Urology billing includes invoicing for the treatment rendered for problems with the male reproductive system and urinary system. Are you struggling with Urology billing and coding? The very nature of the process which includes complicated codes and terminologies makes billing for urology difficult compared to other specialties. Thus, medical billing for urology refers to the process used by healthcare professionals to submit claims to insurance companies for treatment provided to patients.
It takes a urology billing specialist to handle the subtleties of urology billing and coding, which calls for specialized skills and knowledge. Urology is distinct and difficult to comprehend because of its tendency to collide with other specialties like oncology, gastroenterology, andrology, pediatrics, endocrinology, and gynecology. Here are some urology billing guidelines to help you maneuver through the process.
Urology CPT Codes and Types of Surgeries
In order to understand the billing guidelines for urology billing, here’s a quick look at top CPT codes and surgeries that are covered.
Organ-based CPT codes include those for the kidneys, ureters, bladders, urethras, and male and female genitalia. The range of codes used are 50010 through 58294.
The types of surgeries billed for Urology include – Incision/Biopsy; Excision; Transplantation; Catheter Introduction; Laparoscopy; Endoscopy (Cystoscopy, Urethroscopy, Cystourethroscopy, etc.); Repairs; Transplantation.
Best Guidelines in Urology Medical Billing
- Prior Permission – Due to the high expense of urology operations, the practitioner must first acquire prior approval from the insurance carrier. Prior authorizations assist the practice in better comprehending the submission requirements, timely submission of claims, and receipt of reimbursements.
- Medical Requirement – To be able to charge appropriately for the extremely expensive treatments they deliver, the urology service provider needs to be able to demonstrate the medical necessity of the course of treatment.
- Denials – Denials can be minimised by confirming a patient’s eligibility & benefits at least 48 hours beforehand.
- CLIA number – (Clinical Laboratory Improvement Amendments). While invoicing for the lab test, the CLIA number should be updated.
- Services covered and not covered – Non-covered Medicare will reject A Codes like A4357, A4334, A5114, A4340, A4331, etc. as Non-Covered Services, and will not pay for them. However, some supplemental insurance will cover the costs of therapies not covered by Medicare.
- Maximum Benefit Coding – As permitted by the specific payers for the particular CPTs, CPT codes must be coded with the appropriate units.
- Billing CPTs 51701–51703 – Codes In addition to any other treatment that has catheter insertion as a component, providers shouldn’t record 51701-51703.
- Modifier inclusion – When charging for two urological services at once, providers are required to use modifier 59.
- LCD rules – Before charging for urology services, providers should adhere to LCD rules.
Role of Accurate Billing Process in Urology Practice
1. Credentialing – To gain network status, an experienced medical billing practice for urology contacts the carriers of your choice.
2. Advice on Carrier Contracts – There may occasionally be hazards to watch out for in contracts and surroundings that may lead you to select non-network status with difficult carriers. You can have the additional knowledge to provide assistance as needed if you have experience with medical billing for urology practices.
3. Fee Schedule Analysis – This helps find the right change levels. Experts in urology medical billing can enter the necessary sums from the acquired network contracts to monitor any erroneous reimbursements.
4. Coding Knowledge: A qualified staff member to “abstract” codes from documentation or to check your coding is beneficial. Compliance and audit will also provide you with more options for revenue.
Urology Expertise at Info Hub Consultancy Services (ICS)
For those who are unfamiliar with the precise codes for particular procedures, urology billing and coding might be challenging. It is easier to identify the treatment being performed if you are familiar with the pattern and the codes, thereby streamlining the urology billing process. Remember that accuracy in your codes and paperwork is the key to success if you want to be properly reimbursed.
It can be difficult to locate qualified urology billers and coders, expensive to hire them, and difficult to keep them trained. At Info Hub Consultancy Services, our team consists of CPC-certified urology coders with extensive training who can process 25–30 operation reports each day.
We cover the most challenging CPT code material in our urology specialty coding service, and we teach our coders how to deal with all procedural, modifier, and diagnostic coding issues. At every step of the billing and coding process, we guarantee HIPAA compliance. To prevent denials, our team undertakes prior authorization of the patient’s eligibility & benefits. ICS is one of the best offshore medical billing companies that can help boost your revenue.