# ICD-10 Superbill?



## ABridgman (Feb 17, 2014)

Has anyone figured on a way to make a paper superbill for Family Practice (or any other Specialty for that matter) with ICD-10 Coding that isn't nine pages long?

This is what I have been working on so far, as a solution - since I am dealing with a doctor who is reluctant to give up paper superbills.

I have identified the 35 most common, and easiest to report ICD-10 codes we use...for example, Hypertension is going to be I10 - and there is little differentiation in the coding on this, unless you are changing from benign to malignant hypertension...and the doctor could note this in the case of Malignant.

For other codes, that require a designation for Dextral/Sinistral/Bilateral we just put the base code on the Superbill, with place for a checkmark to indicate Dextral/Sinistral/Bilateral.

We also have each ICD-10 code preceded by a small line, so that doctor can designate order of Diagnoses 1-4.

We also have blank Diagnosis boxes for diagnoses not listed on the superbill itself, but which are still common.  for those codes, my doctor's office will be provided, by me, a binder which lists all these diagnoses and their correct codes...and the doctor can write in the code needed.

And for those cases where the doctor is using a diagnosis not on the superbill or my binder, he can just write out the diagnosis and I will then determine the correct coding.

This still allows for a one-page Superbill, and a permanent binder listing all the codes (it makes absolutely no sense to list all the codes on a superbill and have nine page long superbills.)  this is the only way I could come up with to keep Superbills at one page.

Anyone else have any other ideas which could work?
Or is this idea the best we can do?

Fortunately, ICD-10 seems to be fairly consistent with it's codes for designating right versus left and bilateral or unspecified.  Likewise, on the Superbill model I am proposing here, we would have to have some IDC-10 Codes with a checkmark available to indicate Initial Encounter versus Subsequent Encounter versus Seculae.

Hey is it just me or are you glad that they aren't changing the CPT codes, too??
This is Y2K for the healthcare industry for sure!


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## mitchellde (Feb 17, 2014)

Why have codes listed on the superbill at all?  why not just levae blanks for the provider to write in the diagnosis.  The code book is so easy to use there is no need to creat a separate binder of frequent codes.  There are so many new and unique codes in  ICD-10 CM that you are going to need several months/years of practice looking codes up.  Otherwise how will you find the code for unhappiness (R45.2) or encounter for blood pressure monitoring?


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## MarcusM (Feb 18, 2014)

I agree with Debra. ICD 10 is all about adjectives and descriptions of who, what, when, why, where so perhaps modify your super bill to have descriptions the doctor can circle: new, acute, chronic, right, left, etc with a blank line for the doctor to write in new sheep bite W55.31 right ankle.


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## ABonnell CPC (Feb 18, 2014)

Agreed.  Why list the codes on the superbill?  Hopefully the dictation will provide any info needed?


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## ABridgman (Feb 25, 2014)

Well...my doctor is very old-fashioned.  And he likes to just be able to check off the diagnoses.  He certainly is not about to look them up for me...he figures that is my job - and he's right.

So I am looking for ways to make this process as easy for ME as possible.  Hence my desire to list the most common codes on the superbill.  I know his normal office staff will write in codes for me if refinement is necessary, for example, with Diabetes diagnosing...let's face it, IDDM and NIDDM are not going to cut it in ICD-10.  Since his office staff would do this for me...I am also looking for ways to make this as simple for THEM as possible...hence the binder they could look up things that needed refinement, such as diabetes coding.

Certainly, having checkmarks in place can work with some diagnoses...for example, Discoid Lupus Erythematosus could have checkmarks for "Left versus Right" and "Upper versus Lower."

Where needed, a check box can be placed for New, Subsequent, Seculae 
or
Chronic, acute, subacute - or in case of headache coding Intractable Y/N.

I kinda put this thread out there...partly to get ideas from others...and also partly to gather my thoughts on this for myself.

The problem is that there are so many possibilities.  If my doctor was just a Specialist, this would not be as difficult...but as a Family Practice doctor...as well as Nephrologist...

I'm beginning to think two different versions of the Superbill might be a good idea...one for Family, the other for Nephrology.


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## SVarney (Feb 28, 2014)

I work for a large OB/GYN practice, and we use a superbill with CPT on the front, ICD on the back. I have just finished my draft of the encounter form using ICD-10 codes and was able to fit them all in the same space. The page lists approximately 240 most commonly used codes, with space to write in other choices. I listed single codes for the OB billing, with a line to indicate trimester. 
We are not willing to have the provider write something in, then have to take the man hours to research the codes prior to charge entry. This would significantly increase our charge -lag time and slow down revenue.
The goal is to be charge passing from our EMR into the billing system prior to October 1, so hopefully this form will just be a back-up.


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## ABridgman (Mar 9, 2014)

SVarney said:


> I work for a large OB/GYN practice, and we use a superbill with CPT on the front, ICD on the back. I have just finished my draft of the encounter form using ICD-10 codes and was able to fit them all in the same space. The page lists approximately 240 most commonly used codes, with space to write in other choices. I listed single codes for the OB billing, with a line to indicate trimester.
> We are not willing to have the provider write something in, then have to take the man hours to research the codes prior to charge entry. This would significantly increase our charge -lag time and slow down revenue.
> The goal is to be charge passing from our EMR into the billing system prior to October 1, so hopefully this form will just be a back-up.



Are you an in-house biller, or a billing service?
I'm curious, because I am a billing service, not an in-house biller.

As such, my client is not - as far as I know...willing to do half my job or more by creating the superbills in Practice Fusion (in other words, they basically end up doing the coding for me if they do!)

Because I am third-party outside billing, I am trying to develop some sort of mechanism that allows my clients to report to me what took place with each patient encounter...and not have it take up five pages for one patient.

I still have to play around with some things - and a two-sided Encounter Form is an idea I have considered.  I have considered the possibility of having ICD-10 codes on the back for the most common codes they use...and various CPT Encounter codes on the front...with places to mark other diagnoses not listed on the back.

This would assume the office is willing to deal with a two-sided Encounter Form.  Could you possibly send me an example of what you are currently using?


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