A National Coverage Determination (NCD) will reimburse providers for diagnostic tests using sequencing.
Today’s topic is DNA sequencing and its effect on society as a whole, on healthcare, and on Medicare. Sequencing is a laboratory procedure that maps the pattern of nucleotides in DNA.
In 2003, sequencing an individual cost $2.7 billion; by 2006, it was $300,000; and now, the entire genome can be sequenced for $700, with some tests running around $50.
There are four nucleases – cytosine, guanine, adenine, and thymine – abbreviated C-G-A-T. A sugar called deoxyribose with a phosphate group link them into a chain. Hydrogen bonds tie together two chains with base pairs of A/T and C/G.
These DNA strands are long. In only one of the 46 human chromosomes, there are around 220 million base pairs. These chains are torn apart, and the newly created sequence of nucleases helps build proteins. But the system fails some of the time. Most of the time, a failure really doesn’t matter, but sometimes it does, and in a big way. Such as with cancer. By taking the DNA of normal humans and comparing it to the DNA of humans with a special disease, it is possible to determine where the problem is.
A Genome-Wide Association Study
The BRCA gene linked to breast cancer was found this way. A single protein glitch can cause incredible problems. If your DNA at the 9p21.2 location gets messed up, then a single protein is not made, and you can get Lou Gehrig’s disease.
DNA profiling also allows for genetic fingerprinting. It is used in criminal investigations, in finding out who the father really is, or in identification of persons when there is not much left to go on, such as after an airplane crash.
Personalized medicine, or pharmacogenomics, uses genetic information to help identify optimal therapies for individual patients. It also makes it possible to find out if you may be susceptible to certain diseases.
Type 2 diabetes risk can be identified through sequencing. This gives an opportunity to change lifestyle before it is too late. Today’s current rage is the use of DNA sequencing to discover one’s ancestry. People sometimes are surprised to learn that their ancestors are from some very unexpected places. If everyone in the United States took a DNA test, they would quickly realize how mixed up everyone is, and racism would (hopefully) disappear.
In Medicare, DNA sequencing is being used for patients with advanced cancer. The current administration has finalized a National Coverage Determination (NCD) that will reimburse providers for diagnostic tests using sequencing. For example, the F1CDx test is a companion diagnostic for 15 targeted therapies. It looks for genetic mutations in 324 genes and two genomic signatures in any solid tumor.
We should all be proud that the Centers for Medicare & Medicaid Services (CMS) is covering the most advanced DNA sequencing techniques, and at the same time driving research to even greater heights.
As the Centers for Medicare & Medicaid Services (CMS) clarifies existing Medicare policies like the Two-Midnight Rule, which guides the appropriateness of inpatient services, some
Today we’re talking about a major shift in Medicare rules that’s going to impact hospitals, surgeons, and physician advisors alike: the phasing out of the
Please log in to your account to comment on this article.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
