Jonathan Rubenstein, MD

"The conversion factor is slated to undergo a reduction of approximately 3.37% for 2024, decreasing from $33.89 in 2023 to $32.74," write Jonathan Rubenstein, MD, and Mark Painter.

"Many of the new codes are CPT Category III codes, which will require additional research for both coverage and payment rates, especially with private payers," write Jonathan Rubenstein, MD, and Mark Painter.

"ICD-10-CM coding denials have been increasing across the country as payers continue to refine edits," write Jonathan Rubenstein, MD, and Mark Painter.

Proper coding for percutaneous nephrolithotomy includes code 50081.

Proposed rule includes incorporation of controversial E/M code.

"CPT codes 50080 and 50081 describe the antegrade approach to stone removal requiring lithotripsy through a nephrostomy tract, with 50080 being reported for stones less than 2 cm in size in a single location, whereas 50081 would be reported for large or complex stones, stones in multiple locations, or stones in the ureter (such as in the example provided)," write Jonathan Rubenstein, MD, and Mark Painter.

Telehealth is here to stay. Lean into the technology as the new line of business that it is.

Correct code selection depends on whether procedure is simple or complex.

"Although payers are supposed to adopt CPT instructions, we unfortunately do not have a system that contractually binds payers to follow CPT instructions verbatim," write Jonathan Rubenstein, MD, and Mark Painter.

Modifier -25 is defined as a significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure or other service.

Patient communication is key when implementing new policy.

"We will add this question to the continuing saga and changing world of CPT coding," write Jonathan Rubenstein, MD, and Mark Painter.

One factor is whether dissection was performed for staging or for therapeutic purposes.

"PCM codes require the practitioner to develop a disease-specific care plan, to obtain a patient’s verbal or written consent, and to educate the patient on PCM," write Jonathan Rubenstein, MD, and Mark Painter.

"We once again note that even success in the efforts to avoid any payment decreases will be a failure in the long run as overhead continues to rise against flat reimbursement," write Jonathan Rubenstein, MD, and Mark Painter.

"Although Medicare has developed previous coverage directives for several types of PCR tests outside of UTI detection and there are sound arguments for the use of PCR tests in detecting UTIs, Medicare only recently published a local coverage determination that included the use of PCR tests for UTI detection," write Jonathan Rubenstein, MD, and Mark Painter.

eCoin is a new technology for the management of bladder overactivity that is implanted near the posterior tibial nerve subcutaneously.

"For several reasons, the percutaneous nephrolithotomy codes needed to be revised, as the language of the descriptor and what was included and not included was confusing and ambiguous," write Jonathan Rubenstein, MD, and Mark Painter.

On January 1, the following CPT code will be active: 55867 (laparoscopy, surgical prostatectomy, simple subtotal [including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy], includes robotic assistance, when performed).

For CPT 55866, it is typical to remove the seminal vesicles as part of procedure.

Conversion factor for 2023 is set to decrease by approximately 4.4%.

"There are a number of urodynamic tests that can be performed. Urodynamic studies are not a one-size-fits-all procedure, but rather the tests performed should be chosen based upon the patient presentation and the question that needs to be answered by the urodynamic studies," write Jonathan Rubenstein, MD, and Mark Painter.

Supplemental information on safety and efficacy of service may be needed.

"As for the case described of a 75-minute audio-only E/M visit there has been no specific coding guidance provided by CPT," write Jonathan Rubenstein, MD, and Mark Painter.

"For appropriate billing and coding, there are 2 important issues to be satisfied: medical necessity and documentation supporting the performance of the procedure," write Jonathan Rubenstein, MD, and Mark Painter.

Challenge is presented by switching from SWL to ureteroscopy intraoperatively.

Labs will need to apply for unique Z code for each panel of tests ordered.

“If the service is indeed justified and supported, we would recommend checking with the payer prior to submitting code 0649T,” write Jonathan Rubenstein, MD, and Mark Painter.

Pathologic tissue confirmation is usually the best practice.

Payer edits referencing ICD-10-CM guidelines such as “Excludes 1” are on the rise.