“We are big advocates of RCxRules and consider it to be one of the best technological investments we have made. It is one of those rare instances where the product turned out to be even more powerful than we had been anticipating during the sales process.”
Revenue Cycle Director, United Urology Group
Vice President of Information Technology
Trusted By
Customization and Control
You and your team are already experts at navigating the complex world of revenue cycle management. We’ll work with you to identify critical areas where custom rules can dramatically reduce the burden of manual effort by automatically correcting routine billing errors.
Custom Urology Rule Examples
The Challenge
Medicare does not allow ultrasound procedure code 76942 With 76872.
The Solution
When billing Medicare for procedure code 76872 (ultrasound, transrectal), this rule automatically removes procedure code 76942 (ultrasonic guidance for needle placement).
The Challenge
Urethrocystography and cystography procedures require an additional injection procedure code.
The Solution
When billing procedure code 74455 (urethrocystography), or 74430 (cystography), this rule automatically adds procedure code 51600 (injection procedure for cystography or voiding urethrocystography), if missing, to the encounter.
The Challenge
Temporary ureteral catheter should not be billed separately when cystourethroscopy or pyeloscopy are performed.
The Solution
When billing diagnostic or therapeutic cystourethroscopy with ureteroscopy and/or pyeloscopy using procedure codes 52320-52356, the insertion and removal of a temporary ureteral catheter procedure code 52005 is included and should not be billed separately. This rule automatically removes procedure code 52005.
The Challenge
The diagnosis is side-specific (affecting the right or left kidney) and needs a laterality modifier.
The Solution
When billing with a diagnosis code that specifies left side or right side, this rule automatically adds the appropriate LT or RT modifier.
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The Challenge
Medicare does not allow ultrasound procedure code 76942 With 76872.
The Solution
When billing Medicare for procedure code 76872 (ultrasound, transrectal), this rule automatically removes procedure code 76942 (ultrasonic guidance for needle placement).
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The Challenge
Urethrocystography and cystography procedures require an additional injection procedure code.
The Solution
When billing procedure code 74455 (urethrocystography), or 74430 (cystography), this rule automatically adds procedure code 51600 (injection procedure for cystography or voiding urethrocystography), if missing, to the encounter.
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The Challenge
Temporary ureteral catheter should not be billed separately when cystourethroscopy or pyeloscopy are performed.
The Solution
When billing diagnostic or therapeutic cystourethroscopy with ureteroscopy and/or pyeloscopy using procedure codes 52320-52356, the insertion and removal of a temporary ureteral catheter procedure code 52005 is included and should not be billed separately. This rule automatically removes procedure code 52005.
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The Challenge
The diagnosis is side-specific (affecting the right or left kidney) and needs a laterality modifier.
The Solution
When billing with a diagnosis code that specifies left side or right side, this rule automatically adds the appropriate LT or RT modifier.