Mark Painter

"The main [Medical Decision Making section] changes take place in the Complexity of Problem and Amount/Complexity of Data sections," write Jonathan Rubenstein, MD, and Mark Painter.

Use CPT code 52310 when a dangle is within the urethra and a grasper is used.

CPT code 99072 was created in response to extra medical practice expenses associated with patient care during the pandemic.

Are there billable services related to a home uroflow? "The answer is yes, to a point and if done appropriately," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter discuss what CPT code to use for aspirating the sterile water out of an inflatable penile prosthesis.

Also watch for practice expense increases for many high-volume procedures.

"If at any time the goal of performing a test is to acquire data that can assist in patient management, and it is medically necessary and appropriate, it is a billable service," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter tackle a question regarding billing for a stone procedure.

E/M guidelines direct code selection based on face-to-face time with patient.

The deletion of code 99201 is among the evaluation/management coding changes for 2021.

Three codes are available for prostate biopsy, but only one is typically used for perineal biopsy, according to Jonathan Rubenstein, MD, and Mark Painter.

CPT 51798 will not be paid if performed in place of service 21 or 23, according to Jonathan Rubenstein, and Mark Painter.

"CMS has clarified that it will not enforce the requirement that remote services be reported only for patients with whom the physician has a prior relationship, allowing you to provide new patient visits remotely (99201-99205)," write Jonathan Rubenstein, MD, and Mark Painter.

"A 90-day global procedure means that the work for the procedure and associated care has already been factored into the payment for the code, typically including 1 day preoperative work, work on the day of the procedure, and the work that is typical for 90 days beginning the day after surgery," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter answer the question: Our urologists are incorporating Botox injections into urethral strictures after a direct vision internal urethrotomy. How do you appropriately code for the Botox injection into the stricture?

"As we see it, the indication to perform this procedure was that the stone was in the ureter. The fact that it was accidentally knocked back into the kidney is inconsequential," write Jonathan Rubenstein, MD, and Mark Painter.

"First... you have to determine if you are in a global period," write Jonathan Rubenstein, MD, and Mark Painter.

"Category III codes are designated as temporary codes by the AMA. Even though the codes are considered temporary, they are an integral and important part of the system," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter address the coding question: My local hospital tells me that starting Jan. 1, 2020, I have to consult a Clinical Decision Support Mechanism due to the Appropriate Use Criteria program. I thought that didn’t start until 2021. Can you help?

"By creating time-based codes, one can most accurately describe and be reimbursed for the amount of time and effort spent face to face with an individual patient," writes Jonathan Rubenstein, MD, and Mark Painter.

Urology will make a modest gain overall in the 2020 final rule for the Medicare Physician Fee Schedule, although the truly significant changes won’t be felt until 2021.

"If the specific time spent discussing the disease and the appropriate treatment was not documented, then be sure that your documentation meets the criteria (history, physical examination, and medical decision-making) separate from any criteria performed to make sure the patient was prepared and able to have the procedure," write the Painters.

"One of the common issues we have noted for urology practices in updating ICD-10 codes is not the electronic medical record or practice management system failing to load new codes; rather, it is a failure to update templates," write Ray Painter, MD, and Mark Painter.

Documentation must support performance of ‘unusual services,’ according to Ray Painter, MD, and Mark Painter.

"There are two major reasons for you to confirm accuracy: to be sure that fraudulent claims are not being submitted and to confirm that the claims accurately reflect the work you have performed," write Ray Painter, MD, and Mark Painter.

"The much-anticipated proposed rule for the Medicare physician fee schedule was finally released on July 29, 2019. The bottom-line impact to urology for 2020-based changes to relative value units is a projected +1% additionally," write the Painters.

"Respecting what we believe is the intention of the CPT description, if the hernia repair is incidental, we will recommend not coding for the hernia repair," write the Painters.

Detailed consent statements are recommended, even for repeated treatments.

Ray Painter, MD, and Mark Painter answer a coding question regarding postvoid residual measurement.

"It should be noted that payer policies and payment for assistant at surgery will vary if you are paid as primary surgeon during the same encounter," write Ray Painter, MD, and Mark Painter.