June 13, 2025

In this episode, Ray, Mark, and Scott discuss recent denial issues from Aetna and Humana and offer some possible solutions. They also revisit a question covered in Episode #234: billing for amniotic tissue grafts during prostatectomy procedures, outlining strategies to address denials effectively.

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Marianne Desciose

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1. June 6, 2025

In this episode, Ray, Mark, and Scott welcome back Dr. John Lin to discuss topics brought up on the Thriving Urology Practice Facebook Group.

1) Just got a call from ER. 19 year-old cannot get an erection...

2) This notice came from the hospital last week regarding change in financial protocol about scheduled / elective surgical procedures.

Increased Patient Responsibility:

As is customary in the Phoenix market and in-line with other providers, we will move the down payment requirement to 50%. We will be increasing the required patient payment for deductibles and co-pays prior to the day of surgery from 20% to 50% of the estimated patient liability.

3) Our office will be beginning PAE {prostatic artery embolization) for BPH in the near future. This will be performed in the office, POS 11 by an interventional radiologist, who will manage the sedation and the performance of the procedure. We have not had to bill for conscious sedation in the office before. I was hoping to get some guidance on what codes should be investigated for the anesthesia portion (administration, meds, etc.) so we can better prepare ourselves for what is to come.

Bonus Topic

I received an email from a surgery center recently which stated the following:

Recently, we have been using a larger number of disposable ureteroscopes which are very costly to the Center. In order to capture the code C9761 for reimbursement of the disposable flexible ureteroscopes, we need your dictation to reflect the usage of that scope and that suction/aspiration was used.

A vendor’s representative has provided a few examples from other physicians that have resulted in successful reimbursement of these scopes. Below are the examples.

• The op report documents a steerable and suction/aspiration was used. It says "A disposable single use flexible scope with steerable and suction/aspiration was used to improve stone-free rate."
• The op report documents only a scope using a suction feature. It says "A disposable flexible ureteroscope utilizing a suction feature was utilized for the procedure."

If you are not already, please have your dictation reflect that you are using a disposable flexible ureteroscope with suction so that we can bill for reimbursement. As always, we appreciate your help with cost containment and appropriate reimbursement for the Center. Please let me know if have any questions or concerns

PRS Coding and Reimbursement Hub

Access the Hub

Jelmyto Coding and Reimbursement Page

Upper Track Urothelial Cancer (UTUC) Coding and Reimbursement Page

Free Kidney Stone Coding Calculator

Download Now

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 Pract

May 30, 2025

In this episode, Mark and Scott address upcoming significant changes to the prostate biopsy codes and provide guidance on correctly applying modifiers 25 and 59 when billing procedure 51798 and an E/M service. They also discuss coding considerations for the emerging practice of robotic-assisted vasectomies.

PRS Coding and Reimbursement Hub

Access the Hub

Jelmyto Coding and Reimbursement Page

Upper Track Urothelial Cancer (UTUC) Coding and Reimbursement Page

Free Kidney Stone Coding Calculator

Download Now

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/