United Urology Group | Strategic Alliance Partners

"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.

In this installment, Christopher E. Ramsey, MD, FACS, and Rachel Vann, MSN, RN, NP-C, highlight Tennessee Urology, an affiliate of United Urology Group.

"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.

The inclusion of PAE in the American Urological Association BPH Guidelines offers a non-surgical alternative that can provide long-term relief with minimal downtime and fewer complications, according to the United Urology Group.

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.

"Among our accomplishments were the first robotic ureteral reconstructions and completing our first 100 robotic cases within the first half-year," says Michael W. Witthaus, MD.

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

In this installment, Suzanne B. Merrill, MD, FACS, and Dan Humer, PA-C, highlight Colorado Urology, a Denver-based practice within the United Urology group.

The median time to PSA0.2 was 3.5 months in the apalutamide group, 4.4 months in the enzalutamide cohort, and 7.1 months in the abiraterone acetate group.

“I think being savvy about how you deal with BCG supply on the administrative side is important,” says Suzanne B. Merrill, MD, FACS.

"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.

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.

“HIFU also has gone up in its APC, so there's a higher reimbursement for the facility fees for hospital or ASC setting,” says Jonathan Rubenstein, MD.

“These are add-on codes that need to be added on to the evaluation and management service that's done on that patient on that day,” says Jonathan Rubenstein, MD.

“Effective January 1, 2023, anyone who performs a laparoscopic simple prostatectomy should be using CPT code 55867 to report that procedure,” says Jonathan Rubenstein, MD.

Benjamin Lowentritt, MD, discusses how the phase 3 SPOTLIGHT trial showed the efficacy of the PSMA-PET imaging agent 18F-rhPSMA-7.3 PET across a variety of subgroups in prostate cancer.

“What's more concerning is we're seeing an increase in advanced or late-stage diagnosis, which I've seen in my practice as well,” says Derek J. Lomas, MD, PharmD.

“These are codes that had not been updated in decades—since they were originally written,” says Jonathan Rubenstein, MD.

“Now, we only have 1 code set that we have to worry about instead of 2 code sets,” says Jonathan Rubenstein, MD.

“Practices need to be aware that they need to be able to budget for those who perform in-office services that have very little clinical labor, but may have a high practice expense overall,” Jonathan Rubenstein, MD, says.

“Every year, we see our reimbursements go down. Every year, there seem to be some sort of patch,” says Jonathan Rubenstein, MD.

“It certainly seems that we're moving into medical management of advanced diseases,” says J. Christopher Webster, MD, FACS.

“From a patient care standpoint, anything that opens the door and makes the patient feel more secure and open is going to lead to better outcomes for them and allow us to serve their needs best,” says Benjamin Lowentritt, MD, FACS.

Webster also shares his advice for young urologists entering community practice.

“What was found in the sub stratification study was that overall survival favored the addition of darolutamide to ADT and docetaxel in all stratification subgroups,” says Ronald Tutrone, MD, FACS, CPI.