This document discusses how pharmacogenomic (PGx) testing can help medical practices safely and effectively treat patients by determining if medications will be ineffective or dangerous for a patient based on their genetic profile. It provides steps on how the nurse, doctor, and biller should handle PGx testing for eligible patients, which can increase reimbursement for the practice. PGx America offers a simplified process for practices to access this diagnostic tool without investment or additional staff workload, and will provide test results and support to help practitioners incorporate this technology.

1. Many of your patients are predisposed to hyper-metabolize
certain drugs, which can lead to critical adverse reactions.
Many more will hypo-metabolize medications to the point that
they are virtual placebos. PGx, or Pharmacogenomics Testing
is an easy, inexpensive, CMS recommended way to determine if
medication is ineffective or worse, dangerous.
PGx America Corp. has developed a simplified process that will
let your practice access this critical tool without any
investment or additional staff burden. You will learn the
critical technologies that are reshaping the future of
diagnostics today. Therapeutic Drug Monitoring with PGx tests
will greatly increase the scope of bodily systems reviewed in
any clinical situation. Our strategies make sure that your
practice is adequately reimbursed by emphasizing compliance
and transparency.

2. 1) the NURSE
It all begins with the nurse who identifies a patient matching critical CMS criterion
as seriously at risk of Adverse Drug Reaction.
- Number of medications. Four or more prescribed medications can indicate
a high risk.
- Nature of medications. Cardio and vascular medications including statins or
psychiatric drugs including anti-depressants are frequently adverse.
When both number and nature of criterion are met nurse may proceed to take
buccal swab, 20 seconds per side of mouth. Bag and label swabs. Notify practitioner
that Therapeutic Medication Monitoring Encounter is advised. Nurse may also pull
swab kit for practitioner to administer.
2) the DOCTOR
The physician should initiate a Therapeutic Drug Monitoring Encounter with patient
due to concerns with number and nature of drugs taken. Ask for patients
perception of the effectiveness and suspected side effects of each medication.
Charting should be simple but specific. E&M level should be elevated due to
increase scope of body systems reviewed. Indicate that physician initiated
Therapeutic Drug Monitoring Encounter due to concerns of number and nature of
medications, and specify cardio-vascular or psychiatric medication with concern.
An E&M increase of 2 levels is only indicated in a case where the patient may be
experiencing a critical adverse reaction. Never indicate that a test is being
performed to “rule out” a cause, but rather to prove a presumption .

3. 3) the BILLER
Whether the doctor or a transcriptionist charts the visit it is vitally important to
note the Therapeutic Medication Monitoring Encounter along with the concerns due
to number and nature of medications. Even if a test is not determined to be
necessary after the review, the review itself is medically necessary if patient is
taking 4 or more prescription medications including cardio or psych drugs. Thus
E&M coding should reflect that increase in scope of body systems review.
-If a swab is administered use an appropriate local fee.
-Therapeutic Drug Monitoring Encounter:
Z51.81 Z79.01 for long term use of anti-coagulants excluding aspirin
Or: ICD-10-CM Z79.899 Other long term (current) drug therapy
4) the LAB
In 72 hours the lab will securely send the comprehensive pharmacogenomics test
results to the practice for physician to review. It is color coded to readily identify
issues of concern including necessary dosing changes. A laboratory technician will
be waiting by the phone for your call to answer all of your questions and explain the
results in as high a detail as you would like to go. Our people are your people. It’s
like we are just down the hall, any time, every day.

4. Pharmacogenomic testing will be a common tool in the 21st
century doctors’ bag. After just a couple tests this will be a
seamless and integral part of your practice. As more and more
tests are available you will stay on the leading edge of
diagnostic medicine. PGx America will guide you along the way
incorporating this diagnostic miracle into your practice.
The only way to start is by starting. Today. We will be with
you every step of the way.
For help with your account please call your Account Executive
Arney Benson at :
1 (480) 399 - 2877
2015 PGx AMERICA CORP v WASHINGTON PA USA