the definition, they give several urology specific 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 t...2020-05-2130 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 005: Do you know what you are not billing?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.2020-04-1813 minUrology Coding and Reimbursement PodcastUrology Coding and Reimbursement PodcastUCR 001: Welcome to the Urology Coding and Reimbursement Podcast!UCR 001: Welcome to the Urology Coding and Reimbursement Podcast!Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite!  Your cohosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.  Get your questions answered and learn from others by joining our free group Urology Coding and Reimbursement Group here:Sign Up for Urology Coding and Reimbursement Group2020-03-2508 min