Urology Billing & Coding Expertise
End-to-end RCM support for urologists — from routine office visits to complex surgical procedures — maximizing collections while reducing denials.
Our certified coders and billing specialists understand the unique CPT, ICD-10, and modifier requirements specific to urology. We help you maintain compliance, reduce rework, and accelerate cash flow.
Schedule a Free ConsultationAccurate CPT Coding for Urologic Procedures
Our team ensures precise use of CPT codes for diagnostic and surgical services such as cystoscopy (52000), transurethral resection of the prostate (52601), lithotripsy (50590), vasectomy (55250), and urodynamic testing (51728, 51729). Each claim is scrubbed to align with payer guidelines and maximize reimbursement.
Common Surgical Procedures
- TURP (52601, 52647, 52648)
- Ureteroscopy (52356, 52353)
- Prostate biopsy (55700, 55706)
- Orchiectomy (54520, 54522)
Office-Based Procedures
- Cystourethroscopy (52000-52010)
- Urethral dilation (53600-53621)
- Catheterization (51701-51703)
- Bladder instillation (51700)
ICD-10 Expertise for Urological Conditions
We accurately code diagnoses related to common and complex urological disorders, including benign prostatic hyperplasia (N40.0), nephrolithiasis (N20.0), urinary tract infections (N39.0), incontinence (N39.3–N39.4), erectile dysfunction (N52.9), and hematuria (R31.9).
Specialized Coding for:
Modifiers & Bundling Compliance
Our certified coders apply the correct procedural modifiers (e.g., -25 for E/M with procedure, -51 for multiple procedures, -59 for distinct services) and review NCCI edits to prevent unnecessary bundling errors or duplicate billing denials.
Common Urology-Specific Modifier Applications:
| Modifier | Usage | Example |
|---|---|---|
| -26 | Professional component | Ultrasound interpretation |
| -TC | Technical component | In-office ultrasound |
| -XS | Separate structure | Bilateral procedures |
Pre-Authorization & Eligibility Verification
We verify insurance eligibility in real time and obtain pre-authorizations for surgeries, advanced imaging, and expensive injectables — ensuring coverage is secured prior to rendering services. Our pre-checks reduce claim delays and out-of-pocket surprises for patients.
Our Pre-Auth Process:
- Identify procedures requiring prior authorization based on payer policies
- Gather necessary clinical documentation (progress notes, test results)
- Submit complete authorization requests with medical necessity justification
- Track approval status and communicate with your office
- Appeal denied authorizations with additional supporting evidence
Denial Management & Appeals
Our team aggressively works denied claims with a 96% recovery rate. We analyze denial trends, correct errors, and submit appeals with supporting documentation to overturn inappropriate denials.
Common Urology Denials We Resolve:
- Bundled procedures (NCCI edits)
- Medical necessity denials
- Duplicate claim rejections
- Timely filing issues
- Modifier-related denials
Our Appeal Process:
- Root cause analysis of denials
- Clinical documentation review
- Payer policy research
- Customized appeal letters
- Follow-up until resolution
Technology-Driven Urology Billing
Our proprietary billing platform includes urology-specific features to streamline your revenue cycle:
Automated Code Scrubbing
Real-time validation of CPT/ICD-10 combinations against payer rules
Performance Analytics
Specialty-specific KPIs tracking collections by procedure type
Denial Prevention Alerts
Early warnings for potential claim issues before submission
What Urology Practices Say
Dr. Robert Chen
Urology Associates of NJ
"Since switching to their urology billing specialists, our collections have increased by 22% while denial rates dropped to under 4%. Their understanding of complex prostate procedure coding is unmatched."
Jennifer K., Practice Manager
Midwest Urology Group
"Their team caught $18,000 in underpayments for ureteroscopy procedures in our first month together. The detailed monthly reports help us understand exactly where we're leaving money on the table."
Urology Billing FAQs
How do you handle global period billing for urology surgeries?
We meticulously track global periods for procedures like TURP (90 days) and prostatectomies, ensuring proper billing of post-op visits (99024) and separate billable services. Our system flags any encounters falling within global periods to prevent compliance issues.
What's your approach to in-office procedure coding (e.g., cystoscopy)?
We verify documentation supports both the procedure and any separate E/M service, applying modifier -25 when appropriate. Our coders check for required elements like indication, findings, and plan to support medical necessity.
How do you stay current with urology-specific coding changes?
Our team attends AUA coding workshops, reviews CMS transmittals affecting urology codes, and participates in specialty-specific training. We provide quarterly updates to clients on coding changes impacting their practice.