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Infectious Disease Billing Services Billing & RCM Services
Qualigenix codes and bills inpatient and outpatient consults, HIV and hepatitis care, OPAT oversight, antimicrobial infusions and travel medicine for infectious disease practices in 48 states. Our coders work at 98.9% coding accuracy with a 98.6% compliance and audit pass rate.
What Infectious Disease Billing Requires
Infectious disease billing is mostly evaluation and management coding: choosing the right visit level from medical decision making or total time, billing consults the way each payer accepts them, and capturing prolonged time on complex cases. In Medicare's audit data, 82% of infectious disease improper payments came from coding errors. Qualigenix assigns coders who know ID visit rules, so each level matches the note. Call 786-259-0231 for a free billing audit.
01
E/M & Consult Coding
Medicare stopped paying consult codes in 2010, so ID consults for Medicare patients are billed as new visits or initial hospital care. Many commercial plans still pay consult codes 99242–99245 and 99252–99255. Billing every consult the same way loses money on one payer or gets denied by the other.
02
Antimicrobial Authorizations
Specialty antimicrobials, HIV and hepatitis C antivirals, and home infusion courses often need prior authorization, and extended courses need renewal.
03
Prolonged & Time-Based Visits
Complex ID visits often run long. CPT uses 99417 and 99418 for prolonged time, while Medicare requires G2212 and G0316 with different time thresholds. Using the CPT codes on Medicare claims gets them denied.
04
Inpatient & Telehealth Consults
ID physicians see patients across several hospitals and by video. Each setting has its own visit codes and place of service, and telehealth rules have changed several times since 2020.
05
Antiviral Benefit Checks
HIV and hepatitis C medications are often covered under the pharmacy benefit, with manufacturer or program assistance involved. Coverage needs checking before treatment starts.
06
OPAT Documentation
Outpatient parenteral antimicrobial therapy involves lab review, dose changes and calls with home infusion nurses. That work is only billable when the note shows what was done and how long it took, and the payer recognizes the code used.
07
Medical Necessity Denials
Repeat visits, extended antimicrobial courses and imaging orders need diagnosis codes that support them. Notes that say "follow-up" without a clinical question don't hold up.
06
HIV Privacy & HIPAA
Many states have HIV confidentiality laws stricter than HIPAA. Billing staff need to follow them when sending records with claims and appeals.
PRECISION: WHAT QUALIGENIX DOES
How Qualigenix Closes Infectious Disease Revenue Gaps
Qualigenix assigns coders trained on E/M and ID services to your practice, and each gap has a fixed control.
E/M Level Accuracy
We select each visit level from documented medical decision making or total time, whichever the note supports, and review high-level visits before they're sent.
Antimicrobial Authorizations
We submit and track authorizations for specialty antimicrobials and antivirals, including renewals.
Prolonged Time Capture
We apply 99417 or 99418 for commercial payers and G2212 or G0316 for Medicare, based on documented time.
Inpatient & Telehealth Billing
We code each encounter for its setting and check the telehealth rules in effect on the date of service.
Antiviral Coverage Checks
We confirm medical or pharmacy benefit coverage before treatment begins.
OPAT Oversight Notes
We give providers a simple template for OPAT oversight time, and bill care plan oversight (G0181) for Medicare patients under a home health plan of care when the documented time qualifies.
Denial Appeals
Denials are appealed with the full note attached. Qualigenix overturns 79% of denials across its client base.
Privacy Compliance
We apply HIPAA and state HIV confidentiality rules to every record we release with a claim or appeal.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Infectious Disease Coding by Service
Qualigenix codes the full range of ID services across office, hospital and telehealth settings.
Office & Inpatient Visits (99202–99215, 99221–99233)
New and established office visits, and initial and subsequent hospital care.
COMPLIANCE
How We Keep Infectious Disease Billing Compliant
Qualigenix keeps infectious disease billing compliant by selecting every visit level from documented decision making or time, billing consults as each payer requires (including Medicare, which does not recognize consult codes), and applying HIPAA and state HIV confidentiality rules to every record we send. Underbilling complex visits and prolonged time leaves earned revenue unpaid. Overbilling visit levels draws audits and repayment. We hold a 98.6% compliance and audit pass rate with an over- and undercoding rate under 2%. All work is HIPAA compliant, with patient data handled under strict security controls.
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Audit Pass Rate
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Variance Threshold
Why Infectious Disease Practices Choose Qualigenix
Medicare's audit sample shows ID claims rarely fail for missing records. They fail because the visit level or code doesn't match the note, which is the work our coders do.
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IMPROPER PAYMENT RATE
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FROM DOCUMENTATION GAPS
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FROM CODING ERRORS
$0M+
PAID IN ERROR
QUESTIONS BUYERS ASK
Frequently Asked Questions
Qualigenix quotes each ID practice after reviewing visit volume, settings and payer mix. Most practices start with a free billing audit.
Yes. We bill 99417 or 99418 for commercial payers and G2212 or G0316 for Medicare, when documented total time meets each code's threshold.
We handle all records under HIPAA and follow state HIV confidentiality laws when sending records with claims or appeals, releasing only what the payer needs.
Yes. We work aged claims by dollar value and filing deadline. Across our clients, Qualigenix has cut days in A/R from 54 to 36.
For Medicare patients, we bill the consult as a new office visit or initial hospital care, at the level the note supports. For commercial plans that still pay consult codes, we bill 99242–99245 or 99252–99255.
Yes. Qualigenix checks the Medicare and payer telehealth rules for each date of service and applies the required modifier and place of service.
Yes. Qualigenix works in 133 EMR/EHR platforms, including hospital systems where ID consults are documented.