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Will The Superbill be Sidelined by ICD-10

July 15, 2013

ICD-10 superbill will become obseleteWith many healthcare practices still grappling with the transition from ICD-9 to ICD-10 coding, one of the biggest questions concerns the future of the superbill. Love it or hate it, the superbill has been a part of the billing scene for years, in spite of its many coding limitations. Up until now, most superbills consisted of 2 pages of the main bill and applicable condition codes based upon the attending physician’s notes and documentation.

Superbills – then and now:

One of the main problems was the superbill’s short length – usually around two pages – as billing staff often had to decide which possible practice-specific codes and diagnoses to leave in and which to exclude, as well as cope with the limits of the long-outdated ICD-9 system. The advent of improved diagnostics, more advanced treatments and health care technologies as well as changes in reporting requirements created new revision challenges for the superbill.

The limitations of the ICD-9 codes, as well as the brevity of the superbill itself, often resulted in denied claims, as insurers and other payers demanded more accurate supporting information:.

Example 1:

A patient sustains a simple fracture of the left wrist

The following month, the same patient fractures his right wrist

Because ICD-9-CM codes do not identify left versus right, additional documentation will be required for payment.

Now, fast-forward to the advent of ICD-10 and how it more accurately describes the same diagnosis:

Example 2:

Patient fractures wrist – ICD-10 new codes describe left versus right, as well as differentiate between the initial encounter and subsequent encounter.

Due to the greater detail and clarification of injury, your practice is now more likely to receive payment, as long as your staff follows the new coding choices.

The ICD-10 Effect:

So, what is wrong with ICD-10 codes increasing the chances of getting paid the first time a bill is submitted for payment? Nothing – if you and your staff have the time for dealing with pages and pages of newly-created codes, as well as their attendant modifiers, and deciding which inclusions and exclusions are practice-specific and therefore to be added to your office’s revised superbill.

What was once a manageable two-page document has now morphed into a small book full of code choices – in some cases estimated to run well over 40 pages – unless you and your staff can decide which of the hundreds of new codes available to pick and choose for your office’s superbill. Even then, most family practices, if following the ICD-10 templates given by the American Academy of Professional Coders (AAPC) could see their revised superbills burgeon from two (ICD-9) to 9 pages under ICD-10.

According to the Journal of the American Health Information Management Association (AHIMA), many practices may see an increase of 1.5 to over twice the number of reportable codes, depending on specialty and the mix of patients.

As a result of this sharp increase in coding choices and utilization, some observers predict the demise of superbills as more practices turn to clinical computerized encoding to replace inputting the new codes from a paper form.

Get help with superbill questions:

M-Scribe Technologies, LLC, a national leader in health care billing, coding and documentation services, can guide you through the complex maze of necessary documentation, regulations and other coming changes. Contact them for a consultation to discover how M-Script can partner with you to achieve full compliance with ICD-10 integration for your practice at less cost.




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