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. 3 DAYS AGO

    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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 21 FEB

    UCR 277: The New Economics of In-Office Prostate Biopsies

    February 20, 2026  In this episode, Scott, Mark, and Dr. Ray Painter break down the financial realities of the new prostate biopsy CPT codes and what they mean for urology practices. Moving beyond coding mechanics, the discussion focuses on the economic differences between transrectal and transperineal approaches, MRI fusion versus ultrasound guidance, targeted lesion add-on payments, and the site-of-service differential between office and facility settings. They explore how practice expense values, capital equipment costs, disposable supplies, physician time, and block scheduling all factor into the decision to bring advanced biopsy techniques in-house. The episode emphasizes balancing clinical judgment with financial sustainability—helping practices evaluate whether expanding in-office prostate biopsy services makes sense now and in the future.  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/

    34 min

  7. 13 FEB

    UCR 276: Live from New Orleans – Modifier 25, Cystoscopy Denials, and How to Win the Appeal

    February 13, 2026  In this special live episode recorded at the Urology Advanced Coding and Reimbursement Seminar in New Orleans on January 31st, 2026, Scott, Mark, Dr. John Lin, and Marianne DeSciose dive into one of the most contentious coding battles in urology: billing E/M services with cystoscopy on the same day. Prompted by a real-world question from the Thriving Urology Practice Facebook Group, the panel explores when modifier 25 is appropriate, why denials happen, and how to build documentation and appeal strategies that get results. With input from attendees, the episode brings practical insights from the front lines of coding, billing, and payer negotiations.  PRS Coding and Reimbursement Hub Access the Hub Free Kidney Stone Coding Calculator 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/

    38 min

  8. 5 FEB

    UCR 275: Telehealth Extended Through 2027, Proper Instillation Coding, and Medically Impossible Days

    February 5, 2026  In this episode, Scott, Mark, and Dr. John Lin break down the latest telehealth news—Congress has officially extended Medicare telehealth coverage through the end of 2027, offering long-term stability for practices. They also answer a listener's question about billing 52235 and 51720 together, covering when a modifier can be used and how to document instillation in the recovery room properly. The episode wraps with a cautionary tale about “medically impossible days,” where excessive use of time-based coding and level 5 visits can trigger audits and serious compliance risk. Stay informed, stay compliant, and keep calm—telehealth on.  PRS Coding and Reimbursement Hub Access the Hub Free Kidney Stone Coding Calculator Download Now PRS Coding Courses For Urologist For APPs For Coders, Billers, and Admins PRS Billing and Other Services - Book a Call with Mark Painter or  Marianne Desciose Click Here to Get More Information and Request a Quote   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/

    37 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
    281
  • Rating
    Clean
  • Copyright
    © 2026 Urology Coding and Reimbursement Podcast
  • Show Website
    Urology Coding and Reimbursement Podcast

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