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© 2026 Urology Coding and Reimbursement Podcast
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The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life. Your cohosts, Mark, Scott and Dr. Ray Painter discuss urology coding and share best practices for the urology office. We will answer submitted urology coding questions so that you can learn the concepts and apply in your practice. Learn the best practices: urology coding, revenue cycle management, scheduling, collections, patient information collection, pre-authorization, prior approval, charge capture, office communications, claim entry review, appeals, audits and billing, that we have tested and proven so you can adapt and incorporate.
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March 13, 2026 In this episode, Scott, Mark, and Dr. Ray Painter tackle three emerging reimbursement challenges affecting urology practices: widespread denials for testosterone pellet (Testopel®) therapy, the growing trend of secondary payers requiring prior authorization for high-cost drugs, and whether urology questionnaires qualify as billable health risk assessments. PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Pros...
March 6, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the complex “alphabet soup” of Medicare coverage and auditing tools—including NCDs, LCDs, LCAs, RAC audits, and the emerging WISER program—and explain how they work together to shape reimbursement policy. Prompted by a new multi-state LCD affecting Botox coverage, the discussion walks through how coverage determinations are created, how Medicare contractors enforce them, and why documentation requirements conti...
February 27, 2026 In this episode, Scott, Mark, and special guest Dr. John Lin tackle real-world evaluation and management (E/M) scenarios submitted by members of the Thriving Urology Practice Facebook Group. Through practical examples—including BPH follow-ups, elevated PSA management, overactive bladder, recurrent UTIs, and constipation—they break down how to apply medical decision-making rules to determine the correct level of service. The discussion highlights chronic stable ...
February 20, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the financial realities of the new prostate biopsy CPT codes and what they mean for urology practices. Moving beyond coding mechanics, the discussion focuses on the economic differences between transrectal and transperineal approaches, MRI fusion versus ultrasound guidance, targeted lesion add-on payments, and the site-of-service differential between office and facility settings. They explore how practice e...
February 13, 2026 In this special live episode recorded at the Urology Advanced Coding and Reimbursement Seminar in New Orleans on January 31st, 2026, Scott, Mark, Dr. John Lin, and Marianne DeSciose dive into one of the most contentious coding battles in urology: billing E/M services with cystoscopy on the same day. Prompted by a real-world question from the Thriving Urology Practice Facebook Group, the panel explores when modifier 25 is appropriate, why denials happen, and how to bu...
February 5, 2026 In this episode, Scott, Mark, and Dr. John Lin break down the latest telehealth news—Congress has officially extended Medicare telehealth coverage through the end of 2027, offering long-term stability for practices. They also answer a listener's question about billing 52235 and 51720 together, covering when a modifier can be used and how to document instillation in the recovery room properly. The episode wraps with a cautionary tale about “medically impossible days,” ...
January 30, 2026 On this episode, Scott and Mark Painter sit down with Dr. Sida Niu and Tyler Hamik, co-founders of docology, an AI-driven clinical intake and workflow automation platform. Dr. Niu explains how docology was born out of his own frustration with after-hours chart review, and how the tool now distills massive referral packets into clear, focused summaries—saving hours of prep time. Tyler shares how docology integrates with EMRs to automate front-end document intake and in...
January 23 , 2026 In this episode, Scott and Mark Painter discuss what the upcoming January 31 deadline means for telehealth coverage under Medicare, including expectations around funding extensions, potential payment delays, and bipartisan support for long-term access. They also introduce the expanded PRS Coding and Reimbursement Hub—an evolving resource offering disease-specific coding guides, product-specific reimbursement tools, prostate biopsy calculators, EOB insights, and more....
January 16, 2026 In this episode, Scott, Mark, and Ray Painter revisit the new prostate biopsy CPT codes and provide a key update on the use of ProMaxo for MRI-guided biopsies. Mark shares recent insights confirming that CPT codes 55713 and 55714 are appropriate for procedures performed with ProMaxo, clearing up previous ambiguity around the “in-bore” language. Then, the team shifts to deductible season challenges, emphasizing front-desk protocols, eligibility verification, patient co...
January 9, 2026 In this episode, Scott, Mark, and Ray Painter tackle the growing issue of automated downcoding by commercial payers—where level 4 and 5 E/M visits are silently paid at lower levels without a formal denial. They explain how this tactic evades typical RCM detection, outline steps to flag and appeal these incorrect payments, and emphasize why accurate documentation is more important than ever. From setting up payer-specific protocols to understanding how AI-driven reviews...
January 2, 2026 In this episode, Scott, Mark, and Dr. John Lin dive into the complexities of billing G2211, the Medicare add-on code for complex E/M visits, which now pays nearly $18 per use. They unpack a real-world case where a hospital system’s blanket use of modifier 25 is preventing employed physicians from getting reimbursed for G2211, potentially costing them thousands in RVUs. The discussion covers payer-specific rules, how to appeal inappropriate denials, how contract structu...
December 26, 2025 In this episode, Scott, Mark, and Ray Painter answer listener questions about the new 2026 prostate biopsy CPT codes. They clarify global periods, explain the differences between transrectal and transperineal approaches, and tackle the nuances of coding for MRI-guided procedures—especially when using systems like Promaxo. They also break down the use of 55715 for additional targeted lesions, when modifiers like 52 may apply, and how payers might interpret these new c...
December 12, 2025 In this episode, Scott, Mark, and Ray Painter share highlights from the recent Urology Advanced Coding and Reimbursement Seminar in Las Vegas, including robust discussions on E/M coding, prostate biopsy changes, modifiers, and the Wiser program. They also provide an important update on the AMA’s recent meeting about coding and payment for algorithmic services, detailing how CPT and the RUC are approaching AI integration in healthcare. From potential reimbursement mod...
November 21, 2025 In this episode, Scott, Mark, and Ray Painter explore the reimbursement challenges surrounding procedures that may not be covered by insurance, including those considered cosmetic, elective, or medically unnecessary. They discuss how to identify whether a service is reimbursable, when to use ABNs, how different payer rules come into play, and why collecting upfront may be the smartest move. You’ll also hear strategies for handling denials, gray-area procedures, and w...
November 14, 2025 In this episode, Scott, Mark, and Ray Painter discuss the impact of the government’s recent reopening on telehealth services for Medicare patients. With the new continuing resolution extending COVID-era telehealth flexibilities through January 30, 2026, they break down what this means for billing, coverage, and patient refunds. The team also explores what to watch for if another shutdown looms, how CMS might handle claims from the closure period, and why signs point ...
October 31, 2025 In this Halloween-themed episode, Scott, Mark, Ray, and special guest Dr. John Lin explore the “curse” of poor documentation and its real-world consequences, including payer audits, downcoding, and revenue loss. They discuss how vague or incomplete documentation—even when care is appropriate—can lead to denials and clawbacks, especially in today’s AI-assisted claims review environment. The team also covers practical strategies to improve documentation, the risks of ov...
October 24, 2025 In episode 264 of the Urology Coding and Reimbursement Podcast, Scott and Mark Painter sit down with Ken Mitchell, PA-C, a nationally recognized expert in men’s health and a champion for advanced practice providers (APPs) in urology. Ken shares insights on the growing urology workforce shortage, the evolving role of APPs, and recent payer challenges—like restrictions on APP-administered Xiaflex in Arkansas. He also introduces his nonprofit, Gynecology, which promotes ...
October 17, 2025 In this episode, Scott, Mark, and Ray Painter clarify the latest on the Medicare claims hold during the government shutdown, explaining that it applies only to services affected by expired COVID-era provisions like telehealth under traditional Medicare. They also address coding questions on billing for bladder stone removal during robotic prostatectomy—highlighting when to use 51050 vs. 51999—and revisit proper coding for Urocuff procedures following a UnitedHealthcar...
October 10, 2025 In this episode, Scott, Mark, and Ray Painter address two pressing topics for urology practices. First, they provide the latest update on the government shutdown, its impact on Medicare claims processing, and the timeline for when the CMS-mandated 10-day hold may be lifted. They also clarify that Medicare funding is not in jeopardy—this is purely an administrative delay related to expiring telehealth and COVID-era waivers. Next, they tackle a listener-submitted questi...
October 3, 2025 In this episode, Scott, Mark, and Ray Painter discuss two timely and important topics. First, they break down the current government shutdown and its effects on Medicare claims processing, including the 10-day hold issued by CMS to allow MACs to adjust their systems—especially around telehealth billing. They offer practical recommendations for urology practices, including billing guidance and the use of ABNs during the shutdown. Then, the discussion shifts to artificia...
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