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

UCR 287: Stent Removal & Replacement Codes and Bladder Cancer Maintenance ICD-10 Codes

May 1, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down key differences between ureteral stent removal and replacement codes—50385, 50387, and 50688—highlighting how anatomy, access (internal vs. external), and the requirement for radiologic supervision drive proper code selection. They also tackle a growing issue with ICD-10 coding for bladder cancer, where the correct use of “history of” codes during BCG maintenance therapy is leading to unexpected payer denials. The discussion explores when to follow strict coding guidelines versus when payer-specific rules may require strategic adjustments. The takeaway: understanding both the technical details of coding and the realities of payer behavior is essential to avoiding denials and protecting revenue.  PRS Coding and Reimbursement Hub Access the Hub [https://www.prsnetwork.com/urologyhub] Botox LCD Alert Download the Alert [https://prs.mykajabi.com/resource_redirect/downloads/file-uploads/sites/87385/themes/2165170340/downloads/eed805-b468-e746-8bc-06d8c676416_PRSAlert_Botulinum_Toxin_Injections_Bladder_2-24-26_Final_1.docx] Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now [https://www.prsnetwork.com/prscm-uccare] PRS Coding Courses For Urologist [https://partner.prsnetwork.com/drchallenge-urology] For APPs [https://partner.prsnetwork.com/dcr-app-course] For Coders, Billers, and Admins [https://join.prsnetwork.com/dcb-urology-certification-info]   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 [https://www.prsnetwork.com/joinuptp] http://aua.codingtoday.com/try Click Here to Start Your Free Trial of AUACodingToday.com [http://aua.codingtoday.com/try]    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/ [https://www.facebook.com/groups/ThrivingPractice/]

UCR 286: C9761 Clarified – What Actually Qualifies and What’s at Risk

April 24, 2026 In this episode, Scott, Mark, and Dr. Ray Painter break down the latest guidance on HCPCS code C9761 and the growing confusion around what qualifies for payment under this new technology APC. They walk through key interpretations from the AHA, AMA, and MACs, highlighting the critical distinction between steerable ureteral catheters, scopes, and access sheaths—and why that difference can determine whether a case is paid or denied. The discussion emphasizes the importance of precise physician documentation, understanding device labeling, and verifying payer-specific policies before billing. The takeaway: while new technology offers higher reimbursement potential, it also introduces real risk—making clarity, compliance, and payer alignment essential.  PRS Coding and Reimbursement Hub Access the Hub [https://www.prsnetwork.com/urologyhub] Botox LCD Alert Download the Alert [https://prs.mykajabi.com/resource_redirect/downloads/file-uploads/sites/87385/themes/2165170340/downloads/eed805-b468-e746-8bc-06d8c676416_PRSAlert_Botulinum_Toxin_Injections_Bladder_2-24-26_Final_1.docx] Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now [https://www.prsnetwork.com/prscm-uccare] PRS Coding Courses For Urologist [https://partner.prsnetwork.com/drchallenge-urology] For APPs [https://partner.prsnetwork.com/dcr-app-course] For Coders, Billers, and Admins [https://join.prsnetwork.com/dcb-urology-certification-info]   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 [https://www.prsnetwork.com/joinuptp] http://aua.codingtoday.com/try Click Here to Start Your Free Trial of AUACodingToday.com [http://aua.codingtoday.com/try]    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/ [https://www.facebook.com/groups/ThrivingPractice/]

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 [https://www.prsnetwork.com/urologyhub] Botox LCD Alert Download the Alert [https://prs.mykajabi.com/resource_redirect/downloads/file-uploads/sites/87385/themes/2165170340/downloads/eed805-b468-e746-8bc-06d8c676416_PRSAlert_Botulinum_Toxin_Injections_Bladder_2-24-26_Final_1.docx] Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now [https://www.prsnetwork.com/prscm-uccare] PRS Coding Courses For Urologist [https://partner.prsnetwork.com/drchallenge-urology] For APPs [https://partner.prsnetwork.com/dcr-app-course] For Coders, Billers, and Admins [https://join.prsnetwork.com/dcb-urology-certification-info]   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 [https://www.prsnetwork.com/joinuptp] http://aua.codingtoday.com/try Click Here to Start Your Free Trial of AUACodingToday.com [http://aua.codingtoday.com/try]    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/ [https://www.facebook.com/groups/ThrivingPractice/]

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 [https://www.prsnetwork.com/urologyhub] Botox LCD Alert Download the Alert [https://prs.mykajabi.com/resource_redirect/downloads/file-uploads/sites/87385/themes/2165170340/downloads/eed805-b468-e746-8bc-06d8c676416_PRSAlert_Botulinum_Toxin_Injections_Bladder_2-24-26_Final_1.docx] Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now [https://www.prsnetwork.com/prscm-uccare] PRS Coding Courses For Urologist [https://partner.prsnetwork.com/drchallenge-urology] For APPs [https://partner.prsnetwork.com/dcr-app-course] For Coders, Billers, and Admins [https://join.prsnetwork.com/dcb-urology-certification-info]   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 [https://www.prsnetwork.com/joinuptp] http://aua.codingtoday.com/try Click Here to Start Your Free Trial of AUACodingToday.com [http://aua.codingtoday.com/try]    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/ [https://www.facebook.com/groups/ThrivingPractice/]

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 [https://www.prsnetwork.com/urologyhub] Botox LCD Alert Download the Alert [https://prs.mykajabi.com/resource_redirect/downloads/file-uploads/sites/87385/themes/2165170340/downloads/eed805-b468-e746-8bc-06d8c676416_PRSAlert_Botulinum_Toxin_Injections_Bladder_2-24-26_Final_1.docx] Free In-Office Prostate Biopsy Calculator (Suppoted by UC-Care) Download Now [https://www.prsnetwork.com/prscm-uccare] PRS Coding Courses For Urologist [https://partner.prsnetwork.com/drchallenge-urology] For APPs [https://partner.prsnetwork.com/dcr-app-course] For Coders, Billers, and Admins [https://join.prsnetwork.com/dcb-urology-certification-info]   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 [https://www.prsnetwork.com/joinuptp] http://aua.codingtoday.com/try Click Here to Start Your Free Trial of AUACodingToday.com [http://aua.codingtoday.com/try]    The Thriving Urology Practice Facebook group. The Thriving Urology Practice Facebook Group link to join: https://www.facebook.com/groups/ThrivingPractice/ [https://www.facebook.com/groups/ThrivingPractice/]