Urology Coding and Reimbursement Podcast

Mark Painter, Scott Painter and Dr. Ray Painter

The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life. Your cohosts, Mark, Scott and Dr. Ray Painter discuss urology coding and share best practices for the urology office. We will answer submitted urology coding questions so that you can learn the concepts and apply in your practice. Learn the best practices: urology coding, revenue cycle management, scheduling, collections, patient information collection, pre-authorization, prior approval, charge capture, office communications, claim entry review, appeals, audits and billing, that we have tested and proven so you can adapt and incorporate.

  1. 1 DAY AGO

    UCR 285: Bringing More Complex Procedures Into the Office – Is It Worth It?

    April 17, 2026 In this episode, Scott, Mark, and Dr. John Lin tackle a deceptively simple question: does it make sense to perform more complex procedures—like Optilume and other minimally invasive treatments—in the office setting? The discussion breaks down the three critical pillars every practice must evaluate—clinical fit, financial viability, and operational execution—while highlighting key factors such as reimbursement, equipment costs, anesthesia logistics, staffing, and workflow efficiency. They also explore opportunity cost, geographic variability, and how in-office procedures can improve both patient experience and physician productivity when done right. The takeaway: success requires a fully developed plan—because bringing procedures in-house is never just a simple yes or no decision.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    30 min

  2. 10 APR

    UCR 284: UTI PCR Under Fire – OIG Scrutiny, Denials, and What to Do Next

    April 10, 2026  In this episode, Scott and Mark Painter break down the rapidly evolving and increasingly uncertain landscape surrounding UTI PCR testing, following heightened scrutiny from the OIG and a surge in payer denials—particularly for CPT code 87798. They discuss confusion around MUE limits, shifting interpretations from MACs, and the growing use of N35 denials triggering documentation requests. The episode outlines how practices should respond, including when to appeal, how to support medical necessity, and the risks of prematurely changing billing behavior without clear guidance. The key takeaway: stay disciplined, document thoroughly, and play the long game as policies continue to evolve.    PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    29 min

  3. 6 APR

    UCR 283: Saturation Biopsy Confusion and Cystoscopy Risk—Where Interpretation Matters

    April 3, 2026  In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where interpretation is driving real-world coding challenges: when a prostate biopsy truly qualifies as a stereotactic template-guided saturation biopsy (55706), and whether diagnostic cystoscopy meets moderate risk under E/M guidelines. The discussion breaks down what differentiates saturation biopsy from standard transperineal approaches, including the importance of 3D templating and full-gland sampling, and why payer expectations may not align with physician interpretation. They also revisit the E/M risk table, reinforcing why cystoscopy is generally considered moderate risk—even if not explicitly stated in current guidelines. The key takeaway: as coding becomes more nuanced, balancing guideline interpretation with payer expectations is critical to staying compliant and getting paid correctly.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    35 min

  4. 27 MAR

    UCR 282: Playing the Surgical Lottery – Medicare Advantage and Out-of-Network Strategy

    March 27, 2026  In this episode, Scott, Mark, and Dr. John Lin dive into the challenges of navigating Medicare Advantage (Part C) plans—what happens when you’re out of network, why reimbursement can feel like a “surgical lottery,” and how to decide whether to participate at all. Prompted by a real-world scenario involving UnitedHealthcare narrowing its network, the discussion explores out-of-network billing strategies, patient responsibility, contract pitfalls, and the risks of unpredictable payments. The team also breaks down the key differences between traditional Medicare and Medicare Advantage, highlighting how payer incentives, network restrictions, and administrative burden impact both practices and patients. The takeaway: know your numbers, know your leverage, and be intentional about the payers you choose to work with.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    36 min

  5. 20 MAR

    UCR 281: UnitedHealthcare’s New Documentation Rule and MDM Data Clarifications

    March 20, 2026  In this episode, Scott, Mark, and Dr. Ray Painter break down a new UnitedHealthcare policy that could impact payment for professional components of diagnostic services—including urodynamics and other PCTC-coded procedures—and what practices must document to avoid denials. The discussion outlines the need for clearly separated diagnostic reports with findings and impressions, as payers increase prepayment scrutiny.   The key takeaway: as payer oversight intensifies, precise, structured documentation—and understanding how rules are applied—is essential to getting paid.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    34 min

  6. 13 MAR

    UCR 280: Testosterone Pellet Denials, Secondary Payer Prior Auths, and Urology Risk Assessments

    March 13, 2026  In this episode, Scott, Mark, and Dr. Ray Painter tackle three emerging reimbursement challenges affecting urology practices: widespread denials for testosterone pellet (Testopel®) therapy, the growing trend of secondary payers requiring prior authorization for high-cost drugs, and whether urology questionnaires qualify as billable health risk assessments.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    29 min

  7. 9 MAR

    UCR 279: LCDs, NCDs, LCAs, and Audits — Understanding Medicare’s Coverage Landscape

    March 6, 2026  In this episode, Scott, Mark, and Dr. Ray Painter break down the complex “alphabet soup” of Medicare coverage and auditing tools—including NCDs, LCDs, LCAs, RAC audits, and the emerging WISER program—and explain how they work together to shape reimbursement policy. Prompted by a new multi-state LCD affecting Botox coverage, the discussion walks through how coverage determinations are created, how Medicare contractors enforce them, and why documentation requirements continue to expand. The panel also explores how practices can adapt by building workflows, intake forms, and clinical documentation processes that capture the data Medicare expects—helping physicians navigate audits while still delivering appropriate patient care.  PRS Coding and Reimbursement Hub Access the Hub Botox LCD Alert Download the Alert Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    30 min

  8. 27 FEB

    UCR 278: E/M Leveling — It’s as Clear as Mud

    February 27, 2026  In this episode, Scott, Mark, and special guest Dr. John Lin tackle real-world evaluation and management (E/M) scenarios submitted by members of the Thriving Urology Practice Facebook Group.  Through practical examples—including BPH follow-ups, elevated PSA management, overactive bladder, recurrent UTIs, and constipation—they break down how to apply medical decision-making rules to determine the correct level of service. The discussion highlights chronic stable conditions, prescription drug management, documentation pitfalls, automatic downcoding, and the ongoing gray areas that make E/M leveling “clear as mud.” The key takeaway: understanding the rules is essential—but precise documentation is what ultimately gets you paid.   PRS Coding and Reimbursement Hub Access the Hub Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins   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/

    49 min
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About

The Urology Coding and Reimbursement Podcast is for Urologists and urology practice staff: Administrators, APPs, Billers and Coders. We help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life. Your cohosts, Mark, Scott and Dr. Ray Painter discuss urology coding and share best practices for the urology office. We will answer submitted urology coding questions so that you can learn the concepts and apply in your practice. Learn the best practices: urology coding, revenue cycle management, scheduling, collections, patient information collection, pre-authorization, prior approval, charge capture, office communications, claim entry review, appeals, audits and billing, that we have tested and proven so you can adapt and incorporate.

Information

  • Creator
    Mark Painter, Scott Painter and Dr. Ray Painter
  • Years Active
    2020 - 2026
  • Episodes
    284
  • Rating
    Clean
  • Copyright
    © 2026 Urology Coding and Reimbursement Podcast
  • Show Website
    Urology Coding and Reimbursement Podcast

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