Tuesday, October 21, 2008

ICD-10-CM and the Physician's Superbill

No, a superbill is not a bill that includes extravagant costs for a lousy bedside manner. Nor is it a proposed law in Congress that has merit.

A superbill is a form (usually on paper) that a physician uses at the end of every visit to mark all the billing codes she feels apply to that visit. Thus, for the numerous physicians who use a superbill, it is the link between clinical care and reimbursement.

A superbill typically contains a small subset of Current Procedural Terminology (CPT) codes and ICD-9-CM codes: usually those codes for which the physician bills most frequently. Without going into too much detail, the CPT code bills for the services the physician provided at the visit. The most typical codes are the so-called "evaluation and management" or E&M codes. In essence, the more complicated (and thus usually the longer) the visit, the more the physician gets paid.

The superbill also contains a small subset of ICD-9-CM codes to allow the physician to "check off" easily the diagnosis codes relevant to that visit. Thus, given that the most common chronic conditions that result in visits to primary-care physicians are hypertension, arthritis, diabetes mellitus, and depression, your PCP's superbill (assuming she uses one) has the ICD-9-CM codes for these diagnoses (as well as others).

In fact, your PCP's superbill may be derived from a superbill template (warning: pdf) produced by the American Academy of Family Physicians.

So, how will the switch to ICD-10-CM affect the superbill?

Well, the American Academy of Professional Coders (AAPC) recently issued a comparison between the ICD-9-CM superbill and what its ICD-10-CM equivalent would look like. The ICD-10-CM superbill (pdf) is a whopping 9 pages long, as opposed to its ICD-9-CM counterpart (pdf), which is 2 pages long.

The main reason the ICD-10-CM superbill is so long is the problem with combination codes we talked about in an earlier post. Now, instead of a single code for infectious mononucleosis, the superbill has 16 codes, mostly based on whether various complications are present (instead of just listing the complications by themselves with their own codes). Rheumatoid arthritis explodes from one code to approximately 90 codes: from one line to one page!

ICD-10-CM in this respect is worse than ICD-9-CM.

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