Superbill and Forms Revision for ICD-10

The ICD-10 implementation date is just four short months away. Physicians must ensure that their forms, including their superbills, are ready for the conversion on Oct. 1, 2015.

Superbill Revision

Many physician practices use a superbill to account for the services rendered (CPT codes) and patients' diagnoses (ICD-9 and ICD-10 codes). These forms must be updated on a regular basis to reflect any code changes. The conversion to ICD-10 will require a major overhaul of the superbill. Each ICD-9 code that is listed on the existing superbill will need to be converted to the related ICD-10 code. There is not always a 1:1 match when translating an ICD-9 code to an ICD-10 code. In fact, due to the greater specificity in most areas of ICD-10, there could be several ICD-10 codes that map back to just one ICD-9 code.

CMS' website provides a list of the mappings of ICD-9 to ICD-10 codes called the General Equivalence Mappings (GEMs); view it here: bit.ly/CMS-GEMs. This tool is helpful as a first step for practices to compare the commonly used ICD-9 codes to the related ICD-10 codes. However, the user must keep in mind that these GEMs are not a crosswalk. The full list of ICD-10 codes, including coding guidelines and conventions, must be reviewed to determine the appropriate code assignment.

Since the list of ICD-10 diagnosis codes a practice utilizes could be quite extensive, the use of a superbill for diagnosis coding might need to be reevaluated. There are other solutions, such as the use of EHR, which would better assist physicians in selecting appropriate codes.

It's also important to remember that the physician documentation within the record (outside of the superbill), must justify the services provided and fully describe the patient's diagnoses. The superbill does not stand on its own for coding and billing purposes.

Other Forms Revision

Besides the superbill, there may be other forms that will need to be revised in anticipation of ICD-10. Physician practices should take an inventory of all forms currently used, whether paper or electronic, and review them for ICD-9 codes. Any forms that currently include ICD-9 codes will need to be refreshed with ICD-10 codes.

Some areas that may currently include ICD-9 codes are patient scheduling and registration, documentation templates within the EHR, coding and billing forms, and external reporting/databases. Once these impacted areas are identified, it's essential to communicate any required changes to the forms with the affected parties to ensure readiness for the ICD-10 conversion.

EHR Readiness

Most physicians use some type of EHR within their practice. It is essential that the EHR is ready for the conversion to ICD-10. If the practice has purchased an EHR from a vendor, a readiness assessment should have already been completed several months ago for ICD-10. However, if this process has not been done, practices should contact their EHR vendor immediately to ensure that it will be compliant with ICD-10 on Oct. 1, 2015.

Some practices have created their own "home-grown" EHR which will also need to be evaluated for ICD-10 readiness. Physicians and their coding staff should practice assigning ICD-10 codes within their EHR system to ensure that the system is capable of accepting these codes. It's important to remember that the current ICD-9 codes are between three digits and five digits, whereas the ICD-10 codes are between three characters and seven characters.

Many EHRs have built-in documentation templates that physicians use to assist with capturing the complete clinical picture of the patient. These templates may need to be revised for ICD-10 as well.

Next Steps

Leading up to ICD-10 implementation, a physician practice should have already created an ICD-10 communication plan, developed a budget, completed staff and physician education, performed readiness testing, analyzed documentation, reviewed quality reporting requirements, and revised superbills and other forms. Use these remaining four months wisely to ensure a smooth transition on Oct. 1, 2015.

Superbill Samples

To view two sample superbills converted to ICD-10 provided by AHIMA, visit bit.ly/superbill2 and bit.ly/superbill1.

Resources

AHIMA ICD-10 Superbill Examples

AHIMA and AMA Physician's Office ICD-10 Implementation Model

CMS 2015 General Equivalence Mappings (GEMs) - Diagnosis Codes and Guide

Melanie A. Endicott, MBA/HCM, RHIA, CDIP, CCS, CCS-P, FAHIMA, is a senior director of HIM Practice Excellence at AHIMA. She can be contacted at melanie.endicott@ahima.org.

© 2015 American Health Information Management Association (AHIMA). Reprinted by permission.