Urology Coding and Reimbursement Podcast

June 5, 2026In this episode, Scott, Mark, and Dr. Ray Painter provide an important update on the evolving C9761 reimbursement landscape, including CMS’s decision to revise the code description and introduce a new HCPCS code for suction-enabled ureteral access sheaths. The discussion explores what these changes could mean for ASCs, HOPDs, and physicians involved in stone management. The team also answers listener questions about billing intraoperative consultations versus procedures and addresses payer denials related to place-of-service restrictions when procedures are performed in the office setting. The key takeaway: understanding documentation requirements, reimbursement rules, and site-of-service limitations is essential as coding and payment policies continue to evolve. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering 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/joinuptpClick 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/ 

May 22, 2026In this episode, Scott, Mark, and Dr. Ray Painter revisit ureteral stent removal and replacement coding after listener feedback highlighted the need for additional clarification on when cystoscopic codes versus fluoroscopic exchange codes apply. The discussion then shifts to emerging RAC audits targeting prostate artery embolization (PAE) claims involving CPT codes 37242 and 37243, emphasizing the importance of detailed documentation and medical necessity support. The episode wraps with a deep dive into Medicare’s medically unlikely edit (MUE) for add-on code 55715 for additional prostate biopsy lesions—exploring why the edit conflicts with CPT guidance, how practices should report multiple lesions, and why appeals may be necessary to receive proper reimbursement. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering 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/joinuptpClick 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/ 

May 15, 2026In this special live episode from the AUA Annual Meeting in Washington, D.C., Scott, Mark, and Ray Painter share highlights from the AUA Innovation Nexus program, where emerging companies, investors, and industry leaders are working to bring new urology technologies to market  . The discussion focuses on the growing importance of reimbursement strategy early in product development, the operational and financial realities practices must consider before adopting new technology, and why collaboration between innovators, physicians, and practice teams is critical for success. The episode also explores how efficiency, workflow, and return on investment increasingly drive whether promising technologies ultimately make it into everyday urology practice. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering 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/joinuptpClick 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/ 

May 8, 2026In this episode, Scott, Mark, and Dr. Ray Painter discuss the growing wave of innovation in urology and why reimbursement strategy must be part of the conversation from day one. Ahead of the AUA Innovation Nexus meeting in Washington, D.C., the team explores how new technologies move from concept to clinical adoption—and the reimbursement hurdles that can slow that process down. The discussion covers coding, coverage, payer adoption, workflow planning, AI-driven practice tools, and the importance of building a realistic business plan before introducing new technology into a practice. The key takeaway: exciting technology alone is not enough—successful adoption requires clinical value, operational readiness, and a clear reimbursement strategy. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering 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/joinuptpClick 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/ 

May 1, 2026In this episode, Scott, Mark, and Dr. Ray Painter break down key differences between ureteral stent removal and replacement codes—50385, 50387, and 50688—highlighting how anatomy, access (internal vs. external), and the requirement for radiologic supervision drive proper code selection. They also tackle a growing issue with ICD-10 coding for bladder cancer, where the correct use of “history of” codes during BCG maintenance therapy is leading to unexpected payer denials. The discussion explores when to follow strict coding guidelines versus when payer-specific rules may require strategic adjustments. The takeaway: understanding both the technical details of coding and the realities of payer behavior is essential to avoiding denials and protecting revenue. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering 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/joinuptpClick 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/