Have a Realistic Approach to Developing ICD-10-CM Superbills
The process is fairly simple, but it requires time, analysis, and research.
By Susan Theuns, PA-C, CPC, CHC
ICD-10 implementation is approaching, and many practices are relying on vendors to make sure all of the pieces are in place to “go live.” But what if they aren’t ready? For practices using manual superbills/encounter forms, a contingency plan will ensure an uninterrupted revenue stream for Part B services billing beyond ICD-10 implementation.
Create a Timeline
Updating a superbill can be a time-consuming process, and you must anticipate time for printing (especially if you use an “outside” vendor) and distributing forms. The following timeline is recommended for internal superbill conversion from ICD-9-CM to ICD-10-CM:
- Early 2014: Review existing form(s) and begin process (see “Step Out the Process” section) using 2014 ICD-10-CM codes.
- June 2014: Send updated form(s) with ICD-10-CM codes to your print vendor for proof set up.
- August 2014: When 2015 ICD-10-CM codes are released, review and update the superbill proof. Return the final, updated form(s) to the print vendor for final proof.
- September 2014: Submit a print order to vendor, with a delivery date to sites prior to the Oct. 1 effective date.
Hire a Print Vendor
Selecting a reliable print vendor is critical when updating your superbill. Look for a vendor with a reputation for putting out a good product, with reasonable prices, and a quick turnaround. To ensure your forms are printed and ready for use in offices by Oct. 1, agree on a timeline with your vendor. When the timeline is finalized, the process to create the superbill can begin. Maintain close communication with the print vendor to ensure everything stays on course.
Step Out the Process
The steps below will yield a single two-sided superbill, with header and services on the front and diagnosis codes on the back. The front of the form should already be set with current codes from the January 2014 updates.
Here is a basic process for updating a single-specialty form:
- Review existing ICD-9-CM codes on your current forms. Compare it with a “top 100 most used diagnoses” report, using frequency reports from the appropriate billing system(s).
- Revise the list of ICD-9-CM codes based on report data and changes in practice.
- Select the top 20-50 diagnosis codes (as space allows, for a single page).
- Refer to the Centers for Medicare & Medicaid Services’ (CMS) general equivalence mappings (GEMs) to compile a new list of codes using ICD-10-CM. Note that GEMs are not 100 percent accurate, so it’s best to code directly from the ICD-10-CM code book, when possible.
- For each specialty, include applicable manifestation codes for the most commonly used diagnostic conditions in the category.
- For the top 20 most-used codes (based on the frequency report), include all codes to the most specific character (i.e., if the code requires six characters, the reported code must include all six characters, or it will be invalid for billing purposes).
- In each category listed, include blank lines for the provider to include more specific information or additional codes and information not listed on the superbill.
- Furnish additional codes that cannot fit onto the form (on a single side) using laminated reference guides (either produced in-house or purchased).
No one expects every possible code to fit on a standard superbill. But with some planning and knowledge of the most commonly diagnosed problems by specialty and provider, you certainly can cover the codes that are used most frequently. Knowing your clinicians and patient population is key.
For example, there are many different types of diabetes that can be coded in ICD-10-CM, but the two most commonly diagnosed types are type 1 and type 2. Do not try to fit every possibility on the form. Clinicians can write in diagnoses outside of the norm for look-up or use a reference guide to assign a code.
As you transition to ICD-10-CM, the goal should be to code to the highest level of specificity without getting bogged down with details that will not affect care or billing. Finding this balance may take time.
The process of developing a superbill is fairly simple, but it requires time and a lot of analysis and research. Having a backup plan for tentative vendor failure, however, will add peace of mind, as well as familiarize staff and providers with the new codes and nomenclature. Recognition and familiarity may help to alleviate the “fear factor” of the upcoming transition.
Healthcare business professionals, including compliance professionals, coders, billers, auditors, and clinicians, need to be ready to meet the requirements of ICD-10-CM because they are directly tied to reimbursement. It’s up to coding and compliance professionals to lead the way, to implement the tools for billing, to provide training for a smooth and successful transition to ICD-10-CM, and to provide reassurance that it can be done!
Susan Theuns, PA-C, CPC, CHC, is administrative director of physicians’ practices at MedStar Union Memorial Hospital and has an extensive background in healthcare, business management, facilities/operations, and compliance, spanning more than three decades. She holds a master’s degree in leadership and education and a Bachelor of Arts degree in business management. Theuns is a certified physician assistant, coder, and healthcare compliance professional. She serves on the advisory board for OptumInsight and is a contributing author for The Business of Medical Practice. She is a member of the Baltimore, Md., local chapter.