2021 Archives

HIFU Bill Coding 2021

Posted by Mark N. Painter, CPMA, MBS | Apr 2021

Mark N. Painter, CPMA, managing partner of PRS Consulting LLC, the CEO of PRS Urology Service Corporation, the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc., and CEO of Relative Value Studies, Inc., discusses changes to Medicare billing in 2021, covering HIFU (high intensity-focused ultrasound) and detailing how the procedure is reimbursed. He details how the new CPT code for 2021, code 55880, is used for ablation of malignant prostate tissue, transretally approached, using high intensity-focused ultrasound (HIFU) and ultrasound guidance. Mr. Painter details how Medicare has set up facility payments: HIFU can only be billed once per date of service, and many Medicare carriers still consider HIFU as a non-covered service. Also, if the HIFU is done at a non-participating facility, it becomes patient responsibility. The new code does not allow for co-surgeons or assistant surgeons. He points out that there is an established fee schedule for facilities and appropriate values for the code, and advises to look at coverage rules and to keep an eye on individual carriers to see whether they will follow NGS moving forward or not. Mr. Painter also advises to check with each payer before providing this service to find where coverage is, where patient responsibilities lie, and to juggle that with your charges and reimbursement activity.

Practice Efficiency – Same-Day Appointments

Posted by Neil H. Baum, MD | Apr 2021

Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, touts the benefits of offering same-day appointments. He notes a recent downward trend in reimbursement rate, explains the need to increase volume of patients, and offers an implementation plan. Dr. Baum highlights two key components needed to manage same- or next-day appointments: a timely urologist and a willing staff. Front desk staff can increase appointment efficiency by preparing patients for their visit, reminding them to complete paperwork in advance, collecting fees prior to the visit, and explaining estimated costs and copays. It helps to keep a list of conditions requiring immediate care at the front desk, such as acute scrotal pain, urinary retention, and gross hematuria. Advantages of same-day appointments include improved patient satisfaction, reduction in no-shows, increased productivity, and great marketing for the practice. Dr. Baum adds that if the current appointment wait-time is two weeks or longer, creating openings in the schedule, in addition to a waitlist for earlier time slots, will allow the doctor to accommodate new patients and those in need of immediate care. While same-day appointments can initially disrupt the workflow and create stress for staff, doctors can overcome these challenges by seeking feedback, clarifying the purpose of same-day appointments, and offering monetary or verbal rewards for their staff’s flexibility.

Sacituzumab Govitecan Given Accelerated FDA Approval for Advanced Urothelial Cancer

Posted by Daniel P. Petrylak, MD | Apr 2021

Daniel P. Petrylak, MD, Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center, discusses the FDA’s recent approval of sacituzumab govitecan for metastatic urothelial carcinoma. He notes how previously, treatment options were limited for patients who failed initial chemotherapy. Dr. Petrylak then describes how the new antibody drug conjugate sacituzumab govitecan acts as a “smart bomb” in the way it can recognize cancer markers and deliver chemotherapy directly to affected cells. He then describes the trial that led to the approval of sacituzumab govitecan, including differences between it and enfortumab vedotin, how treatment has been combined with both drugs, and how it is expanding the spectrum of treatments for advanced urothelial carcinoma. Dr. Petrylak also discusses side effects of the drug and potential next steps for its use in treatment.

Relugolix and Concomitant Treatment for Advanced Prostate Cancer

Posted by Daniel J. George, MD | Apr 2021

Daniel J. George, MD, Professor of Medicine and Surgery, Divisions of Medical Oncology and Urology in the Duke University School of Medicine, comments on research presented at the 2021 GU ASCO conference about the recent approval of Relugolix and concomitant therapies. He first notes the results of the HERO trial in which Relugolix was shown to be superior to Leuprolide in continuous suppression of testosterone levels in men with advanced prostate cancer. As a follow up to the study, researchers looked at a subset of patients who received concomitant treatment, either radiation therapy to metastatic or primary disease site or drug therapy with Docetaxel or Enzalutamide. Dr. George highlights that patients on Relugolix and additional drug therapy had continued testosterone suppression equal to those on Relugolix alone and lower testosterone levels than patients on Leuprolide. He adds that there were no safety concerns with regard to toxicity. Notably, the HERO trial found a 54% reduction in serious cardiovascular events between Relugolix and Leuprolide. In summary, the study suggests that Relugolix can be safely combined with other therapies and that additional research is needed.

Men with High-Risk Prostate Cancer Should Not Undergo Neoadjuvant Therapy Prior to Surgery

Posted by David Utz | Apr 2021

J. Kellogg Parsons MD, MHS, FACS, Professor of Urology at the University of California, San Diego, explains why neoadjuvant therapy prior to surgery may not be the best option for prostate cancer patients. He reviews findings from definitive randomized clinical trials that show ADT does not improve survival, and addresses common side effects, such as cognitive impairment and loss of testosterone function. Dr. Parsons then explains AUA Clinical Guidelines published in alignment with SUO and ASTRO that strongly recommend against routine neoadjuvant therapy prior to surgery. Lastly, he gives examples of when physicians can consider the option despite such caveats.