Infectious disease billing involves accurate coding, claim submission, and reimbursement management for diagnosing and treating conditions such as HIV/AIDS, tuberculosis, hepatitis, COVID-19, and antibiotic-resistant infections. Specialized billing ensures compliance with Medicare, Medicaid, and private insurers while maximizing reimbursements.

Some common challenges include:

• Complex coding for chronic and acute infections
• Frequent insurance policy changes affecting coverage
• Managing prior authorizations for specialized treatments like biologics and IV therapy
• Navigating bundled payments for inpatient and outpatient services

Some frequently used CPT codes include:

• 99202-99215 – Office or outpatient visits
• 99221-99233 – Inpatient hospital visits
• 87535-87539 – PCR tests for infectious diseases
• 96365-96367 – IV infusion therapy for antibiotic administration

To minimize claim denials, providers should:

• Verify patient insurance coverage before services
• Ensure proper documentation of medical necessity
• Use correct ICD-10 codes to specify infection types
• Stay updated on payer guidelines for infectious disease treatments

Outsourcing infectious disease billing services helps:

• Reduce administrative burden, allowing focus on patient care
• Improve revenue cycle management with faster reimbursements
• Ensure compliance with evolving coding regulations
• Minimize claim denials with expert handling of complex cases