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The article reports on the Calendar Year 20225 Medicare Physician Fee Schedule Proposed Rule released by the U.S. Centers for Medicate & Medicaid Services on July 10, 2024 and explores its impact on urology practices. Topics discussed include the proposal to decrease the conversion factor for 2025, revisions in evaluation and management services, and the delay in the implementation of the weights based on Medicare Economic Index.

The article provides an answer to a question on reporting robotic nephroureterectomy with bladder cuff for ureter or renal pelvis cancer.

The article reports on the final rule for the Medicare Physician Fee Schedule for 2024 unveiled by the U.S. Centers for Medicare & Medicaid Services (CMS) that include implementation of the add-on health care common procedure coding system code G2211. It informs the reduction of conversion factor and changes to evaluation and management services. It cites examples of encounters for which the code G2211 is not payable and identifies types of visits that qualify for reporting of code G2211.

In the article, the authors discuss the current procedural terminology (CPT) code for 2024, including the coverage for work relative value units (wRVU) and the Medicare Administrative Contractors (MAC), and advanced practice providers (APP). Other topics include the CPT codes for procedures like cystourethroscopy, the insertion or replacement of percutaneous electrode array, and female pelvic examination.

The article answers a question on whether an ambulatory surgical center (ASC) that has been using disposable endoscopes for a few years without billing for them is eligible for the additional payment for disposable endoscopes and how the coding team code would bill for the procedure.

The article provides an answer to a question on billing procedures for the performance of complex urodynamics.

The article presents questions and answers related to coding for removal of a bladder calculus via Mitrofanoff including Correct Procedural Terminology (CPT) code for the removal of a bladder calculus via a Mitrofanoff and the correct code for a bladder catheterization via a Monti channel.

The article offers recommendations for using Medicare's add-on Healthcare Common Procesure Coding System (HCPCS) code G2211 in urology. Instances for non-reporting of G2211 include dates of service, encounter with a patient who is not under a physician's care or when second opinion in rendered and directed service for single complex problem. Documentation to support reporting of code G2211 cover evaluation and management (E/M) visit focused on care and on unrelated treatment of patient.

The article provides an answer to a question on whether it is possible to reimburse the use of nitrous oxide for urology procedures by an insurance company.

The article discusses some of the most notable rules that affect those who practice urology. These include the conversion factor for 2023 which is set to decrease by about 4.5 percent, the change made by the Centers for Medicare and Medicaid Services (CMS) on the update process for clinical labor included in the calculation of the practice expense component within the Medicare Physician Fee Schedule, and new and updated urology Current Procedural Terminology (CPT) codes.

The article presents an answer to a query on the changes in the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes in urology.

The article outlines significant areas of the proposed 2024 Medicare Physician Fee Schedule that are relevant to urologists and urology practices. Topics discussed include conversion factor, evaluation and management services proposed revisions, split/shared health care services, delayed implementation of the updated Medicare Economic Index weights, relative value unit changes, telehealth, and merit-based incentive payment system/Medicare access and CHIP Reauthorization Act of 2015.

An interview with Jyoti Chouhan, assistant professor of urology at Oregon Health & Science University (OHSU), and Sarah Hecht, assistant professor of pediatric urology at OHSU Doembecher Children's Hospital, is presented. Hecht talks about the struggle of urologists with efficiency and cites steps to overcome barriers for efficiency such as standardization of care and optimizing electronic health record. Chouhan discusses required documentation for billing and the importance of job promotion.

The article provides an answer to the question on how to bill for percutaneous nephrolithotomy (PCNL) using existing and new access under the Current Procedural Terminology (CPT) codes.

The article provides an answer to confusions regarding percutaneous nephrolithotomy (PCNL) coding using the updated Current Procedural Terminology (CPT) codes 50080 and 50081.

The article discusses modifier-25, which is defined as a significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service. Topics include a report which showed that modifier-25 was incorrectly reported in 35 percent of cases reviewed in 2005, reporting rules for modifier-25, and factors that need to be considered for the clinical aspects of the E/M visit.

The article provides an answer to a question of how to bill Principal Care Management codes when a patient's care is split between two providers from different specialties.

The article presents answers to questions related to coding and reimbursements in urology practice in the U.S.

The article presents questions and answers related to reporting Current Procedural Terminology (CPT) code 99072, which is meant for reporting extra expenses related to COVID-19, including the coding guidelines for 99072, how to bill for remote uroflow and the CPT code to use for aspirating the sterile water out of an inflatable penile prosthesis.

The article addresses questions about laparoscopic simple prostatectomy code. Topics discussed are updates to the Current Procedural Terminology (CPT) code set, inapplicability of dilation codes when performing percutaneous nephrolithotomy, and the reporting of CPT code 64590 when placing eCoin device for the management of bladder overactivity that is implanted near the posterior tibial nerve.

The article reports on the use by Medicare to relax requirements that will enable physicians to offer telemedicine and telehealth services amid the COVID-19 pandemic in the U.S. Medicare made the move after the government orders people to stay at home to prevent the spread of the virus. The list of services covered by telemedicine include evaluation and management services, mental health and opioid addiction care.

An interview with Jonathan Rubenstein and Mark Painter, compliance officer and medical director of coding and reimbursement at the United Urology Group and Chesapeake Urology, and chief executive officer of PRS Urology SC, respectively, is presented. They talk about how to best cost a scenario that involves removal of stone during cystoscopy, and the code to be reported when performing a urine analysis dipstick when the urine is obtained by catheterizing the patient's bladder.

The article presents questions and answers related to medical coding in the U.S., namely, whether a seminal vesiculectomy is built in the prostatectomy current procedural terminology (CPT) code 55650 and the correct coding for complex uroflowmetry.

The article examines the proposed changes for payment and policy under the 2023 Medicare Physician Fee Schedule (MPFS) drafted by the U.S. Centers for Medicare & Medicaid Services (CMS), particularly those that affect the practices of urologists. Among the major changes include the decline in the conversion factor, the clinical labor update, evaluation and management (E/M) services, and global surgical services.

The article presents an advice column regarding billing for unlisted codes. Topics discussed include suggestions for appropriate billing of an unlisted code for a new procedure the doctor is performing, kinds of urodynamic tests that can be performed, and whether luteinizing hormone-releasing hormone (LHRH) agonist that can be used for men with advanced prostate cancer should be billed the same with other LHRH agonists.

The article presents questions and answers related to coding in urology, including coding on the treatment of kidney stones, how to bill an encounter when both the kidney and bladder are imaged with ultrasound, and an add-on code that can be used for a prolonged audio-only evaluation and management (E/M) visit in which a provider spent 75 minutes with the patient by phone.

The article discusses issues in the operation of Medicare Administrative Contractors (MAC) in the U.S., particularly on the use of local coverage determinations (LCD) to address problems from nucleic acid amplification test (NAAT) panels for infectious disease testing. Also cited are the flexibility enjoyed by MACs in developing policies for payment protocols that do not violate national Medicare directives, and the need to communicate coding/billing instructions linked to LCDs.

The article presents questions and answers related to medical coding, namely, whether it is okay to bill a cancer diagnosis on visits before the diagnosis was made, and whether it is okay to use 0649T code as add-on code to multiparametric magnetic resonance imaging (MRI) of the prostate.

An interview with urology professor Doctor Daniel Shoskes is presented. When asked on the estimated 4.75% prevalence of chronic scrotal pain in all men, he replies that coding the condition as epididymitis may be as often as its non-coding. Shoskes notes that true chronic orchialgia is an exclusion diagnosis by definition. He states that many men who have recently received epididymitis treatment have also been treated with unwarranted antibiotics.

The article focuses on urology practices that are accused of violating the U.S. False Claims Act. Topics discussed include the amount to be paid by for Skyline Urology to settle Medicare overbilling allegations, the False Claims Act liability settled by FWC Urogynecology , LLC in 2018 for knowingly misusing Medicare billing codes with modifier -25 to receive additional payment, and major categories of improper billing according to the Centers for Medicare & Medicaid Services.

The article discusses the passage of the Protecting Medicare and America Farmers from Sequester Cuts Act, which became law on December 10, 2021. Topics include expectations on 2022 Medicare fee schedule, the positive effects on Medicare payments for the 2022 calendar year, and additional updates and rule changes that need to be addressed in 2022.

The article presents questions and answers related to coding and reimbursement in urology in the U.S., including how to bill a percutaneous nephrolithotomy for a large kidney stone on a patient with a previously placed ureter stent, and what to do when receiving a special request from a Medicare Advantage Plan that a practice is contracted asking it to send them over 600 records to review.

A correction to the article "What are your thoughts on reporting CPT code 64590 when placing an eCoin device?" published in the October 20, 2022 issue is presented.

The article presents questions and answers on coding for laser lithotripsy of the prostate channel stone, coding bilateral uretral stent removal, and the difference and appropriate use of modifiers -57 and -25.

The article presents updates to the U.S. Current Procedure Terminology (CPT) codes scheduled for implementation in January 2022. Among the Category I codes include periurethral transperineal adjustable balloon continence device and bilateral insertion including cystourethroscopy. Also cited are ultrasound-guided focal laser ablation prostate tissue and monopolar radiofrequency remodeling of the female bladder neck.

The article presents questions and answers related to urology including the role of biofeedback as a billable service after a robotic radical prostatectomy, the number of units that should be billed by Common Procedural Terminology (CPT) code 52310 for cystoscopy with bilateral ureteral stent removal, and the appropriate diagnosis when a patient underwent ureteral stone removal and stent placement.

The article highlights issues and factors concerning the proposed rules for the Medicare Physician Fee Schedule on July 13, 2021 by the U.S. Centers for Medicare & Medicaid Services. In terms of financial impact, the conversion factor is projected to decline by 3.89 percent which will affect physician payment for work performed to Medicare and Medicare Advantage plans. It also cites the proposal to change the Quality Payment Program system to make measures more applicable to patient care.

The article presents questions and answers related to urology coding and reimbursement, including data points that are considered under the 2021 evaluation and management (E/M) guidelines, whether modifying CPT 51702 with the -52 modifier for reduced services is allowed for a patient who presents the office for a catheter change and brings his own catheter, and how to deal with an insurance company that reduced the reimbursement for a transurethral resection of the prostate.

The article reports on the passage of the Medicare Access and CHIP Reauthorization Act of 2015 that became law in the U.S. on April 16, 2015. The House version of the bill carries language intended to ramp up the ability of the Medicare to fight fraud. Section 7 of the bill cites that the Secretary of Health and Human Services will make a plan in revising the incentive program that urges increased participation to report Medicare abuse and fraud. INSET: How to protect your practice: Four suggestions.

The article discusses the impact on the implementation of the International Classification of Diseases-10 (ICD-10) to the urology practice of the urologists in the U.S. It highlights the readiness campaigns for ICD-10 small- and medium-sized practices. It also notes that ICD would be the coding system that the providers would use for billing purposes.

The article presents questions and answers related to medical coding which includes the incorporation of data in medical decision-making, the use of Common Procedural Terminology (CPT) code 38571-52 in a scenario at the time of a robot-assisted laparoscopic prostatectomy, and other code that better supports the postvoid residual (PVR) urine.

The article presents questions and answers related to medical coding and reimbursement in the U.S. of interest to urologists, including the whether diagnostic tests and procedures like 51798 is a billable service under the global surgical package, the appropriateness of billing 51700 for urinary retention 2 weeks after transurethral resection of the prostate (TURP), and what does the word complete mean in the Common Procedural Terminology (CPT) 52601 description.

The article discusses the potential impact of the final rules for payment in 2017 and for the new Quality Payment Program (QPP) of the Centers for Medicare and Medicaid Services (CMS) on urology practice in the U.S. Topics covered include the changes relating to the conversion factor for 2017 and relative value units (RVUs) for urology services, CMS' global data collection system, and compliance to the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA).

The article discusses the role of the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC). RUC conducts three meetings each year to review that help the Centers for Medicare & Medicaid Services (CMS) set Medicare rates for physician reimbursements. It also has huge influence over physician reimbursements.

In the article, the authors discuss the 2021 evaluation and management (E/M) guidelines on medical coding, particularly in the area of documentation. Other topics include the medical decision-making categories (MDM) like the complexity of presenting problem, and the American Medical Association (AMA) Current Procedural Terminology (CPT) guidelines.

In the article, the authors discuss the reintervention rate for benign prostate hyperplasia (BPH). Also cited are the calculated annual reintervention rates for transurethral resection of the prostate (TURP), prostatic urethral lift (PUL), and laser photo-vaporization of the prostate (PVP) as BPH treatments, as well as how to assess the durability of the treatments.

The article presents questions and answers related to medical coding in the U.S., including the chronic condition code G2211 and the reason behind its delay by three years, the COVID-19 Current Procedural Terminology (CPT) code 99072, and the documentation requirements for code 51798.

The article discusses the U.S. Centers for Medicare & Medicaid Services' (CMS) final rule for the 2021 Medicare Physician Fee Schedule (PFS). Topics covered include urologists' likely lower revenue increases from Medicare due to the conversion factor decrease, and changes for office/outpatient evaluation and management (E/M) services to be determined by medical decision-making (MDM) or total time. Also noted is the expansion of the number of services payable under telehealth.

An introduction is presented in which the editor discusses various reports within the issue on topics including interviews with doctors Brant A. Inman and Howard Goldman, neoadjuvant renal cancer cell carcinoma treatment, and out of clinic issues of gender diverse people.