Jonathan Rubenstein, MD

Include clear reason/diagnosis for each test, image, and diagnostic service ordered.

Physician involvement in responses to payer audits is crucial.

"There are a number of physicians who would not feel comfortable using the word 'complete' unless they were confident that all prostate tissue had been removed," write Jonathan Rubenstein, MD, and Mark Painter.

"Placing a catheter to irrigate obstructing blood clots (CPT 51700) is specifically included in the payment for the TURP if this complication is managed outside of an operating room," write Jonathan Rubenstein, MD, and Mark Painter.

Medical necessity must be documented on the chart in order to bill code.

Providers must carefully outline their clinical thought process.

"Unfortunately, we have found that most if not all insurers do not pay for this code and additionally often have policies against charging patients for extra supplies, and balance billing would be a violation of their contract," write Jonathan Rubenstein, MD, and Mark Painter.

“If one performs a bladder catheterization to obtain the post-void residual, use CPT code 51701,” write Jonathan Rubenstein, MD, and Mark Painter.

Recent legislation appears to have delayed implementation of the new code.

CMS also expands the number of services payable under telehealth.

Evaluation/management changes should benefit providers and patients.

"The main [Medical Decision Making section] changes take place in the Complexity of Problem and Amount/Complexity of Data sections," write Jonathan Rubenstein, MD, and Mark Painter.

Use CPT code 52310 when a dangle is within the urethra and a grasper is used.

CPT code 99072 was created in response to extra medical practice expenses associated with patient care during the pandemic.

Are there billable services related to a home uroflow? "The answer is yes, to a point and if done appropriately," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter discuss what CPT code to use for aspirating the sterile water out of an inflatable penile prosthesis.

Also watch for practice expense increases for many high-volume procedures.

"If at any time the goal of performing a test is to acquire data that can assist in patient management, and it is medically necessary and appropriate, it is a billable service," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter tackle a question regarding billing for a stone procedure.

E/M guidelines direct code selection based on face-to-face time with patient.

The deletion of code 99201 is among the evaluation/management coding changes for 2021.

Three codes are available for prostate biopsy, but only one is typically used for perineal biopsy, according to Jonathan Rubenstein, MD, and Mark Painter.

CPT 51798 will not be paid if performed in place of service 21 or 23, according to Jonathan Rubenstein, and Mark Painter.

"CMS has clarified that it will not enforce the requirement that remote services be reported only for patients with whom the physician has a prior relationship, allowing you to provide new patient visits remotely (99201-99205)," write Jonathan Rubenstein, MD, and Mark Painter.

"A 90-day global procedure means that the work for the procedure and associated care has already been factored into the payment for the code, typically including 1 day preoperative work, work on the day of the procedure, and the work that is typical for 90 days beginning the day after surgery," write Jonathan Rubenstein, MD, and Mark Painter.

Jonathan Rubenstein, MD, and Mark Painter answer the question: Our urologists are incorporating Botox injections into urethral strictures after a direct vision internal urethrotomy. How do you appropriately code for the Botox injection into the stricture?

"As we see it, the indication to perform this procedure was that the stone was in the ureter. The fact that it was accidentally knocked back into the kidney is inconsequential," write Jonathan Rubenstein, MD, and Mark Painter.

"First... you have to determine if you are in a global period," write Jonathan Rubenstein, MD, and Mark Painter.

"Category III codes are designated as temporary codes by the AMA. Even though the codes are considered temporary, they are an integral and important part of the system," write Jonathan Rubenstein, MD, and Mark Painter.