Urology uses specific codes for diagnoses and treatments, and these codes can be intricate compared to other specialties. Urology intersects with other medical fields like oncology, gastroenterology, and endocrinology, making accurate coding more challenging. Specialists with expertise in urological coding assign the correct codes to procedures and diagnoses.Urology billing services aim to make the billing process smoother for urology practices, allowing them to focus on patient care.

Billing Care Solutions Services

Medical Billing & Coding:

Billing Care Solutions employs certified coders with in-depth knowledge of urological procedures and diagnoses (CPT and ICD-10 codes). This ensures accurate code selection based on medical documentation. Regular internal audits and reviews identify coding errors before claim submission, minimizing denials and maximizing reimbursements. Billing Care Solutions stays updated on the latest urology coding guidelines published by the American Urological Association (AUA) to ensure claims adhere to these specific requirements.

Revenue Cycle Management (RCM):

Utilizing sophisticated software, Billing Care Solutions verifies patient insurance eligibility, benefits, and authorization before claim submission. This reduces claim denials due to errors. A dedicated team analyzes denied claims to identify root causes and work with payers for resolution, ensuring you receive rightful reimbursements. Billing Care Solutions provides real-time data on key revenue cycle metrics, allowing you to track coding accuracy and identify potential areas for improvement.

Account Receivable Management:

Billing Care Solutions team specialists focuses on collecting outstanding patient balances, improving cash flow for your urology practice. Billing Care Solutions automate billing and take timely follow-up through various channels (phone, email, etc.) ensure patients receive their statements promptly and resolve outstanding balances efficiently. Integration with online payment portals allows patients to conveniently pay their bills online, speeding up collections.

Provider Enrollment & Credentialing:

Billing Care Solutions assists in the complex process of provider enrollment and credentialing with various insurance companies, ensuring timely participation in insurance networks. Billing Care Solutions manage credentialing renewals and updates to avoid disruptions in patient care and billing processes.

Eligibility & Benefit Verification:

Billing Care Solutions utilizes integration with insurance databases to verify patient eligibility and benefits in real-time, eliminating the need for manual verification that can lead to errors. Billing Care Solutions assist with obtaining prior authorizations from insurance companies for specific procedures, reducing delays in treatment and billing complications.

Authorization Referral Services:

Billing Care Solutions provides a dedicated team to handle prior authorization requests, ensuring accurate completion and timely approval by insurance companies. Billing Care Solutions proactively reach out to insurance companies for clarification or additional information, minimizing delays in authorization and streamlining the billing process.

Business Intelligence & Reporting Services:

Billing Care Solutions reports are customized to track key urology-specific metrics like coding accuracy by procedure type, payer mix, and denial trends. This allows you to identify areas for improvement and optimize coding practices. Billing Care Solutions data analysts interpret reports and provide actionable insights to improve coding accuracy, optimize revenue cycle performance, and identify opportunities to increase reimbursements.

Patient Support:

Billing Care Solutions offers patient education materials and resources to explain billing procedures and answer patient questions about their bills. This reduces frustration and improves patient satisfaction. Billing Care Solutions dedicated team of patient billing representatives can answer patient billing inquiries and assist them with understanding their statements and resolving issues efficiently.

Coding System

Current Procedural Terminology (CPT) codes:

These codes represent the specific medical procedures performed by the urologist. The CPT code range for urologic surgeries is typically 50010 – 58999. This range covers a wide variety of procedures, including:

• Cystoscopy (examining the bladder)
• Ureteroscopy (examining the ureters)
• Prostate biopsy
• Vasectomy
• Kidney stone removal
• And many other urologic procedures

International Classification of Diseases, Tenth Revision (ICD-10) codes:

These codes represent the diagnoses a patient has. ICD-10 codes for urology typically fall within the N00-N99 range, which encompasses diseases of the genitourinary system. Some examples include:

• N30.1 – Urinary tract infection
• N20.0 – Benign prostatic hyperplasia (enlarged prostate)
• N32 – Kidney stones
• N42 – Incontinence

Modifiers

Modifier 51:

This indicates multiple procedures performed during the same endoscopic session that aren’t included in a more comprehensive code. For instance, a renal endoscopy with biopsy, fulguration, and stone removal would use this modifier.

Modifier 59:

This signifies two distinct procedures performed on the same day, each requiring separate justification. In urology, it might be used for a cystoscopy (bladder exam) and a separate procedure like a prostate biopsy.

Modifier 25:

This indicates a significant, separate evaluation and management service by the same physician on the same day as a procedure. This might be used if a patient has a complex urological issue requiring a lengthy pre-operative evaluation beyond the typical pre-op workup included in the procedure code.

KX Modifier:

It specifies urological supplies and signifies that the statutory and regulatory requirements for coverage have been met. It’s mandatory for claims involving catheters, external collection devices, or other urological supplies. (Note: There are variations of the KX modifier depending on the specific supply type).

GY Modifier:

This indicates that urological supplies were furnished even though the statutory criteria for coverage weren’t met. Claims with this modifier will likely be denied by insurance.

57 Modifier (limited use):

Traditionally used for E/M services on the same day as surgery. However, Medicare has restricted its use. It might still be applicable in some situations depending on the payer and procedure.

In conclusion, utilize these services from Billing Care Solutions, urology practices can significantly improve coding accuracy and optimize revenue cycle performance. The combination of experienced coders, robust RCM processes, and data-driven insights provides a comprehensive solution for navigating the complexities of urology billing.

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