Mark Painter

"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.

In this article, Ray Painter, MD, and Mark Painter share with you steps you can take to increase your income, and, at the same time, significantly decrease the chances of take-backs.

"In this article, we attempt to provide a way for a practice to consider the question, 'Does this new technology make sense for my practice?' " write Ray Painter, MD, and Mark Painter.

The Painters also answer coding questions regarding prostate needle biopsy and InterStim.

Ray Painter, MD, and Mark Painter also answer coding questions regarding vasectomy and code 50543.

"One of the most common complaints we hear is, 'I am working harder and making less.' Even if you were perfect in billing and collections, this would be true," write the Painters.

"If you are hoping to be paid more with the –22 modifier, make sure you are committed to both the documentation and the follow-up," write Ray Painter, MD, and Mark Painter.

Ray Painter, MD, and Mark Painter also answer questions regarding BCG instillation and reporting of simple laparoscopic prostatectomy.

Also watch for new telemedicine codes and positive relative value unit updates.

Charging by time is permissible with appropriate documentation, according to Ray Painter, MD, and Mark Painter.

Errors related to bladder cancer site and symptom codes could lead to take backs.

"If a high percentage of the radicals are billed with urethral suspension, then it is likely to be bundled in the future and it is possible that it will be tagged with an indicator that will not allow unbundling," write Ray Painter, MD, and Mark Painter.

"If the rule changes proposed by Medicare for 2019 are passed, they may very well change the way you practice," write Ray Painter, MD, and Mark Painter.

Advanced-practice providers can report services incident to an MD under a few circumstances.

The programs present an opportunity for urologists to evaluate how they practice.

Be prepared to supply supporting clinical reasons as part of your appeal to the payer.

Modifier use without supporting documentation could be considered fraudulent, write Ray Painter, MD, and Mark Painter.

In this edition of "Coding Q&A," Ray Painter, MD, and Mark Painter also discuss the use of the –59 modifier when instilling mitomycin after TURBT, and whether you can charge for a establishing a treatment on the same day for a patient on whom you have just performed a cystoscopy.

In this column, we outline the issues that we know will be important in 2014 and discuss what we think might be implemented by Medicare for 2014.

Make sure that you are coding correctly for the instillation based on the type of drug you are using and charge separately for the drugs that are instilled.