Urology Medical Billing - An Ultimate Guide

Urology Medical Billing

The situation gets much more complicated when it comes to Urology Billing. Medical billing is a highly complex field that demands experience-based knowledge and skills to deal with insurance companies. Only a company with well-trained Urology Billing personnel can handle such complexity. The medical billing professional must be familiar with the Urology Billing and coding guidelines.

What is Urology Medical Billing?

Urology Billing is the mechanism through which clinicians bill insurance companies for services delivered to patients. Medical billing and coding specialists provide predefined codes for various procedures. That paves the road to restructuring the overall process of Urology Billing specific treatments to accomplish this formality.

On-time billing, prompt follow-up, and account reimbursement all affect the revenue generated by your Urology services. Contracting a quality medical billing services organization is one of the most critical decisions medical service providers ever make. So, to understand the business aspect of Urology Billing services.

Urology CPT coding for Surgeries

CPT codes of Urology have been categorized based on the organs like Bladder, Kidney, Urethra, and Male and Female genital organs.

Code Range: 50010-58294

The following are some of the most commonly used integrated CPT Codes in Urology Billing.

51700: 51700 CPT Code (Bladder irrigation, lavage, simple, or instillation) can use to report irrigation with therapeutic agents or as an independent restorative procedure. For instance, bladder irrigation is part of a more extensive service, such as gaining access to or seeing the urinary system. Then it is not independently reportable. 

The worldwide surgical package includes irrigation of a urinary catheter. Albeit, 51700 CPT code shall not be misused to report urinary catheter irrigation.

52310: These CPT codes (52310 and 52315) has used for removing an indwelling ureteral stent via cystoscopy. In this process, the stent (CPT Code 52310) has visualized and subsequently gripped with a grasping tool to remove it. The procedure can carry out in a doctor’s office, an ambulatory surgical center, or a hospital.

51701-51703: A urinary bladder catheter placement is part of the overall surgical procedure. Urinary bladder catheterization (CPT Codes 51701, 51702, and 51703) is not separately reportable with a surgical procedure. 

52356: CPT Code 52356 (Cystourethroscopy, Ureteroscopy, or Pyeloscopy; with Lithotripsy including insertion of indwelling ureteral stent (e.g., Gibbons or double-J type). However, it includes the performance of Lithotripsy and the insertion of the indwelling stent on the same side.

Types of Surgeries in Medical Billing Urology 

ICD-10 CODE (Urology Coding Guidelines)

ICD-10 codes have primarily utilized in compliance with the LCD guidelines to minimize insurance denials. Following ICD- 10 codes used by the coders while coding for Urology surgeries is as below.

Understanding Structure of Urology Medical Billing and Codes

Keep in mind that Urology Billing codes vary depending on the procedure performed on the patient.

The code for treating the patient’s proper Kidney repair, for example, would be 0TQ00ZZ.

Once again, ‘0T’ classifies the code as a surgical procedure for the urinary system. The ‘Q’ entitles the root operation as a repair.

The ‘0’ indicates that the right Kidney is undergoing therapy or repair. The next ‘0’ means that the operation is open-ended. The ‘Z’ indicates that the healing technique is an open one. And there are no other qualifiers for this procedure.

The information is transferred to a billing form and given to the insurance company when entered the procedure codes. The insurance payer then transforms the code to determine how much of the procedure is covered by the particular patient’s insurance plan.

The insurance company will then reimburse the Urology practitioner or facility for its designated amount. And the patient will bill for any remaining balance. Patients hardly, if ever, see the particular billing code assigned to them for any procedures. Overall, this is for internal usage and documentation mainly.

Urology coding for the procedure can be problematic for those who do not know the specific codes for precise procedures. It’s easy to identify the process if you know the pattern and the codes, making billing even easier.

Urology Medical Billing - Neo MD
Urology Medical Billing – Neo MD

Key Steps in Urology Medical Billing

Prior Authorization: 

As Urology treatments are expensive, the practitioner must first acquire prior authorization from the insurance company. Prior Authorizations assist the organization in better understanding the filing rules, timely submission of claims, and reimbursements rather than denials.

Medical Necessity:

To be able to charge effectively for the costly services clinicians provide. The service provider’s medical billing for Urology must be able to demonstrate the medical necessity of the course of treatment.

Eligibility & Benefits denials:

Verifying patient eligibility and coverage for a particular service at least 48 hours before the appointment can help reduce denials.

Invalid/ Missing CLIA number:

The practitioner must update the CLIA number while billing for the Lab test.

CLIA:(Clinical Laboratory improvement Amendment)

Non-Covered: 

Medicare will not pay for A Codes like A4331, A4334, A4340, A4357, A5114, etc., and denied as Non-Covered Services. Although, some secondary insurance plans will cover Medicare’s non-covered services.

Coding for Maximum benefits:

CPT codes for particular CPTs should encode with the correct units as authorized by the payer. For example, if we charge for more than one unit, payors will refuse CPT codes 51700, 52300, 52310, and 77263.

Medical Record Documentation in Billing CPT’s 51701-51703.

Codes Providers should not report 51701-51703 in addition to any other procedure that includes catheter insertion as a component. 

Modifier 59: 

When billing for two Urology services simultaneously, the providers must utilize 59 modifier.

LCD Guidelines: (Local Coverage Determination)

Before billing Urology services, Providers should follow LCD guidelines.

How NEO MD works?

NEO MD is well-versed in the nuances of Urology Billing. Whether you’re billing Medicare for a non-screening PSA (prostate Specific Antigen Test) or advanced prostate cancer immunotherapy or just working on structuring your out-of-network charges, NEO MD is there. For more than10 years, NEO MD has been working hand in hand with urologists nationwide. Our professionals maximize reimbursement, reduce costs and streamline practice operations. NEO MD will work to identify problem areas and ensure the correct use of modifiers. Furthermore, we will educate your practice on best-in-class billing practices and procedures.

For more details and queries, you can contact us at (info@neomdinc.com) or (929) 502-3636).

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