ICD-10 Coding and Superbill
In the ICD-9 era, the ICD Codes were small in number, though not highly organized as ICD-10 is. Given that the ICD-10 codes bring in the granularity and accuracy to the diagnostic and procedure coding, not to mention decades of familiarity of the coders in ICD-9, how does a provider ensure that these codes are coded correctly?
In my view there are two ways to tackle this. First, train the two major stakeholders i.e physicians and the coders, rigorously in ICD-10 terminology / granularity. With this, the doctors could write/dictate elaborate discharge summaries, procedure/diagnosis notes, taking care of what is required for ICD-10 coding. While this is an option for long term, in short term the coders and physicians will struggle to get the coding right.
Secondly, providers can adopt technology assisted coding of ICD-10, which basically involves software aides for the coder to navigate the ICD-10 Procedure and Diagnosis hierarchy, find and narrow down to the right ICD-10 Code. If the information at hand (Discharge summaries, procedure/diagnosis notes) are not sufficient for ICD-10 coding, the case is sent back to the physician for additional information. In this, huge training period can be avoided for the physicians and coders, however cases will be shuttling between coder and physician will be higher, at least in the initial period.
Third is an hybrid approach, the training of the physicians and coders is reduced to more to an awareness, and with this at least the coder will be provided with the software tools, if not both coder and Physician, will be enable to put together the right pieces of the ICD-10 code into place. The process of collecting the right information required for ICD-10 can start much before the ICD-10 cutover date, so that the transition is smooth when ICD-10 is actually implemented.
Given this, from a physician’s point of view, Superbill will have 4-5 pages of annexure for listing the ICD 10 codes. It will be difficult to sift through and to select the right codes. Does this mean will paper based Superbill be a thing of past? This may not be the case.
A mechanism or an approach is required for generating Superbill specific to a context. How can we do this ? A Office Assistant has the information about patients visit based on the appointment, based on the past history of visits. Since usually the medical records of patients are pulled up on the previous day of appointment, the specific superbills can be printed along with it. If not, they could be printed just-in-time based on the patients answering informal question ‘Why are we here today ?’ by the office assistant. In-any case the generated Superbill will be very specific and customized to the patient visit and will have very small number of codes to choose from.
There will be cases where the context-specific Superbill cannot be generated, or generated Superbill will not be useful. However, the above approach serves the purpose by reducing the physician’s time, the inconvenience of selecting the right codes from a large number of ICD-10 codes, not to mention the implicit benefit of printing shorter Superbill and saving the paper.