Urology billing and coding services involve billing and coding for all diagnoses & treatments provided to correct the urinary system’s dysfunctions and the male reproductive system. Billing for urology services can be more convoluted than other specialties due to the nature of its codes & terminologies.

Urology billing and coding requires specialized expertise and knowledge, and only a urology billing specialist can handle its nuances. Urology tends to overlap with other specialties such as oncology, gastroenterology, andrology, pediatrics, endocrinology, and gynecology, making it distinctive & challenging to understand.

As Urologists focus on delivering excellent medical care, often, they lose track of their revenue cycle. Non-payment or underpayment for urology services rendered can substantially impact the practice as urology procedures are typically costly. An in-house billing team can be helpful but may cause many denials on account of the lack of expertise. Outsourcing to a focused urology billing service provider like Medical Billing Wholesalers, who is familiar with urology codes and terminologies, can offer better control over collections & denials to healthcare organizations.

CPT & ICD codes for Urology Surgeries

CPT codes are categorized based on the organs like Kidneys, Ureter, Bladder, Urethra, Male, and Female genital organs.

Code Range: 50010 – 58294

Types of Surgeries in Urology 

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

ICD-10 codes

ICD-10 codes should be used based on the LCD guidelines to avoid insurance denials. ICD- 10 codes being used by our coders while coding for urology surgeries are as below

• C00 – D49 – Neoplasm
• E00 – E89 – Endocrine, nutritional and metabolic diseases
• N00-N99 – Diseases of the genitourinary system
• Q50-Q56 – Congenital malformations of genital organs
• R30-R39 – Symptoms and signs involving the genitourinary system

Our Expertise in Urology Billing Services

Our team of urology billers & coders understands the nuances of urology billing and coding. We have developed a set of urology-specific best practices, which help us reduce denials and improve collections. Our client base extends across all 50 states and includes different healthcare entities, including hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are CUC certified (Certified Urology Coder) by the American Academy of Professional Coders (AAPC). 

Applying best practices for Urology Billing & Coding 

Trained urology coders are challenging to find, expensive to recruit, and their ongoing training can be quite costly. Our team comprises well-trained, CPC certified urology coders that can process 25-30 surgery reports/day. In our Urology specialty coding service, we cover the most complicated portion of the CPT codes and train our coders to handle all procedural, modifier, and diagnostic coding challenges. We ensure HIPAA compliance at all stages of the billing & coding process. Our team performs prior authorization of the eligibility & benefits of the patient to avoid denials.

Best Practices in Urology Billing & Coding

• Prior Authorization. As Urology procedures are costly, the provider must obtain prior authorization from the insurance company before rendering the services. Prior Authorizations help the organization understand the submission guidelines better, submit the claims on time, and get reimbursements instead of denials.
• Medical Necessity. The urology service provider should be able to justify the medical necessity of the course of treatment to be able to charge accordingly for the highly costly services they provide
• Eligibility & Benefits denials. Verifying a patient’s eligibility & benefits for a particular service at least 48 hrs prior can help reduce the denials.
• Missing/Invalid CLIA number (Clinical Laboratory Improvement Amendments). CLIA number should be updated while billing for the lab test
• Non covered – Medicare will not pay for A Codes like A4357, A4334, A5114, A4340, A4331, etc., and deny as Non-Covered Services. But some secondary insurance will pay for the Medicare non-covered services.
• Coding for Maximum benefits. CPT codes should be coded with the correct units as allowed by the specific payers for specific CPTs. For example, Payers will deny CPT codes 51700, 52300, 52310, 55876, and 77263 if we bill for more than one unit.
• 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. Providers must use modifier 59 when billing for two urology services together
• LCD Guidelines. Providers should follow LCD guidelines before billing Urology services

Our Value

We apply our experience in Urology billing & coding to rectify, improve, and achieve a dynamic, denial-free revenue cycle management process. Our team of Urology experts focuses on improving your collections while you focus on improving patient care. We bring you a team of specialists that are:

• CUC Certified by The American Association of Professional Coders (AAPC) and has received training in most common Medical Coding Software
• Successful in processing medical claims with most commercial insurance companies including UHC, WellPoint, Aetna, Humana BCBS, and Anthem, and government payers such as Medicare
• Successful in working with Medicare and understand state-specific Medicaid Policies
• Experts in reducing costs and helping you achieve improved clinical and operational efficiency
• Strong prior authorization team to ensure detailed patient information collection