PRSnetwork

09/23/2026

Coding question of the week: can you bill C9761 and C8014 together? 🩺

Short answer: no. That holds for the hospital outpatient department and the ASC, even when the case used both a steerable scope/catheter and a suction-enabled sheath.

Here's how to choose:
✅ Steerable ureteral catheter or suction-integrated ureteroscope used → C9761 (regardless of whether a suction sheath was also used)
✅ Suction-enabled ureteral access sheath only → C8014

The physician's claim isn't affected. It's still 52353 or 52356.

Want the full breakdown, including status indicators, APCs, payment, and device-specific coding and documentation pages? It's all on the PRS Urology Coding & Reimbursement Hub, and it's free for urology practices.

👉 prsnetwork.com/urologyhub

What should we add to the Hub next? Let us know in the comments!

Educational content only. Does not guarantee coverage or payment. Verify payer policy before billing.

09/18/2026

🚨 **The payer already knows how it plans to deny your bladder cancer drug claim.**

Before you submit it, does your team know what the payer is going to look for?

With newer bladder cancer drugs, the practice may have already been billed for the medication — and the patient may receive another dose or two — before the first claim is even adjudicated.

That makes getting the details right from the start critical.

The **PRS Urology Coding & Reimbursement Hub** now includes a Pharma section with guidance for **INLEXZO™ (gemcitabine intravesical system).**

We’ve brought together the information your team needs to check:

✓ Prior authorization
✓ J-code and units
✓ NDC formatting
✓ Procedure coding
✓ Diagnosis coding
✓ Documentation requirements
✓ Same-day services
✓ Discard modifiers
✓ Potential payer traps

You'll find separate **Physician and Facility** guidance, plus a **PRS CodeMatrix quick-reference guide** with the codes, units, and modifiers in an easy-to-use format.

🔎 **Check your claim before the payer does.**

Explore the PRS Urology Coding & Reimbursement Hub:
**prsnetwork.com/urologyhub**

06/26/2026

🚨 Pediatric Urology Coding Question! 🚨
Can CPT 51701 be billed for urine capture in UA testing for pediatric patients when there’s no Medicare involved? And what about billing 81001 or 81003 for the UA itself?
We tackled this great question in episode 187 at 19:06 of the PRS Podcast. Get expert insights on E/M bundling, commercial payers, and best billing practices. 🎧
💬 Drop your experience or thoughts in the comments! https://www.prsnetwork.com/187

Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.

06/22/2026

🚨 Billing Alert for ICD-10 Code N30.10 🚨
One of our PRS Network clients is running into denials from multiple payers stating that N30.10 (Interstitial cystitis, without hematuria) is not valid, even though it’s listed as billable in the ICD-10 code book.
Have you seen this issue in your practice? Tune in to episode 187 at 13:43 where we break it down and share possible solutions! https://www.prsnetwork.com/187
🎧

Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.

06/19/2026

🚨 New Code Alert! CPT 99459 is here, and documentation is key! 📝
One crucial element? Chaperone documentation is a must.
In episode 187 (8:50 mark), we break down what your template should include.
➡️ Don’t miss it – tune in and stay compliant! https://www.prsnetwork.com/187

Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.

06/18/2026

🚨 Is Your Practice Losing Revenue Without Knowing It? 🚨

Payers are increasing scrutiny on urology practices through automatic E/M downcoding, stealth denials, medical record requests, takebacks, and RAC-style reviews—and many practices don't discover the impact until it's too late to appeal.

In UCR Episode 292, Scott, Mark, Dr. Ray Painter, and special guest Marianne DeSciose discuss real-world examples from hundreds of recently identified downcoded claims and share practical strategies to help practices:

✅ Detect reimbursement issues before appeal deadlines expire
✅ Prioritize revenue cycle resources effectively
✅ Strengthen clinical documentation and audit processes
✅ Monitor payer behavior and contract compliance
✅ Protect revenue through proactive appeals and oversight

The bottom line: Clean claims are no longer enough. Practices must actively monitor, audit, appeal, and defend their reimbursement.

🎧 Listen now: https://www.prsnetwork.com/292

Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.

06/16/2026

🎙️ New Podcast Episode: UCR 291 – C9761 Update, Intraoperative Consults, and Office-Based Procedure Challenges

CMS continues to refine reimbursement policies impacting urology providers. In this episode, Scott, Mark, and Dr. Ray Painter discuss recent developments surrounding C9761, including CMS’s decision to revise the code description and establish a new HCPCS code for suction-enabled ureteral access sheaths.

The conversation covers:
• Potential implications for ASCs, HOPDs, and physicians performing stone management procedures
• Appropriate billing of intraoperative consultations versus procedures
• Common payer denials related to office-based procedures and place-of-service restrictions
• Documentation and compliance considerations that can affect reimbursement outcomes

As coding and payment policies evolve, healthcare organizations must stay informed to ensure accurate billing, optimize reimbursement, and reduce denial risk.

🎧 Listen to the episode here: https://www.prsnetwork.com/291

06/16/2026

🎙️ New Episode Available: UCR 291 – C9761 Update, Intraoperative Consults, and Office-Based Procedure Challenges

In this episode, Scott, Mark, and Dr. Ray Painter break down important updates to the evolving C9761 reimbursement landscape, including CMS’s decision to revise the code description and create a new HCPCS code for suction-enabled ureteral access sheaths.

They also discuss:
✅ What these changes may mean for ASCs, HOPDs, and physicians involved in stone management
✅ Billing intraoperative consultations vs. procedures
✅ Payer denials tied to place-of-service restrictions for office-based procedures
✅ Documentation, reimbursement, and compliance considerations

As coding and payment policies continue to evolve, understanding reimbursement rules and site-of-service limitations is more important than ever.

🎧 Listen now: https://www.prsnetwork.com/291

06/03/2026

🎙️ New Episode: UCR 283 – Saturation Biopsy Confusion and Cystoscopy Risk—Where Interpretation Matters

🎧 Listen here: https://www.prsnetwork.com/283

Accurate coding often comes down to interpretation, and this episode addresses two areas generating significant discussion among coding professionals and providers.

Scott, Mark, and Dr. Ray Painter examine:

• What distinguishes a stereotactic template-guided saturation biopsy (CPT® 55706) from standard transperineal biopsy techniques
• The importance of 3D templating and comprehensive gland sampling when evaluating saturation biopsy criteria
• Why payer expectations may differ from physician documentation and clinical interpretation
• Whether diagnostic cystoscopy qualifies as moderate risk within E/M coding guidelines

The conversation also revisits the E/M risk table and provides practical insights into navigating areas where coding guidance is less explicit.

As coding and reimbursement requirements continue to evolve, successfully balancing guideline interpretation with payer expectations remains essential for both compliance and financial performance.

Listen to the episode and join the conversation.

Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.

06/01/2026

💡Urology Coding Insight!
A PRS Network client asked: Can you bill both 50783 LT and 50780.51 RT when performing a tapered ureteral reimplant on one side and a standard on the other? 🤔
The key issue: Does using LT/RT modifiers solve the bundling conflict, or is 50783 considered inclusive of 50780 regardless of laterality?

Tune into Episode 186 (10:48) to hear our coding experts break this down! 🎧
https://www.prsnetwork.com/186

Urologists and urology practice staff: Administrators, APPs, Billers and Coders Unite! Your co-hosts, Mark, Scott and Dr. Ray Painter are on a mission to help urologists and staff achieve peak economic and practice efficiency so there is time and energy to focus on patient care and a happy life.