"If a practice has determined in writing that there are insurers whose policies advised that they will not accept this code, it seems reasonable not to report that code to that insurer even when criteria are met," write Jonathan Rubenstein, MD, and Mark Painter.
"As a result of the changes and the programmed phase-in of the changes, the cystoscopy code total RVU for the office setting will be 8% lower in 2025 than the current value," write Jonathan Rubenstein, MD, and Mark Painter.
"The final rule for 2025 poses several challenges to urology. Lobbying efforts to preserve telehealth access and the CF will continue, perhaps dragging into 2025," write Jonathan Rubenstein, MD, and Mark Painter.
“Opportunity wise, I always say that if you don't perform the test, then you're limiting treatment options for your patients,” says Kara Cossis, PA-C, MPH.
“When a patient knows that there are so many tools that are there for people, it gives them hope. It gives their caregivers hope,” says Joy Maulik, CRNP.
“I think this is the future, and if we don't go down that path and we don't explore, we're not going to make it better for us and for the patients,” says Geoffrey N. Sklar, MD, FACS.
“Particularly [in] bladder cancer, there's 2 new drugs on the market that are exceptionally expensive, but they do provide benefit to patients,” says Geoffrey N. Sklar, MD, FACS.
"If the documentation supported the use of modifier –22, it should be appended," write Jonathan Rubenstein, MD, and Mark Painter.
"When determining which code you should use, you must consider your Medicare carrier’s published rules and commercial payer processing policies," write Jonathan Rubenstein, MD, and Mark Painter.
“[This way, I can] educate myself and put myself in their shoes and suggest a treatment or a plan or an evaluation, and then find out what their feedback might be from a collaborative standpoint,” say Robert D. Hoy, MPAS, PA-C.
“Sometimes there's some difficulties with continuity of care, because I'm not the sole provider for that patient,” says Robert D. Hoy, MPAS, PA-C.
"The CF for 2025 is proposed to decrease to $32.36 from $33.29 in 2024. This is a decrease of 2.80%," write Jonathan Rubenstein, MD, and Mark Painter.
"Nurse practitioners and physician assistants are considered qualified health care professionals and are able by license to supervise diagnostic tests and interpret based upon state laws," write Jonathan Rubenstein, MD, and Mark Painter.
"Documentation must support the existence and treatment of a separate stone," write Jonathan Rubenstein, MD, and Mark Painter.
"Based on your question, C9761 would not be appropriate for using the access sheath," write Jonathan Rubenstein, MD, and Mark Painter.
"The medical necessity of the service needs to be expressed within the documentation submitted," write Jonathan Rubenstein, MD, and Mark Painter.
"Ultimately, it is best to report CPT 50548 (only) for the performance of a typical laparoscopic nephroureterectomy," write Jonathan Rubenstein, MD, and Mark Painter.
"Although the Medicare physician fee schedule, which is typically the primary focus of many of our discussions, is what is used to determine physician payment for a service, payment for an ASC is governed by separate rules," write Jonathan Rubenstein, MD, and Mark Painter.
“Variation is the enemy of quality. The more streamlined we can do these things and include APPs in the teachings of procedures and understanding different subspecialties of prostate cancer, I think it would be helpful,” says Joy Maulik, CRNP
“Cancer is a journey which is very emotional as much as it is physical. And not only for the patients, but it is also for their caregivers, whoever that person is,” say Joy Maulik, CRNP.
"We felt that it was important to again address this topic because we have received numerous questions regarding the correct use of this code and we have had some experience using the code now that it is active and been able to observe some of the initial payment processing by the payer," write Jonathan Rubenstein, MD, and Mark Painter.
"To answer this question, one must know what is and is not included in the global payment for the UDS, and the definition and instructions for appropriate use of modifier 25," write Jonathan Rubenstein, MD, and Mark Painter.
"Use code 51702 for the routine insertion of an indwelling bladder catheter, such as a Foley," write Jonathan Rubenstein, MD, and Mark Painter.
"Per CPT coding instructions, when procedures or services performed by physicians do not have a valid or descriptive CPT or Healthcare Common Procedure Coding System (HCPCS) code, the service should be reported using an unlisted code," write Jonathan Rubenstein, MD, and Mark Painter.
"What we saw was it that there were a significant number of patients that did change their management based on the findings. Of those patients, 88% of them changed because of a positive test," says Benjamin H. Lowentritt, MD, FACS.
From a show dog to a family of cats, let's see who some of the top medical professionals are spending their time with when they're not in the clinic.
"When we think about a typical procedure for performing a radical cystectomy for cancer with an ileal conduit, that would typically involve lymph node dissection, and therefore CPT 51595 would be best chosen to report that combined procedure," write Jonathan Rubenstein, MD, and Mark Painter.
"Based on the definitions from the ASA and coverage rules for Medicare, the use of nitrous oxide for urology procedures is a noncovered service," write Jonathan Rubenstein, MD, and Mark Painter.
"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.
