Rubenstein is compliance officer and medical director of coding and reimbursement, United Urology Group and Chesapeake Urology, in Towson, Maryland.
2024 Medicare final rule: Here comes code G2211
"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.
Current Procedural Terminology code urology updates for 2024
"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.
Dr. Rubenstein, Mark Painter on urology-related ICD-10 changes
"ICD-10-CM coding denials have been increasing across the country as payers continue to refine edits," write Jonathan Rubenstein, MD, and Mark Painter.
How to bill for PCNL using existing and new access
Proper coding for percutaneous nephrolithotomy includes code 50081.
Will the 2024 fee schedule rule see the debut of G2211?
Proposed rule includes incorporation of controversial E/M code.
Billing for nephroscopy with ureteroscopy and laser lithotripsy
"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.
What will telehealth reimbursement look like post public health emergency?
Telehealth is here to stay. Lean into the technology as the new line of business that it is.
How to bill for bladder stone removal performed during cystoscopy
Correct code selection depends on whether procedure is simple or complex.
Clearing up confusion surrounding percutaneous nephrolithotomy coding
"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.
Using modifier –25 on an E/M visit: Is it worth it?
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.
Be careful when charging for patient portal messages
Patient communication is key when implementing new policy.
Billing for lithotripsy of upper ureter stones followed by URS in the kidney
"We will add this question to the continuing saga and changing world of CPT coding," write Jonathan Rubenstein, MD, and Mark Painter.
How to code an open radical nephrectomy with retroperitoneal lymph node dissection
One factor is whether dissection was performed for staging or for therapeutic purposes.
How to bill Principal Care Management codes when 2 specialists are involved
"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.
Breaking down the CMS 2023 final rule for urologists
"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.
How to get reimbursed for multiplex PCR urine cultures
"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.
What are your thoughts on reporting CPT code 64590 when placing an eCoin device?
eCoin is a new technology for the management of bladder overactivity that is implanted near the posterior tibial nerve subcutaneously.
Why can’t CPT 50436 and 50437 be used when performing percutaneous nephrolithotomy?
"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.
Laparoscopic simple prostatectomy code is coming
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).
Is seminal vesiculectomy included within the prostatectomy code?
For CPT 55866, it is typical to remove the seminal vesicles as part of procedure.
What’s in the Medicare Physician Fee Schedule proposed rule?
Conversion factor for 2023 is set to decrease by approximately 4.4%.
Urology Coding: Can CPT 51728 and 51741 be billed together?
"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.
What to know about billing for unlisted codes
Supplemental information on safety and efficacy of service may be needed.
How do you bill for a 75-minute audio-only E/M visit?
"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.
What is the best way to report an encounter when both the kidney and bladder are imaged?
"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.
Same-side shock wave lithotripsy, URS present coding questions
Challenge is presented by switching from SWL to ureteroscopy intraoperatively.
LCD addresses NAAT panels for infectious disease testing
Labs will need to apply for unique Z code for each panel of tests ordered.
Is it appropriate to use 0649T as an add-on code to multiparametric MRI of the prostate?
“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.
Can one choose a cancer diagnosis code without tissue?
Pathologic tissue confirmation is usually the best practice.
Urology Coding: Can N20.0 and N13.2 be billed on the same CPT line?
Payer edits referencing ICD-10-CM guidelines such as “Excludes 1” are on the rise.
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