Challenges of Converting an ICD-9 Superbill to ICD-10

The U.S. healthcare system is now 10 months away from the ICD-10 “live” date and physician practices around the U.S. are currently deciding on whether or not to convert their current ICD-9 superbill to an ICD-10 superbill. Of course, there are several physicians who currently capture ICD-9s and CPTs through an EMR system or practice management system. However, there are several physicians who would prefer to use a superbill with ICD-10 codes; there will be a larger number of codes on an ICD-10 superbill, and the superbill could be multiple pages.

It is well known that if a practice tries to convert their entire 1 page ICD-9 superbill (up to 200 ICD-9 codes) to an ICD-10 superbill, they could have up to a 15 page ICD-10 superbill, depending on the specialty and the number of the ICD-9 codes you choose to convert. To show the added complexity that providers will face when using ICD-10-CM, the Blue Cross Blue Shield Association converted a superbill from ICD-9-CM to ICD-10-CM.

1)      Blue Cross Blue Shield Association started with a model superbill created by the American Academy of Family Practitioner’s practice management journal, Family Practice Management (FPM). The back of the superbill showed 164 ICD-9 diagnosis codes identified by FPM as being those most commonly used by family physicians.

2)      About half of the 164 ICD-9 codes on the superbill were general codes such as “unspecified” or “not otherwise specified.” While these “unspecified” codes lack the specificity necessary to infer diagnosis details, they are often used on superbills due to space limitations. Continuing their use in ICD-10 will only further prevent ICD-10 code set’s increased granularity.

3)      BCBSA used CMS’ GEMS (General Equivalence Mapping) crosswalks to convert each ICD-9 code on the superbill to its equivalent ICD-10 code or codes.

4)      The superbill went from a 1 page ICD-9 superbill to an almost 9 page ICD-10 superbill.

MTBC recommends that physicians who want to continue to use a multi-page ICD-10 superbill begin to “dual code” clinic encounters and procedures using ICD-9 and ICD-10 codes. Practice managers should then track how much longer it takes a physician to find and circle codes on a 5 or 10 page ICD-10 superbill than it does on an ICD-9 superbill. This exercise will allow practices to decide whether the more cumbersome ICD-10 superbill is compromising the efficiency of the charge capture process that currently runs smoothly with a 1 page ICD-9 superbill.

Practices need to be open that an electronic charge capture may be the best solution in an ICD-10 coding environment. Use these next few months to decide whether or not your practice will continue to use an ICD-10 superbill.