PRSnetwork

🎙️ New Podcast Episode: UCR 291 – C9761 Update, Intraoperative Consults, and Office-Based Procedure Challenges

CMS continues to refine reimbursement policies impacting urology providers. In this episode, Scott, Mark, and Dr. Ray Painter discuss recent developments surrounding C9761, including CMS’s decision to revise the code description and establish a new HCPCS code for suction-enabled ureteral access sheaths.

The conversation covers:
• Potential implications for ASCs, HOPDs, and physicians performing stone management procedures
• Appropriate billing of intraoperative consultations versus procedures
• Common payer denials related to office-based procedures and place-of-service restrictions
• Documentation and compliance considerations that can affect reimbursement outcomes

As coding and payment policies evolve, healthcare organizations must stay informed to ensure accurate billing, optimize reimbursement, and reduce denial risk.

🎧 Listen to the episode here: https://www.prsnetwork.com/291

🎙️ New Episode Available: UCR 291 – C9761 Update, Intraoperative Consults, and Office-Based Procedure Challenges

In this episode, Scott, Mark, and Dr. Ray Painter break down important updates to the evolving C9761 reimbursement landscape, including CMS’s decision to revise the code description and create a new HCPCS code for suction-enabled ureteral access sheaths.

They also discuss:
✅ What these changes may mean for ASCs, HOPDs, and physicians involved in stone management
✅ Billing intraoperative consultations vs. procedures
✅ Payer denials tied to place-of-service restrictions for office-based procedures
✅ Documentation, reimbursement, and compliance considerations

As coding and payment policies continue to evolve, understanding reimbursement rules and site-of-service limitations is more important than ever.

🎧 Listen now: https://www.prsnetwork.com/291

🎙️ New Episode: UCR 283 – Saturation Biopsy Confusion and Cystoscopy Risk—Where Interpretation Matters

🎧 Listen here: https://www.prsnetwork.com/283

Accurate coding often comes down to interpretation, and this episode addresses two areas generating significant discussion among coding professionals and providers.

Scott, Mark, and Dr. Ray Painter examine:

• What distinguishes a stereotactic template-guided saturation biopsy (CPT® 55706) from standard transperineal biopsy techniques
• The importance of 3D templating and comprehensive gland sampling when evaluating saturation biopsy criteria
• Why payer expectations may differ from physician documentation and clinical interpretation
• Whether diagnostic cystoscopy qualifies as moderate risk within E/M coding guidelines

The conversation also revisits the E/M risk table and provides practical insights into navigating areas where coding guidance is less explicit.

As coding and reimbursement requirements continue to evolve, successfully balancing guideline interpretation with payer expectations remains essential for both compliance and financial performance.

Listen to the episode and join the conversation.

UCR 283 Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

💡Urology Coding Insight!
A PRS Network client asked: Can you bill both 50783 LT and 50780.51 RT when performing a tapered ureteral reimplant on one side and a standard on the other? 🤔
The key issue: Does using LT/RT modifiers solve the bundling conflict, or is 50783 considered inclusive of 50780 regardless of laterality?

Tune into Episode 186 (10:48) to hear our coding experts break this down! 🎧
https://www.prsnetwork.com/186

UCR 186: FAQs Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

❓ Coding Question Spotlight from Episode 184 (12:34)
"Does CPT 52281 apply when a cystoscope is passed to dilate a urethral or meatal narrowing, or is it reserved only for procedures involving an actual incision (like meatotomy or DVIU)?"
🎧 Tune in to our latest podcast episode to hear the full discussion and clarify when it's appropriate to use 52281. https://www.prsnetwork.com/184

UCR 184: FAQs - Clarification of split shared visit, and cystoscopy Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

🔍 Coding Clarity Alert!
Can you bill 52001 for cysto and clot evacuation when using a syringe under local anesthesia? Or is it more appropriate to use 52000 + 51700? 🤔
We broke it down in Episode 184 at 10:06 of the PRS Podcast!
🎧 Tune in to avoid miscoding and ensure accurate reimbursement.
https://www.prsnetwork.com/184

UCR 184: FAQs - Clarification of split shared visit, and cystoscopy Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

💡 Split/Shared Visits & Real-Time Documentation
In Episode 184 (3:23), we address a key Medicare compliance question: Does a physician need to document their portion of the MDM during the APP’s visit to bill under their NPI? The answer may surprise you! Tune in to learn why real-time involvement matters and how to protect your practice’s billing integrity.
🎧 Listen now: https://www.prsnetwork.com/184

UCR 184: FAQs - Clarification of split shared visit, and cystoscopy Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

👨‍⚕️👩‍⚕️ Billing Alert for Hospitals!
Can physicians bill for procedures performed by PAs in the hospital setting? 🤔
This came up on Episode 182 at 3:18 — and it’s a key compliance point you’ll want to understand.
🎙️ Listen in for the full breakdown and stay compliant! https://prsnetwork.com/182

UCR 182: Clarifying Split or Shared Visits Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

🎧 Listen now: https://www.prsnetwork.com/282

🎙️ Podcast 282: Playing the Surgical Lottery – Medicare Advantage and Out-of-Network Strategy
📅 March 27, 2026

In this episode, Scott, Mark, and Dr. John Lin unpack the realities of working with Medicare Advantage (Part C) plans. From out-of-network challenges to unpredictable reimbursement—what they call a “surgical lottery”—they explore how providers can navigate an increasingly complex landscape.

Prompted by a real-world case involving UnitedHealthcare narrowing its network, the discussion covers:
• Out-of-network billing strategies
• Patient financial responsibility
• Contract pitfalls and risks
• The uncertainty of payment outcomes

💡 Bottom line: Know your numbers. Know your leverage. Be intentional about the payers you work with.

UCR 282 Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.

👩‍⚕️👨‍⚕️ Billing via Supervisory Role – What’s Allowed?
Can a physician bill if they only supervise and discuss the case with a PA without seeing the patient in person? 🤔
We break it down in Episode 182 (3:18) of the PRS Network podcast!
🎧 Tune in to learn the compliance rules and how to avoid billing pitfalls. https://www.prsnetwork.com/182

UCR 182: Clarifying Split or Shared Visits Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to 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.