The Complete Guide To Urology Medical Billing

by | Jul 15, 2022 | Medical Billing

Urology billing is the process through which practitioners submit claims to insurance companies for services rendered to patients. The medical billing and coding professionals predefined codes for various treatments. To achieve this formality, the whole procedure of Urology Billing individual treatments has to undergo restructuring.

Account reimbursement, rapid follow-up, and timely invoicing affect the income earned through your Urology services. One of the most important decisions a medical service provider can make is to hire a good medical billing company to comprehend the commercial element of Urology Billing services.

Let us deep dive into this guide to urology medical billing.

Types of Surgeries in Medical Billing Urology 

A few of the most renowned types of surgeries under medical billing urology include:

  • Endoscopy (Urethroscopy, Cystourethroscopy, Cystoscopy, etc.)
  • Laparoscopy
  • Transplantation
  • Catheter introduction
  • Incisional/Biopsy
  • Excision
  • Repairs

The Changes in Urology Medical Billing Procedures?

Urology billing and coding is pretty comparable to other medical billing and coding. The urinary-related treatments billing codes begin with ‘0T’ and continue depending on the type of procedure conducted, according to the Medical and Surgery category.

For example, if the treatment involves inserting an artificial sphincter into the patient’s urethra to aid with incontinence, 0THD0LZ will be the ideal billing code.

The ‘0T’ indicates that this is a urinary system surgical operation. The ‘H’ indicates that the primary procedure is a Urology medical billing insertion. The letter ‘D’ represents the portion of the body where the ultimate procedure will take place; in this example, the urethra. The ‘0’ indicates that the method is approached in an open manner.

When a patient is open to undertaking specific treatments, it is called an open approach. The ‘L’ indicates that the equipment being injected is an artificial sphincter, whereas the ‘Z’ indicates that the treatment has no extra qualifiers.

Understanding the Urology Medical Billing and Coding Structure

Keep in mind that urology billing codes vary depending on the operation performed on the patient.

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

‘0T’ again places the code in the category of urinary system surgical procedures. The ‘Q’ denotes a repair for the root operation.

The ‘0’ indicates that the right kidney is undergoing therapy or repair. The next ‘0’ indicates that the operation is open-ended. The ‘Z’ indicates that the healing technique is open and that there are no further criteria for this therapy.

Following the entry of the procedure codes, the information is transferred to a billing form and delivered to the insurance company. The insurance payer then transforms the code to determine how much of the procedure is covered by the patient’s specific insurance plan.

The insurance company will then repay the urology practitioner or facility for its allocated amount, and the patient will be billed for any leftover balance. Also, patients seldom, if ever, see the particular billing code allocated to them for any operations. Overall, this is for internal usage and documentation only.

For individuals who are unfamiliar with the various codes for certain procedures, urology billing and coding might be difficult. Moreover, you can identify the performed procedure if you know the pattern and the codes, which makes billing even easier. Finally, keep in mind that the correctness of your codes and paperwork is critical to receive full reimbursement.

Urology Medical Billing: Key Steps

Prior Authorization:

Because urology treatments are costly, the doctor must first obtain prior approval from the insurance provider. Prior Authorizations help the organization comprehend the filing procedures, submit claims on time, and receive reimbursements instead of denials.

Medical Necessity: 

To charge appropriately for the high-cost services as per the physicians, medical billing for Urology must show the medical importance of the course of therapy.

Denials due to eligibility and benefits: 

Verifying a patient’s eligibility and coverage for a specific service at least 48 hours before the appointment will decrease denials.

Invalid or missing CLIA number: 

While invoicing for the Lab test, the practitioner must update the CLIA number. CLIA stands for Clinical Laboratory Improvement Amendments (Clinical Laboratory improvement Amendment)

Not Covered

Medicare will not pay for A Codes such as A5114, A4357, A4340, A4334, A4331, and others, and they will be denied as Non-Covered Services. Some supplemental insurance policies, on the other hand, will cover Medicare’s non-covered treatments.

CPT codes for certain CPTs should be encoded with the right units as approved by the payer. Payors will deny CPT codes 77263, 52310, 52300, and 51700 if we bill for more than one unit.

CPT 51701-51703 Medical Record Documentation in Billing:

Providers should not report 51701-51703 in conjunction with any other operation that requires catheter insertion.

Modifier 59: 

When invoicing for two Urology services at the same time, the providers must use the 59 modifier.

LCD (Local Coverage Determination) Recommendations:

Providers should follow LCD rules before charging for Urology services.

Best coding and billing practices for urology

Urology coders are difficult to find and expensive to hire, and their continued training might be pricey. Our urology coders have received the necessary training and have CPC certification, and they can handle several operation reports each day. We cover the most difficult component of the CPT codes in our Urology specialty coding service, and our coders can handle all diagnostic, modifier, and procedural coding issues. 

At every level of the billing and coding process, we assure HIPAA compliance. To avoid rejections, our team undertakes prior authorization of the patient’s eligibility and benefits. Contact Medical Healthcare Solutions for more information.

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