Developing ICD-10-CM Superbills
By: Susan Theuns PA-C, CPC, CHC
ICD-10 implementation is quickly approaching. For practices using manual superbills/encounter forms, a contingency plan is best practice to ensure an uninterrupted revenue stream for Part B services billing beyond October 1, 2014.
Close communication with vendor(s) is critical to ensure that forms will be printed and ready for use in the offices for the effective date of October 1, 2014. Selecting a reliable printer is critical. If you’ve used a printer that has provided a good product with reasonable prices and turnaround, stick with them.
Here is a basic process for a single specialty form:
- Review existing ICD-9 codes on the forms currently used. Compare with a “top 100 diagnoses” report, using frequency reports from the appropriate billing system(s).
- Revise the list of ICD-9 codes based on report data and/or change in practice.
- Select the top 20-50 diagnosis codes (as space allows, for a single page).
- Using CMS GEMs (Generalized Equivalency Mappings), compile a new list of codes using ICD-10 CM s. Note that GEMs are not 100 percent accurate, so it is best to code directly from the ICD-10 CM manual, when possible.
- For each specialty, include any applicable manifestation codes for the most commonly used diagnostic conditions in the category.
- For the top 20 codes (based on the frequency report), include all codes possible 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/information not listed on the encounter/superbill.
- Additional codes that cannot fit onto the form (on a single side) can be furnished using laminated reference guides (either produced in-house, or purchased).
No one expects that every possible code will fit on a standard superbill. But, with some planning and knowledge of the most commonly diagnosed problems by specialty/provider, you can cover those codes that will be 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 still going to be 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.
The process of developing a superbill is fairly simple, but it requires time, and a lot of analysis and research. Capturing the necessary codes for billing is important to compliance professionals, coders, billers, auditors, and clinicians. Coding and billing professionals, and others in the industry, will need to be ready to meet the requirements of ICD-10 CM because they are directly tied to reimbursement. As you transition to ICD-10 CM, the goal should be to code to the highest level of specificity without getting bogged down in details that will not affect care or billing. Finding this balance may take time.