How Will Your Practice Transition Its Superbill to ICD-10? | Kareo

How Will Your Practice Transition Its Superbill to ICD-10?

Lisa Eramo August 28th, 2012

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Practices need to start thinking about how they’ll revamp their superbill in preparation for ICD-10

It’s difficult enough today—in ICD-9-CM—to ensure that your superbill encompasses as many of the diagnosis and procedure codes you report on a regular basis. How will you ensure that it continues to do so once the volume of codes increases exponentially when ICD-10 takes effect in 2014?

Practices really need to start thinking about how they’ll revamp their superbill in preparation for the new coding system, says Mandy Thompson, CPC, coding and compliance consultant at Kraft Healthcare Consulting in Nashville, TN. Physicians don’t have the option to ignore the changes, as all providers must be prepared to report the new codes as of October 1, 2014, according to a proposed rule published in the Federal Register in April.

ICD-10 won’t affect procedure or supply codes, but it will affect the diagnosis codes that physicians report.  Thompson says that many of the physician practices she audits nationwide are already starting to develop a strategy for how they’ll revise the superbill to accommodate the new codes.

The American Health Information Management Association (AHIMA) converted a sample superbill to from ICD-9-CM ICD-10-CM to demonstrate what the new form might look like. However, it cautions providers that the sample doesn’t represent an endorsement by AHIMA of the use of superbills or of this particular superbill format.

Know what you’re dealing with

Practices must determine how the ICD-9-CM codes they currently report will map to ICD-10-CM codes. In some cases, there may be a one-to-one mapping. In others, one ICD-9-CM code may map to multiple more specific ICD-10-CM codes.

A coder or biller should ideally be mapping the codes one-by-one to determine how the changes will affect their particular practice. The General Equivalence Mappings (GEM) can be extremely helpful with this task. The American Academy of Professional Coders (AAPC) provides a three-step mapping process that coders can use in conjunction with the GEMs to cross-reference ICD-9-CM with ICD-10-CM. The three-step process requires the following:

  • Compare and map all relevant ICD-9-CM codes with their ICD-10-CM counterparts.
  • Complete a backward mapping by reviewing every ICD-10-CM code with its ICD-9-CM predecessor.
  • Perform a quality review to remove inherent mapping flaws, clarify unspecified ICD-9-CM codes, and clarify combination codes and additional choices, etc.

To access the GEMs, visit http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-CM-and-GEMs.html and then click on ‘2013 General Equivalence Mappings—Diagnosis Codes and Guide.’ The file ‘2013_I10gem’ includes a backward map. The file ‘2013_I9gem’ includes a forward map. Note that codes in each column don’t include any decimal points. For example, ICD-9-CM code 0020 (which is actually 002.0, typhoid fever) maps to the following seven different ICD-10-CM codes: 

  • A01.00, typhoid fever, unspecified (listed as A0100)
  • A01.01, typhoid meningitis (listed as A0101)
  • A01.02, typhoid fever with heart involvement (listed as (A0102)
  • A01.03, typhoid pneumonia (listed as A0103)
  • A01.04, typhoid arthritis (listed as A0104)
  • A01.05, typhoid osteomyelitis (listed as A0105)
  • A01.09, typhoid fever with other complications (listed as A0109)

In addition, the AAPC offers on its Web site a code translator that allows coders to map codes from ICD-9-CM to ICD-10-CM and vice versa. However, the AAPC includes a disclaimer stating that this shouldn’t be the only tool on which coders rely. Practices can also purchase a specialty-specific crosswalk from the AAPC that includes the 50 most frequently-used codes. 

Specialty practices may want to consider creating one superbill specifically for diagnosis codes and another for procedure or HCPCS codes to accommodate the changes, says Thompson. Including the diagnosis codes on a separate page means that practices can print more code options from which physicians can choose. She says one orthopedic practice with which she worked plans to do this simply because of the sheer volume of code changes related to diseases of the musculoskeletal system.  

Lisa A. Eramo is a freelance writer and editor specializing in medical coding, health information management, and other healthcare regulatory topics. Visit her website at http://lisaeramo.wordpress.com/. Lisa wrote recently for Getting Paid on Take a Closer Look at Your Superbill to Ensure Accurate Billing and Prevent Denials with More Accurate Medical Coding. Lisa has also written on Understanding RVUs: Ensure Accurate Reimbursement for the E/M Services You Provide.

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