A urology clinic can run cystoscopy, prostate biopsies, hormone injections, and PSA screening on the same day. Each follows its own global, unit, and frequency rules. Sexual medicine adds services that many plans pay differently or not at all.
Book a demoMost urology rework traces back to one of these three areas.
Diagnostic cystoscopy and many office procedures carry zero-day or 10-day global periods, while prostate and kidney surgery generally carry 90 days. A visit on the procedure day is paid only when it stands apart from the decision to do the procedure.
Hormone injections for prostate cancer and in-office bladder instillations are billed as a drug code with units plus an administration code. Medicare also requires the JW or JZ modifier on single-dose container drugs to report a discarded amount or attest there was none.
Medicare covers a screening PSA test and digital rectal exam once every 12 months for eligible men over 50. A PSA ordered to follow known prostate disease is diagnostic, so the diagnosis code has to show which kind of test it was.
Urology practices buy and administer expensive drugs, which puts inventory and billing close together.
Urologists and advanced practice providers document each scope, biopsy, and injection, including drug amounts given and discarded, then approve the codes Taiga drafts. Drug purchasing and inventory stay in the clinic.
Claim scrubbing against payer and drug-unit edits, eligibility checks, submission, and every denial and appeal, including small-dollar screening and injection denials. Patient statements and follow-up come with it.
Sexual medicine services that plans often exclude, in-house lab or imaging, and surgery at a hospital or surgery center each need a clear owner. Settle which claims move before onboarding.
Bring de-identified encounter examples and a recent denial report. Keep patient details out of the booking form.
List scopes, biopsies, injections, instillations, and urodynamic testing with rough monthly volume. Drug-heavy service lines deserve their own review.
Note which erectile dysfunction, testosterone, or Peyronie's treatments go to insurance and which are self-pay, and how patients learn their cost before treatment.
Identify the hospitals and surgery centers you operate at, who submits each professional claim, and how operative notes reach billing.
Useful to an independent urology practice whose drug-unit, modifier, and screening denials pile up faster than staff can work them, and that wants coding and appeals handled inside its current EHR.
Some sexual medicine treatments are excluded by many plans and paid by the patient, which keeps them outside insurance claim work. This page does not decide coverage, drug units, or codes for any service.
For separately payable Part B drugs from single-dose containers, Medicare requires JZ when nothing was discarded and JW to report a discarded amount. Check whether each product comes in a single-dose or multi-dose container.
Once every 12 months for eligible men over 50, with no cost to the patient for the test itself. A PSA to monitor known disease is diagnostic and follows different rules.
Only when the visit is significant and separately identifiable from the decision to scope, reported with modifier 25. An exam done just to confirm the need for the scope is included in the procedure.
Yes. Taiga can take over open A/R or run in parallel with your current billing, and it works alongside the EHR you already use.
Share a month of procedure and injection volume, your payer list, and recent denials. Taiga will tell you what it could own and what onboarding would look like.
System guides show possible billing handoffs, not proven specialty compatibility.