Ray Painter, MD

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.

What does this all mean to the practicing urologist? Here is an overview of what to expect in the months and years ahead.

In a recent audit of urodynamics charges, Medicare recognized some codes but not others, and the documentation for all services that were reviewed only included the report from the urodynamics machine. This review pointed out the lack of understanding of these codes by payers and physicians.

There are many aspects of the business of medicine that are difficult to influence. Here are some ways that you can have some control.

Private payer rules differ from Medicare rules. From payment for procedures to globals, bundling, coverage, and modifier usage, private payers are not required to use Medicare rules.

Once again, we face a Medicare payment update for the new year that raises a number of questions, the answers to which are not favorable to practicing urologists.

Once again we face a Medicare payment update for the new year that raises a number of questions, the answers to which are not favorable to practicing urologists.

The issues are too complex for a simple answer when it comes to 'incident to' billing.

As the debate over health care reform rages, one thing is certain: Regardless of what happens in Washington, changes will occur in 2010 that will directly affect your practice.

The definition of "consult" has moved the target for reimbursement over the years.

The question is no longer if health care reform will occur, but when and what it will look like.

The 2009 Medicare Physician Fee Schedule final rule was recently published, containing many important changes in reimbursement for urologists.

The regulations guiding the Centers for Medicare & Medicaid Services for the establishment of the 2008 physician fee schedule remain unchanged for the most part.

Codes vary by cancer type, but liability for bladder Ca diagnosis rests with the doctor

Medicare has mandated a change from the current provider identification system to a new National Provider Identifier (NPI). The change will occur on May 23, 2007. This change is not an option, but is mandated for Medicare and, ultimately, all private payers that accept electronic claims.

Control of postoperative pain is usually considered follow-up care similar to wound care, removal of sutures, and other related services.

If possible, contracts based on straight percentage of Medicare should be avoided.

What is considered the usual postoperative bleeding time following a transurethral resection of the prostate?

If the conversion factor cut stands, urologists' Medicare income will decrease overall by about 5%.

What you discuss with patients and when you do it can make a difference in how you code

Be prepared for a short-term gain that may be a long-term pain. The AmericanMedical Association has claimed a major political victory with passage ofthe Medicare Prescription Drug Improvement and Modernization Act of 2003,and I certainly hope the AMA is correct. Certainly the pay increase overthe next 2 years is great. However, I have concerns about many of the otherissues addressed in the bill.

Instructions for coding for all Evaluation and Management (E&M) services have several elements in common. One should always base documentation and coding on the amount of work required to provide good patient care.

Physician must be immediately available, and the service must be performedby an employee

In a previous issue of Urology Times, this column discussed multiple procedures and the bundling edits for a single physician ("When to bill and not to bill for multiple procedures," May 2002, page 62). This article will address multiple procedures performed at the same encounter by two separate physicians.

There are two key elements to successful billing and collection-bothnow and in the future. The first is the accuracy of your documentation andcoding, basically the responsibility of the urologist. The second elementis the billing process, which can be computerized, automated, and performedby others.

Societies can help with Medicare matters and with private insurance companies