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. 3d ago

    UCR 309: Quantitative Urinalysis Medical Necessity and Modifier 58 for Planned Stent Removal

    October 23, 2026 In this episode, Scott, Mark, and Dr. Ray Painter take on two questions that came in over the past week. First, quantitative urinalysis: the expanded, stack-coded urine test panels that some practices are starting to use in place of a standard UA. Mark explains why that pattern looks a lot like the early days of PCR testing, why payers are already issuing diagnosis-based medical necessity denials, and why every practice should write protocols for when a quantitative UA is ordered instead of a standard UA—with documentation that supports the reason for the test on that patient. The team also clarifies that meeting a payer's criteria means accurately documenting the patient's actual condition, never adjusting a diagnosis to get paid. Second, modifier 58 on a stent removal: Mark walks through the global surgery package and the three circumstances modifier 58 covers, and explains why a cystoscopic stent removal that was planned at the time of the original stone procedure is a staged procedure that can be reported with modifier 58 on the second procedure—as long as the plan is documented in the pre-operative or operative note. The key takeaway: written protocols, clear communication with the billing team, and documentation that supports medical necessity are what hold up when the payer reviews the record. PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration 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/

  2. Oct 16

    UCR 308: Hot Topics from the UPTP — XIAFLEX Costs, PAE Audits, UA Denials, Biosimilars, and Payer AI

    October 16, 2026 In this episode, Scott, Mark, and Dr. Ray Painter share what they heard at the October meeting of the Urology Pharma and Tech Pioneer (UPTP) group—a monthly forum where urology practices from around the country compare notes on new technology, payer behavior, and office workflows. They discuss XIAFLEX acquisition costs now running above ASP plus six and how practices are moving away from buy-and-bill toward specialty pharmacy or other acquisition options, with a reminder that some states, such as New Jersey, restrict in-office dispensing. They review payer-specific payment problems with INLEXZO and ZUSDURI, early Medicare claim sampling, UPIC and RAC record requests, and Anthem prior authorization questions around prostatic artery embolization, and denials for PCR, quantitative urinalysis, and routine dipstick UA. The conversation also covers Altaviva, eCoin, biosimilars, appeal turnaround times of 90 to 120 days, and payers' growing use of AI in claims processing. The key takeaway: documentation and communication—inside the practice and across the urology community—are the foundation for getting paid in an environment that is changing MAC by MAC and payer by payer. 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 PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration 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/

  3. Oct 9

    UCR 307: Billing for Injections and Instillations — NDCs, Biosimilars, Compounded Drugs, and What to Do After a Second Denial

    October 9, 2026 In this episode, Scott, Mark, and Dr. Ray Painter tackle two areas where the details payers are watching can make or break payment. First, they look at why billing for injected and instilled drugs has become more complex: biosimilars that carry their own Q codes and NDCs, compounded drugs such as interferon being used during the BCG shortage, and rising acquisition costs that Medicare's ASP-based payment has not caught up with. Mark explains why the code and NDC on the claim must match the exact drug given, why most MAC policies call for an unlisted code for compounded drugs with pharmacy labeling and invoices as backup, and why practices should confirm coverage and pricing before the drug is administered. The team then turns to double denials—what to do when a correctly coded claim is denied again after the documentation has been reviewed. Using same-day stone cases as examples, they discuss adding a cover letter that explains medical necessity and context at the second-level appeal, when peer review or an ALJ appeal may be worth pursuing, and how to allocate limited resources as denials and audits continue to escalate. The key takeaway: build the internal team and processes to get the drug details right up front, and stay persistent on appeals when the documentation supports the work that was performed. PRS Coding and Reimbursement Hub Access the Hub PRS Urology Coding and Reimbursement Seminar Information and Registration 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/

  4. Sep 25

    UCR 306: Prostate Biopsy Coding in 2026 — Approach, Fusion, Targeting, and Documentation

    September 25, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the 2026 prostate biopsy coding changes and the documentation details that determine which code should be used. They review transrectal versus transperineal approaches, ultrasound-guided versus MRI-fusion biopsies, systematic versus targeted sampling, and when the add-on code for additional targeted lesions may apply. The team also discusses diagnosis coding, current denial trends, the risks of separately billing imaging guidance that is already built into the biopsy codes, and considerations for performing transperineal biopsies in the office. The key takeaway: prostate biopsy coding now depends heavily on approach, imaging method, targeting, and precise documentation—so getting the details right is essential for compliant reimbursement.  PRS Coding and Reimbursement Hub Access the Hub   PRS Urology Coding and Reimbursement Seminar   Information and Registration  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/

  5. Sep 18

    UCR 305: RAC Audits, UPIC Reviews, and Denials — How to Get Paid and Keep the Money

    September 11, 2026  In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose take a closer look at the growing number of RAC audits, UPIC reviews, and medical record requests facing urology practices. They discuss current areas of scrutiny, including sacral neuromodulation, UTI PCR testing, newer technologies, and high-dollar procedures, while emphasizing the importance of meeting LCD, LCA, and payer documentation requirements before the claim ever goes out. The team also walks through how to respond when an audit arrives, including timelines, record selection, internal checklists, appeal strategy, and when legal or clinical support may be necessary. The key takeaway: getting paid is only half the battle—strong documentation, organized workflows, and a disciplined audit response process are essential to keeping the money you have already earned.  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/

  6. Sep 11

    UCR 304: Prior Authorization Codes, Billing for DME Supplies, and Can You Trust AI?

    September 11, 2026  In this episode, Scott and Mark Painter are joined by Dr. John Lin to tackle several practical coding and reimbursement questions from the urology community. They discuss whether there is a right number of CPT codes to include on a prior authorization, when catheter and other DME supply A-codes can—or cannot—be separately billed, and how those rules apply to Foley catheter changes and BCG instillations. The conversation also explores the growing use of AI for coding research and why an answer that sounds authoritative may still be wrong. The key takeaway: use AI as a tool, but understand the fundamentals, ask the right follow-up questions, and always verify important coding answers against primary sources.  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/

  7. Sep 4

    UCR 303: Downcoding Is Surging — Is the Appeal Worth the Effort?

    September 4, 2026 In this episode, Scott, Mark, Dr. Ray Painter, and special guest Marinne DeSciose take a deeper look at the sharp increase in payer downcoding and the growing workload it creates for urology practices. They discuss how downcoded E/M claims can quietly reduce revenue, why these adjustments may not show up clearly in traditional AR reports, and how practices can build workflows to identify, review, and appeal them efficiently. The team also explores when the return on investment justifies the additional staff time, how provider documentation and audit performance should influence the appeal process, and why practices need ongoing monitoring even after a payer appears to stop downcoding. The key takeaway: downcoding is becoming a significant revenue-cycle issue, and practices need a deliberate strategy to decide when to fight, when to change workflows, and when a payer relationship may no longer be worth the effort.  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/

  8. Aug 28

    UCR 302: Telehealth in 2026 — Current Rules, 2027 Proposals, and the Future of Urology Care

    August 28, 2026 In this episode, Scott, Mark, and Dr. Ray Painter review where telehealth stands today and why it is becoming an essential part of the future of urology care. They discuss Medicare’s current rules for audio-visual and audio-only visits through 2027, documentation requirements, place-of-service rules, telehealth for hospitalized patients, and the importance of state licensure. The team also looks ahead to Medicare’s proposed 2027 group medical visit model and explores how telehealth can improve access, increase efficiency, support remote monitoring, and become a true line of business within a urology practice. The key takeaway: telehealth is no longer just a temporary convenience—it is becoming a foundational part of how practices will deliver 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/

See All (308)

Ratings & Reviews

4.8
out of 5
15 Ratings

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
    308
  • Rating
    Clean
  • Copyright
    © 2026 Urology Coding and Reimbursement Podcast
  • Show Website
    Urology Coding and Reimbursement Podcast

You Might Also Like