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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.
271 Episodes
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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...
September 26, 2025 In this episode, Scott, Mark, and Ray discuss the looming federal government shutdown and how it could impact urology practices—especially telehealth services. They explain the latest developments in Washington, what Medicare and Medicaid payments will look like during a shutdown, and offer practical guidance for handling telehealth visits, front-office operations, and prior authorizations. Mark shares specific strategies and options for practices, including use of ...
UCR 259: Bladder Cancer Reimbursement Strategies – Using Unlisted J Codes and the New Zusduri Hub Tools September 19, 2025 In this episode, Scott, Mark, and Ray Painter dive into bladder cancer reimbursement with a special focus on billing strategies for new intravesical therapies like Zusduri, which currently lack established J codes. Mark outlines the complete reimbursement pathway from diagnosis coding through installation documentation, prior authorizations, appeals, and follow...
September 17, 2025 In this episode, Scott, Mark, and Ray Painter break down the latest updates on the future of Medicare telehealth coverage as the September 30, 2025, deadline approaches. Mark shares insights into recent bipartisan efforts in Congress, including a proposed stopgap measure to extend current telehealth rules through November. They also discuss the political tug-of-war surrounding ACA tax credits and how the budget debate could impact telehealth services. Tune in to und...
September 5, 2025 In this episode, Scott, Mark, Ray, and special guest Dr. John Lin delve into the nuances of coding and billing for steerable vacuum-assisted catheters used in large stone removal. They clarify the differences between DISS (Direct In-Scope Suction) and FANS (Flexible and Navigable Sheaths), explain the use of HCPCS code C9761, and discuss what it means for facilities, surgery centers, and urologists. Urology Advanced Coding and Reimbursement Seminar Information and...
August 15, 2025 In this episode, Scott, Mark, Ray, and special guest Dr. John Lin dive deep into Medicare’s upcoming Wiser Program—set to begin in 2026—which brings prior authorization to traditional Medicare for select urology services. Learn which states are impacted, what procedures are targeted, and what steps urologists need to take to prepare. The team also discusses the growing use of steerable ureteral catheters and how facilities can (or can’t) use code C9761 for reimbursemen...
August 22, 2025 In this special episode, Scott, Mark, and Ray welcome Dr. Marc Rose, a practicing urologist in Vero Beach, Florida, to share his journey of transitioning to a hybrid urology practice that combines traditional insurance with concierge medicine. Dr. Rose walks us through the burnout that led him to make a change, how he structured his new model, and the lessons he’s learned since making the leap. He explains how the practice operates day-to-day, how patients respond to c...
August 8, 2025 In this episode, Scott, Mark, and Ray discuss the troubling expansion of automatic E/M downcoding by payers—and what your practice can do about it. Mark explains which payers are leading this trend, how to identify if your claims are being affected, and practical steps to reverse these denials and protect revenue. Then, the team unpacks the recent news about UnitedHealthcare dropping certain Medicare Advantage plans, what it really means, and how to prepare your front d...
August 1, 2025 In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Helpdesk. Pay er: Anthem BCBS State: NV Code/Codes: Tranurethral resection of bladder clot that was organized to facilitate removal Catagory: OtherQuestion: I'm looking for a CPT code for : transurethral resection of bladder clot that was organized t facilitate removal Pt was inpt and Dr tried to do a clot removal from the bladder, but was unsuccessful as the whole bladder was ...
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