ICD 10 Superbill Family Practice Related Services

Touseef Riaz

August 30, 2022

ICD 10 Superbill Family Practice

Superbills in medical billing is a form used by healthcare providers. This form contains all the patient’s information, from diagnosis to the procedures/services performed. These superbills are the primary source of information for claim preparation. Later the medical claims are submitted to the insurance payers. Superbills also play a significant role in reimbursements of the healthcare physician as incorrect information leads to claim denials.

 ICD-10-Superbill-Family-Practice-UCB

What information does the superbill ICD 10 contain?

After implementing the ICD-10 coding system, physicians were required to use ICD-10 superbills. These forms must contain the following information to receive reimbursements:

1. Provider’s information

Healthcare provider’s information includes the following:

Physician’s or provider’s NPI (National Provider Identifier) number

Name of the physician

If applicable, the referring provider’s name

If applicable, the referring provider’s NPI number

– Provider’s address & contact info

2. Patient’s information

This includes all the basic information of the patient, including:

Patient’s name

Date of birth (DOB)

Address

Phone number/contact details

Patient’s insurance information

  • Social security number
  • Kind of insurance policy
  • Patient’s policy number
  • Deductibles/co-payment

3. Details about the patient’s visit to the physician

This part includes:

Correct and specific ICD-10-CM diagnosis codes:

In order to receive reimbursements from the insurance payer for the services or procedures performed, ICD 10 CM diagnosis codes must be included. The payer might not approve/accept the claim otherwise.

Modifiers:

There are several commonly used modifiers in medical billing. These modifiers provide additional information to the insurance payer regarding the codes provided in the insurance claim. Note that a modifier doesn’t change the meaning of the medical code (e.g., ICD 10, CPT, HCPCS, etc.). Commonly used modifiers include:

  •   Modifier 22
  •   Modifier 25
  •   Modifier 59
  •   Modifier 91

Accurate CPT codes (procedure codes):

Current Procedural Terminology (CPT) codes are used to describe the procedures performed by the healthcare physician. Correct procedure codes are also crucial for proper reimbursements and revenue generation, along with diagnosis codes. The use of incorrect or outdated CPT codes can result in claims being denied or rejected by the insurance payers.

Other details included in the superbill:

The date of service/appointment/visit

Referring physician

Total amount charged for the service/visit

Minutes or units

Place of service (POS) code

Physician’s Signature

ICD 10 Superbill: Family Practice

In family practice, ICD 10 superbills can be any of the three types. Superbills examples/types may include:

For small healthcare practices, the superbills comprise the list of most commonly used diagnosis codes.

For a little larger healthcare practice, the staff extracts billable information from the patient’s medical records. This information is then translated into specific and valid codes to be incorporated into the superbills and then in the medical claim.

For healthcare practices using EHR systems, the software automatically converts the billable information.

In order to submit clean claims, correct and accurate medical codes must be used. In case of incorrect codes, the insurance payer can reject or deny the claim leading to lower reimbursements and revenues. For instance, when it comes to ICD 10 diagnosis codes assigning the code with correct laterality (and many more factors) is essential.

 Superbill vs. Claim:

Superbills are the healthcare providers’ main information source for preparing an insurance claim. It contains all the necessary information regarding the service(s) rendered and its charges. 

What is a super bill for insurance and its role in medical billing?

Superbill contains all the essential information of the patient and provider as well as details about the visit/service performed. These superbills are the primary source of information for healthcare providers in making a claim. They play a vital role in the following:

1. Reimbursements/revenues of the practice:

Superbill is an essential part of generating an insurance claim. It provides the healthcare provider/billing team with all the necessary information regarding the medical visit/services provided to the patient. Complete and accurate information is required in the claim so that the insurance payer doesn’t reject/deny it. Claim denials or rejections result in late/lost payments, lower reimbursements, therefore, lesser revenues.

2. Patient’s medical history or track record keeping:

As mentioned earlier, a superbill contains all the necessary patient medical and personal information. Therefore, it can also function as a document for maintaining a proper track of the patient’s medical data and information.

Why are Superbills necessary?

If superbills are offered by you, it may consume time to create a template. Following are some of the advantages of superbills, including proper record keeping, higher reimbursements, etc. 

Benefits of electronic superbills:

Manually entering diagnosis or procedure codes and other information can be quite frustrating, time-consuming, and dull. Moreover, entering manually also increases the risk of human error, meaning incorrect codes/info leading to claim denials or rejections. 

However, using the EHR system can simply resolve this issue. Electronic Health Records (EHR) software is used by various healthcare physicians/staff. But what if your practice doesn’t have an EHR?

Don’t worry; you can implement electronic superbills into your practice. Following are some of the benefits of electronic superbills in a non-EHR environment:

Quick selection of the ICD-10 codes

An improved Revenue Cycle Management (RCM) process

Saves valuable time of the healthcare physicians

Reduced paperwork

– The lesser risk of human errors

Faster payments

Electronic superbills are pretty beneficial for the healthcare practice compared to paperwork.

Superbill vs. CMS-1500:

Superbills contain all the information regarding services rendered along with their charges. CMS-1500 forms are used when the practice is an in-network provider with the insurance provider. However, superbills are used if the practice is out of the network with an insurance provider. Superbills allow them to receive payments for the services rendered upfront.

Commonly used ICD 10 codes for Family Practice:

Following is the list of commonly used diagnosis codes for family practice and their specific/billable codes.

Abdominal pain:

R10 Abdominal and pelvic pain

  •  R10.0 Acute abdomen
  •  R10.1 Pain localized to the upper abdomen
    •  R10.10 Upper abdominal pain, unspecified
    •  R10.11 Right upper quadrant pain
    •  R10.12 Left upper quadrant pain
    •  R10.13 Epigastric pain
  •  R10.2 Pelvic and perineal pain
  • Asthma:

 J45 Asthma

  •  J45.2 Mild intermittent asthma
    •  J45.20 …… uncomplicated
    •  J45.21 …… with (acute) exacerbation
    •  J45.22 …… with status asthmaticus
  •  J45.3 Mild persistent asthma
    •  J45.30 …… uncomplicated
    •  J45.31 …… with (acute) exacerbation
    •  J45.32 …… with status asthmaticus
  • Underdosing:

The concept of underdosing is new in ICD-10 coding. These codes identify whether the patient is taking less medicine than the amount prescribed. 

T36 Poisoning by, adverse effect of and underdosing of systemic antibiotics

  •  T36.0 Poisoning by, adverse effect of and underdosing of penicillins
    •  T36.0X Poisoning by, adverse effect of and underdosing of penicillins

   T36.4X6 Underdosing of tetracyclines

T45 Poisoning by, adverse effect of and underdosing of primarily systemic and hematological agents, not elsewhere classified

  •  T45.0 Poisoning by, adverse effect of and underdosing of antiallergic and antiemetic drugs
    •  T45.0X Poisoning by adverse effects of and underdosing of antiallergic and antiemetic drugs
      •  T45.0X1 Poisoning by antiallergic and antiemetic drugs, accidental (unintentional)

 Z91.12 Patient’s intentional underdosing of medication regimen

 Z91.120 …… due to financial hardship

 Z91.128 …… for other reason

Hypertension:

2022 ICD-10-CM Diagnosis Code I10 Essential (primary) hypertension. I10 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. This ICD-10 code includes:

  • High blood pressure 
  • Hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic)

Some of the Approximate Synonyms of I10 include:

  • Benign essential hypertension
  • Benign essential hypertension (htn)
  • Benign hypertension
  • Bilateral hypertensive retinopathy
  • Essential hypertension
  • Essential hypertension (high blood pressure)
  • Hypertension
  • Hypertension (high blood pressure)

Some other ICD-10 codes for hypertension include the following:

  •  I11 Hypertensive heart disease
    •  I11.0 Hypertensive heart disease with heart failure
    •  I11.9 Hypertensive heart disease without heart failure

 I15 Secondary hypertension

  •  I15.0 Renovascular hypertension
  •  I15.1 Hypertension secondary to other renal disorders
  •  I15.2 Hypertension secondary to endocrine disorders
  •  I15.8 Other secondary hypertension
  •  I15.9 Secondary hypertension, unspecified
  • Diabetes, Hyperglycemia & Hypoglycemia:

 E08 Diabetes mellitus due to underlying condition

 E08.2 Diabetes mellitus due to underlying condition with kidney complications

  •  E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy

E08.65 Diabetes mellitus due to underlying condition with hyperglycemia

 E08.69 Diabetes mellitus due to underlying condition with other specified complication.

  •  E08.8 Diabetes mellitus due to underlying condition with unspecified complications
  •  E08.9 Diabetes mellitus due to underlying condition without complications

 E09 Drug or chemical-induced diabetes mellitus

  •  E09.0 Drug or chemical-induced diabetes mellitus with hyperosmolarity
    •  E09.00 …… without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
    •  E09.01 …… with coma

 R73 Elevated blood glucose level

R73.01 Impaired fasting glucose

  R73.02 Impaired glucose tolerance (oral)

  R73.03 Prediabetes

  R73.09 Other abnormal glucose

  •  R73.9 Hyperglycemia, unspecified

Family practice medical billing:

Unlike primary care physicians who specialize in one field, family practice physicians provide healthcare services in various fields of medicine. And that makes family practice one of the most complex and challenging medical billing and coding fields. The list of some top ICD 10 codes for family practice is mentioned above. This is why family practice medical coders must have a vast knowledge of CPT, ICD 10, & HCPCS codes for appropriate reimbursements.

Like every other kind of medical field, the family practice also relies on proper billing and coding. Due to high complexity, healthcare practices tend to outsource their billing services to third-party billing companies. With outsourced billing services, your practice can rely on:

Higher clean claim rate

– The lesser risk of errors

Timely submissions

Claim denial management

Faster payments

Increased revenues or reimbursements

Medical billing services at UControl Billing:

UControl Billing offers:

Competitive and affordable pricing

Faster turnaround

Increased cashflows

Error-free claim submission

Fee schedule review and analysis

Eligibility verification.

Referrals, Authorization alert, Claim tracking, reduced rejections and denials

Patient statement processing, Mailing, Customized Monthly financial reports

Rules-based claim review, scrubbing, Insurance follow-up.

Helping with the collection agency to recover patient balances

Always remain HIPAA Compliant

Common Family Practice Billing Errors:

Errors in family practice medical billing and coding can lead to claims being denied or rejected by the insurance payer. The errors can be prevented by providing the following in an insurance claim:

Accurate patient information

Correct provider information

Billable and specific ICD-10 codes (diagnosis codes)

Correct CPT Codes (procedure code) & modifiers

– Following the coding guidelines and insurance payer’s requirements

However, medical billing is a complex process; therefore, errors are pretty common. The most common mistakes in medical billing and coding include the following:

Incorrect or missing information

– Patient’s personal & demographic information

– Medical information

Incomplete documentation

Incorrect diagnosis or procedure codes

Unbundling

Upcoding

Billing for services not performed

Not following NCCI edits (coding guidelines)

Frequently Asked Questions (FAQs)

1. What information must be included in a superbill?

ICD 10 superbills must contain the following information in order to receive reimbursements:

Patient’s information

Provider’s information

Details about the visit

ICD 10 codes

CPT codes

Modifiers

Referring physician and more

2. What two codes must always be included in the superbill?

Correct CPT codes (procedure codes) and the ICD 10 CM codes (diagnosis codes) must be present on the superbill. These codes provide the insurance payer information regarding the visit, and in their absence, payers can reject or deny the claim.

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