Mark Painter

"Although Medicare has developed previous coverage directives for several types of PCR tests outside of UTI detection and there are sound arguments for the use of PCR tests in detecting UTIs, Medicare only recently published a local coverage determination that included the use of PCR tests for UTI detection," write Jonathan Rubenstein, MD, and Mark Painter.

eCoin is a new technology for the management of bladder overactivity that is implanted near the posterior tibial nerve subcutaneously.

"For several reasons, the percutaneous nephrolithotomy codes needed to be revised, as the language of the descriptor and what was included and not included was confusing and ambiguous," write Jonathan Rubenstein, MD, and Mark Painter.

On January 1, the following CPT code will be active: 55867 (laparoscopy, surgical prostatectomy, simple subtotal [including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy], includes robotic assistance, when performed).

For CPT 55866, it is typical to remove the seminal vesicles as part of procedure.

Conversion factor for 2023 is set to decrease by approximately 4.4%.

"There are a number of urodynamic tests that can be performed. Urodynamic studies are not a one-size-fits-all procedure, but rather the tests performed should be chosen based upon the patient presentation and the question that needs to be answered by the urodynamic studies," write Jonathan Rubenstein, MD, and Mark Painter.

Supplemental information on safety and efficacy of service may be needed.

"As for the case described of a 75-minute audio-only E/M visit there has been no specific coding guidance provided by CPT," write Jonathan Rubenstein, MD, and Mark Painter.

"For appropriate billing and coding, there are 2 important issues to be satisfied: medical necessity and documentation supporting the performance of the procedure," write Jonathan Rubenstein, MD, and Mark Painter.

Challenge is presented by switching from SWL to ureteroscopy intraoperatively.

Labs will need to apply for unique Z code for each panel of tests ordered.

“If the service is indeed justified and supported, we would recommend checking with the payer prior to submitting code 0649T,” write Jonathan Rubenstein, MD, and Mark Painter.

Pathologic tissue confirmation is usually the best practice.

Payer edits referencing ICD-10-CM guidelines such as “Excludes 1” are on the rise.

Increase in conversion factor and delay of sequestration are among changes.

Check for surgical approach and bundling edits when choosing a code.

Urology as a specialty will see a 3.71% decrease in overall payments.

"As always, document well and use the modifiers when appropriate," advise Jonathan Rubenstein, MD, and Mark Painter.

"The short answer is that this will be paid once," according to Jonathan Rubenstein, MD, and Mark Painter.

Code selection will depend on the size of the stone being treated.

New and updated codes encompass balloon continence devices, hypospadias

"When taking into account the various rules surrounding both codes, 52310 or 52315 should be reported with 1 unit for the removal of bilateral stents," write Jonathan Rubenstein, MD, and Mark Painter.

"Each bill that is submitted for reimbursement must have a code for both the service performed and a reason for the service," writes Jonathan Rubenstein, MD, and Mark Painter.

Medicare typically does not pay for preventive services unless specifically allowed.

Conversion factor is expected to decrease by 3.89%

"Depending on the age of the surgeon, one may be surprised to hear that it was common to perform a vasectomy routinely on patients undergoing a TURP procedure," write Jonathan Rubenstein, MD, and Mark Painter.

"It is clear that if a practice were to require or encourage all or some of their patients to supply their own catheters, it would be considered a violation of your Medicare participation and could result in takebacks, fines, or even exclusion from Medicare," write Jonathan Rubenstein, MD, and Mark Painter.

SHIM and other questionnaires do not satisfy categories within Data section.

"Either way the service is reported, the payer should require documentation be submitted for review prior to payment, and the use of the –52 on the 38571 will provide more appropriate guidance for reimbursement processing," write Jonathan Rubenstein, MD, and Mark Painter.