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Medical Billing for Infectious Disease Practices

Infectious Disease Billing That Pays What You Earn

Infectious disease billing is centered on complex evaluation and management services, HIV management billing, antibiotic and antifungal infusion therapy, and long-term IV antibiotic home infusion coordination. ID physicians are frequently consulted in hospital settings, requiring correct inpatient consultation billing, critical care coding, and hospital discharge planning codes. 360Solutions provides infectious disease billing specialists who capture complex E&M at the correct level, manage HIV-specific billing codes, and coordinate home infusion billing for long-term antibiotic therapy.

26%
avg ID practice revenue lost to E&M level undercoding
$340
avg additional revenue per HIV management visit with correct coding
93%
first-pass rate for ID inpatient consultation claims
Infectious Disease Billing Challenges
Where practices lose the most revenue:
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Complex E&M Level Selection
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HIV Management Billing
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Inpatient Consultation Coding
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OPAT & Home Infusion Coordination
Infectious Disease Billing Challenges

Where Infectious Disease Practices Lose Revenue

These are the coding and billing pitfalls that cost infectious disease practices the most — and where our specialised billers add the most value.

Complex E&M Level Selection

ID visits routinely involve multiple complex medical problems, high MDM, and lengthy review of diagnostic data. Many ID physicians undercode to 99214 out of habit when MDM or time-based criteria clearly support 99215. We audit E&M levels against documented MDM and total encounter time.

HIV Management Billing

HIV management involves antiretroviral prescribing, viral load and CD4 monitoring, opportunistic infection prophylaxis, and PrEP management — each with specific documentation requirements. Incorrect diagnosis coding (Z21 vs. B20) affects covered services and reimbursement rates differently across payers.

Inpatient Consultation Coding

Many payers do not reimburse consultation codes (99241-99255); they require initial hospital visit codes (99221-99223) instead. ID physicians frequently bill consult codes that are automatically converted or denied. We apply the correct code by payer to prevent systematic underpayment.

OPAT & Home Infusion Coordination

Outpatient parenteral antibiotic therapy (OPAT) requires coordination between the ID physician's visit billing and the home infusion agency's drug and nursing billing. Incorrect physician order documentation or failure to bill IV management codes leads to missed revenue.

Coding Intelligence

High-Risk CPT Groups

Code ranges payers audit most aggressively in Infectious Disease.

99213–99215
Office E&M — established patient — moderate to high complexity MDM
99221–99223
Initial hospital visit — used in place of consult codes by most payers
99231–99233
Subsequent hospital visit — ID follow-up during inpatient stay
86703 / 86704
HIV-1/HIV-2 combination antibody testing — confirmatory testing
99495 / 99496
Transitional care management — 7-day / 14-day discharge follow-up
Denial Intelligence

Common Denial Patterns

Knowing these before submission is the difference between a 60% and a 96% first-pass rate.

Consultation code billed to Medicare (non-covered — requires initial visit code)

HIV diagnosis coded as B20 (AIDS) when patient is asymptomatic HIV positive (Z21)

Subsequent hospital visit billed daily without documented daily medical decision-making

OPAT prescription documentation insufficient for home infusion agency payer auth

Transitional care management billed within 30 days of prior TCM claim

Free Denial Audit

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Our Process

How 360Solutions Works for Infectious Disease Practices

01

Free 2-Week Billing Audit

We review your last 90 days: denial breakdown by category, AR aging by payer, charge lag, collection rate, and any recurring coding issues specific to your specialty. No commitment required.

02

Specialty Coder Assignment

You are paired with a coder trained specifically in infectious disease coding. They learn your providers, your documentation patterns, and your payer mix before touching a claim.

03

Parallel Billing Transition

We run alongside your current billing for 10–14 days with zero cash flow disruption. Claims keep moving during the transition. Your account manager provides daily status updates.

04

Live KPI Dashboard

Real-time visibility into billed, paid, denied, AR aging, and collection rate — segmented by provider and payer. No black box, no month-end surprises.

05

Weekly Account Manager Call

Every week your dedicated account manager walks through last week's KPIs, denial trends, and any action items. Critical issues are escalated the same day — not at the next scheduled call.

Infectious Disease Billing FAQ

Questions From Infectious Disease Practices

We apply the correct initial hospital visit codes (99221-99223) for first-contact hospital evaluations and subsequent visit codes (99231-99233) for daily follow-up. For commercial payers that do accept consult codes, we bill 99241-99255 with the correct refer-back documentation.
Yes. We maintain separate billing workflows for outpatient E&M and inpatient hospital visits. We reconcile hospital rounding lists against daily billing submissions to ensure no hospital visits are missed — a common and costly gap in ID billing.
We audit the visit documentation against the E&M guidelines — reviewing the number and complexity of problems, the amount and complexity of data reviewed, and the risk of treatment options. HIV management typically supports high MDM (99215) when multiple chronic conditions are managed and the plan involves prescription drug management.
Yes. PrEP management visits are billable as preventive medicine counseling or as E&M when a problem is addressed. We apply the correct code based on the documentation — preventive visit codes for purely risk-reduction counseling, E&M when comorbidities or clinical issues are managed.
Ready to Fix Your Infectious Disease Billing?

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No-Obligation Audit

Two weeks, no contract. A certified infectious disease billing specialist reviews your claims, denial patterns, and AR — and shows you exactly what is recoverable.

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