Urology Coding and Reimbursement Podcast
The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We 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. Your cohosts, Mark, Scott and Dr. Ray Painter discuss urology coding and share best practices for the urology office. We will answer submitted urology coding questions so that you can learn the concepts and apply in your practice. Learn the best practices: urology coding, revenue cycle management, scheduling, collections, patient information collection, pre-authorization, prior approval, charge capture, office communications, claim entry review, appeals, audits and billing, that we have tested and proven so you can adapt and incorporate.
Episodes
August 22, 2025
In this special episode, Scott, Mark, and Ray welcome Dr. Marc Rose, a practicing urologist in Vero Beach, Florida, to share his journey of transitioning to a hybrid urology practice that combines traditional insurance with concierge medicine. Dr. Rose walks us through the burnout that led him to make a change, how he structured his new model, and the lessons he’s learned since making the leap. He explains...
August 8, 2025
In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advant...
August 1, 2025
In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Helpdesk.
- Pay er: Anthem BCBS
State: NV
Code/Codes: Tranurethral resection of bladder clot that was organized to facilitate removal
Catagory: Other - Question: I'm looking for a CPT code for : transurethral resection of bladder clot that was organized t facilitate removal Pt was inpt and Dr tried to do ...
July 25, 2025
In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Help Desk.
1) Payor: Medicare
State: FL
Code/Codes: 52353-52 and 52332-59-51
Catagory: Kidney Stones
Question: If I have to abort a planned ureteroscopy and laser lithotripsy because the UO is too narrow to pass the ureteroscope so I place a stent. Can I bill the 52353-52 and 52332-59-51
2) Can you clarify what ...
July 18, 2025
In this episode, Scott, Mark, and Ray Painter break down their first impressions of the 2026 proposed Medicare physician fee schedule. From conversion factor changes and telehealth updates to significant RVU and facility payment shifts, they explore what’s in store for urology and what it all means for your bottom line.
PRS Coding and Reimbursement Hub
Free Kidney Stone Coding Cal...
July 11, 2025
In this special episode, Dr. Peter Bretan—president of the AACU—joins Scott, Mark, and Ray to share his journey from transplant surgeon to national urology advocate. He highlights the power of grassroots advocacy, the importance of local engagement, and AACU’s evolving mission to support all urology professionals.
PRS Coding and Reimbursement Hub
Free Kidney Stone Coding Calculato...
June 27, 2025
Scott, Mark, and Ray discuss how new FDA rulings—like the recent update for Rezūm—impact coverage, coding, and reimbursement. They walk through the layers of medical necessity, CPT codes, payer policies, and documentation strategies needed to ensure payment.
PRS Coding and Reimbursement Hub
Free Kidney Stone Coding Calculator
PRS Coding Courses
June 20, 2025
In this episode, Ray, Mark, and Scott answer questions that came into the PRS Helpdesk and give an update on Telehealth and where it stands.
- Patient with BPH and bladder stones. When treating both the BPH (N40.0) and bladder stones (N21.0) during the same surgery, is it appropriate to bill both 52649 {Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, comple...
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.
PRS Coding and Reimbursement Hub
- 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 mark...
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
May 23, 2025
Scott, Mark, and Ray answer listener questions on coding for remote uroflowmetry, defining high-complexity MDM, and dealing with low Medicare Advantage reimbursements. They discuss CPT code options, provide examples of immediate-risk diagnoses, and offer strategies for contract negotiations.
PRS Coding and Reimbursement Hub
May 16, 2025
Scott and Mark switch roles to introduce the new PRS Coding and Reimbursement Hub, featuring Jelmyto as an example. The Hub helps practices simplify workflow, coding, and reimbursement processes. Scott explains how the Hub provides clear, trusted guidance, enabling urology practices to streamline reimbursement, reduce confusion, and accelerate patient access.
PRS Coding and Reimbursement Hub
May 9, 2025
In this episode, Scott, Mark, and Ray answer questions that came into the PRS Helpdesk.
- One of my specialties is pedsurology and there is just not much guidance for surgery coding.
Is it appropriate to use 54360 (plastic operation on penis to correct angulation) for correction of penile torsion?
I found an article from AAPC dated 2005 that stated to use 14040 for penile torsion repair when performed...
May 2, 2025
In this episode, Scott, Mark, and Ray share highlights from the AUA 2025 Annual Meeting in Las Vegas, discussing exciting new technologies, reimbursement challenges, key conversations, and updates from the urology community.
Free Kidney Stone Coding Calculator
PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose
Click Here to Get More Information and Request a Quote
...
April 25, 2025
Scott, Mark, and Ray discuss the pressures of Urology practice in 2025. They talk about what you need to be aware of and why you need to plan for the future.
Free Kidney Stone Coding Calculator
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
Em...
April 18, 2025
Scott, Mark, and Ray discuss questions that came into the PRS Helpdesk:
- 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 b...
April 11, 2025
Scott and Mark discuss questions that came into the PRS Helpdesk:
- 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
- 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...
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.
Free Kidney Stone Coding Calculator
PRS Billing and Other Services - Book a...
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...
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