Looking to hire consultant to help with Billing of Antibiotic PCR

myriam27

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Hello,

I am needing help from someone experienced in billing for PCR for wound infection and antibiotic resistance.

Thanks!
 

SharonCollachi

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Guidelines

Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels: Medicare limits coverage of multiplex PCR respiratory viral panels. Panels of 3-5 pathogens are covered under limited circumstances. Specifically the test must be ordered either in a healthcare setting that is equipped to care for and routinely does care for critically ill patients, or it must be ordered by an infectious disease specialist, unless an infectious disease specialist is not available.

Multiplex PCR respiratory viral panels of 6 ormore pathogens are non-covered. The pathogen targets that compose the panels are determined by the manufacturers that make them, and do not represent specific pathogens that cause a common syndrome, or the organisms that commonly are found in a specific sample type or patient population or reflect seasonal variations. The fixed nature of these multiplex panels includes pathogens that cause infections different enough that simultaneous testing for these pathogens should be rare. Examples include Chlamydophilia (Chlamydia) pneumoniae or Bordetella pertussis in combination with rhinovirus, influenza viruses, and respiratory syncytial virus (RSV). The multiplex PCR respiratory viral panels are effectively a “one size fits all” diagnostic approach, and do not meet Medicare’s “reasonable and necessary” criteria. Non-coverage of these multiplex RCR respiratory viral panels does not deny patient access because appropriate clinician directed testing is available.

Is it any more complicated than that?
 

myriam27

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Hi Sharon,

Wow! Does sound complicated. I've been trying to find guidelines on wound samples, but only keep coming up with respiratory stuff. Maybe I'm not searching with the right terminology. I appreciate your comment!
 
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