April 18, 2025

Scott, Mark, and Ray discuss questions that came into the PRS Helpdesk:

1. For the past 8 months, I have been in an employed position with a county hospital system that provides inpatient and ambulatory services. Their coding consultants (acsteam.net) are telling the hospital that foley catheter insertions, bladder irrigations, and a list of other procedures commonly performed in urology clinics cannot be billed if they are not performed personally by the physician according to CMS. They reference a list of procedures from CMS and state that these services cannot be billed when performed by ancillary staff regardless of the level of supervision. They use https://www.cms.gov/status-indicators as their source citing the section on PC or TC indicators. Can this be true? Is it possible that this consultant is giving advice from a hospital perspective and not aware of differences between the ambulatory setting? The urology clinic I am working in is not a department of the hospital. It is freestanding. I have never worked in a clinic that did not bill for these services performed by ancillary staff with physician supervision.
2. I look forward to your response.
3. Good afternoon, my question is regarding "Incident to" required documentation. When we attended your seminar this past December, on Day 2, the new "Incident to Rule" was discuss. Can you please help clarify the new rule? My notes are not clear.
   We are in the process of CMS Review -"Targeted Probe and Educate Round 1". The letter states we were chosen for review because of being in the 60th percentile for our jurisdiction for code 99214.
   Our practice has the challenge of servicing and underprivilege community and estimated population of 590,142. We have 7 Urologist, 4 Apps and 1 Radiation Oncologist in our practice. Hence our volume is overwhelming.
   Earlier this year we submitted a batch of approximately forty records. Today we received a notification request "Incident to documentation: needed 2 previous office visits done by MD to support physician/supervising provider's initiation and continued involvement in treatment, and documentation to support direct supervision met.
   I appreciate any assistance with clarifying the “Incident to” rule.
   Thank you in advance for your assistance.
4. Doctor did a stent pull in the ASC but not with Cysto scope. How would we go about billing this?

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April 11, 2025

Scott and Mark discuss questions that came into the PRS Helpdesk:

1. Hello, Some years ago we were using the SRS urocuff. Can you tell me what the current codes are? I know this has been mentioned at the seminars- cannot find the slide :( Thanks
2. How are groups coding for the new Revi procedure for urge incontinence, urgency of urination, for both professional and facility fees. Is it best to use a 0817T or a 64581 w/ crosswalk? Cannot find a lot of information about this. Any feedback or suggestions would be greatly appreciated!
3. I would like your thoughts about the use of Pelvic Floor rehab CPT code 91122 in a urology practice. The company UroVal Inc. is promoting this procedure for urologists to perform in the office setting.
4. E/M question pls. Thank you! For a follow up office visit, Pt has prostate cancer, and he is on "Active Surveillance". For Problem Component of E/M, would you consider pCA on Active Surveillance is a Moderate VS a Low-level problem? (as opposed to personal history of pCA - Watchful Waiting). I think it's a moderate level 4, but would like to hear your opinion, thank you!!

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April 4, 2025

Scott and Mark discuss who can perform biofeedback services, clarify billing requirements, and explore practical scenarios involving incident-to billing. Mark and Scott break down key Medicare guidelines, share best practices for documentation, and offer tips for optimizing biofeedback delivery within your urology practice.

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Marianne Desciose

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March 28, 2025

Scott, Mark, and Dr. Ray Painter discuss questions that came into the PRS Helpdesk.

1. NGS sent a newsletter about the use of: cpt code G0463 as a primary code for G2211. Need more info if possible.
2. Do nurse practitioners get paid at 100% for procedures like a PNE when signing notes in NM by themselves?
3. 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 able to find any changes regarding stents insertion or exchanges.
   Thanks
   b)Hi,
   Wondering if you can help me with this Medicare patients.
   NGS is denying the claim on several patients stating that this code has a frequency limit on 52332.
   NGS has a problem with both frequency and bilateral stents
   I have searched everywhere and find no information on this code for frequency limits per year or bilateral stents.
   Appreciate any help on this code.

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March 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.

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

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Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

March 14, 2025

Scott, Mark, and Ray discuss three coding questions from the PRS Community and the Thriving Urology Practice Facebook group.

1. My question is regarding G2211. Is there a time frame for the follow-up that needs to be dictated. My doctor has been putting return to clinic in a year in the notes and billing G2211. Wondering if this is ok, or if the follow up must be sooner?
2. Our new urologist started placing an amniotic tissue membrane graft around the urethral anastomosis during a laparoscopic robotic radical prostatectomy. Would this be included in the 55866 or is there a CPT code for this? I was looking at 15275 but not sure if that is correct either. I am a coder with questions.
3. Would you be so kind to give me your opinion on 50548 for robotic radical nephroureterectomy versus using 50545 for that surgery?

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

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Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

March 7, 2025

Scott, Mark, and Ray discuss the latest updates (or lack thereof) on telehealth policies as the current extension nears expiration. They break down what practices should consider when scheduling telehealth visits, the potential impact of congressional actions, and how to prepare for possible changes.

The second topic dives into specialty designations within the same practice—what happens when different taxonomy classifications exist under the same tax ID, and how this affects new vs. established patient billing.

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

Click Here to Get More Information and Request a Quote

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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

February 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 Calculator

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

Click Here to Get More Information and Request a Quote

Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

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