February 14, 2025

Scott, Mark, and Ray discuss questions that came into the PRS Network Community.

1. Our doctor's occasionally use the ESWL (Extracorporeal Shock Wave Lithotripsy) for bladder stones. Insurance requires a laterality modifier. I am not sure if we can bill for it or not. If we can bill for it, what is the correct way to do it?
2. Can you please clarify the relaxation of the in person requirement for supervision in 2025? As I read it and as I understand that you have explained it, this is a new rule stating essentially that if I am a physician supervising a nurse practitioner, the in person supervision is waived and I only need to be available via telecommunication. Am I interpreting this correctly? My coders are pushing back saying that this only applies to telehealth visits not in person visits for my supervisoion of a nurse practitioner.
3. Coding Challenging Stone Cases: Is there a CPT code I'm missing here? What financial incentive is there to use the suction/vacuum technology and perform FANS/DISS for larger stones? Just the 22-modifer? Seems like from a billing/time perspective, it's not worth tackling larger stones with either FANS or DISS.
4. 
   Does the 22-modifier really make that much difference? Can you provide an example of generally what additional time (ie double/triple, etc) actually generates for additional RVUs?

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The Thriving Urology Practice Facebook group.

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February 7, 2025

Scott and Mark welcome back Dr. John Lin and Marianne Descoise to discuss some key takeaways from the Urology Advanced Coding and Reimbursement Seminar, which took place in New Orleans from January 31st to February 1st.

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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose

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Join the Urology Pharma and Tech Pioneer Group

Empowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.

https://www.prsnetwork.com/joinuptp

Click Here to Start Your Free Trial of AUACodingToday.com

The Thriving Urology Practice Facebook group.

The Thriving Urology Practice Facebook Group link to join:

https://www.facebook.com/groups/ThrivingPractice/

UCR 228: G0559 clarification, GC Modifier Explained, and G2211 documentation suggestion.

January 24, 2025

Scott, Mark, and Dr. Ray Painter address questions submitted to the PRS Network.

1. I recently attended your Billing and Coding conference in Las Vegas this past December.
   I need clarification on New CPT code G0559, can someone please contact me as soon as possible.
2. From a coding perspective, I have a question regarding the GC modifier for a teaching facility. Also, is there a difference between the coding perspective and the compliance side of the question?
   How crucial is adding the modifier GC to the encounter when a patient is seen by both the Resident and the Faculty member?
3. Appreciate any insight y'all can provide.
4. My coder is requiring me to add a statement for G2211 codes.
5. "E and M visit today is associated with current or anticipated ongoing medical care services related to a patient's single serious condition or complex condition."
   
   Is this necessary? Reading the CMS guidelines they say no. They are worried about "Bulletproof" Documentation. I am coding these with many of my follow up patient who have chronic BPH, OAB, ED and cancer. Thoughts on how to respond to them?

Free Kidney Stone Coding Calculator

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PRS Billing and Other Services - Book a Call with Mark Painter or
Marianne Desciose

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Urology Advanced Coding and Reimbursement Seminar - New Orleans, LA

Register Now for the Urology Advanced Coding and Reimbursement Seminar

Click Here for Information and Registration

Event Details

Location:
New Orleans: January 31-February 1, 2025, at Harrah's

Time: Friday 8 am - 4 pm, Saturday 8 am - 3:30 pm

Includes: Breakfast and Lunch on both days, plus 14 AAPC CEUs

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