Changing your existing superbill over to ICD-10 codes may feel like a daunting task — but it doesn’t have to be. Here are five tips to make a smooth transition.
1. Be strategic. Rather than converting all the diagnoses on your form, run a report to determine those you bill most frequently. Many practices leave the same diagnoses on the slips year after year, rather than eliminating the ones that aren’t used. Being proactive can help you make more efficient use of staff time.
2. Assess your coding volume. Use ICD-10 for Ophthalmology to predict which codes you’ll use most. Take a look at each section header under Chapter 7 “Diseases of the Eye and Adnexa” to determine where your volume of codes will be:
H00-H05 Disorders of eyelid, lacrimal system and orbit
H10-H11 Disorders of conjunctiva
H15-H22 Disorders of sclera, cornea, iris and ciliary body
H25-H28 Disorders of lens
H30-H36 Disorders of choroid and retina
H40-H42 Glaucoma
H43-H44 Disorders of vitreous body and globe
H46-H47 Disorders of optic nerve and visual pathways
H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction
H53-H54 Visual disturbances and blindness
H55-H57 Other disorders of eye and adnexa
H59 Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified
3. Account for XX diagnoses. Certain diagnoses, such as esotropia, have many different types listed under section header H50. After reviewing the list, determine which ones are most often seen in your practice and add only those to your superbill.
4. Avoid general equivalence mappings. These popular online “crosswalks” plot ICD-9 to ICD-10 unspecified codes, but such maps can delay reimbursement. Although unspecified codes are considered valid in ICD-10, billing them may result in a denied claim or a request for additional information.
5. Leverage your EHR system. Some electronic health record systems let you create a “favorites” list of top diagnoses. If you have already uploaded all diagnoses to your system, determine whether you should delete (or hide/inactivate) unlisted codes. You can also instruct staff not to choose those codes without authorization.
How One Practice Does It
To show you how this approach to conversion can work in practice, YO Info editorial board chair and cornea specialist Natasha Herz, MD, provided the five most-billed diagnoses from her solo practice.
Current ICD-9 codes appear alongside ICD-10 codes to demonstrate how they could be listed on your superbill. Although not all ICD-10 codes have laterality, you may want to use this format when creating a superbill for codes that do.
Primary open-angle glaucoma
ICD-9 365.11 ICD-10 H40.11X- (1,2,3)
Senile cataract
ICD-9 366.10 ICD-10 H25.1- (1,2,3)
Dry eye syndrome
ICD-9 375.15 ICD-10 H04.12- (1,2,3)
Dry AMD
ICD-9 362.51 ICD-10 H35.31
Wet AMD
ICD-9 362.52 ICD-10 H35.32
Type 2 diabetes without complications
ICD-9 250.00 ICD-10 E10.9
How to Get Help
The Academy and the American Academy of Ophthalmic Executives have developed several products to help you choose the most appropriate codes. Developed by ophthalmologist Gordon E. Johns, MD, 2014 ICD-10-CM for Ophthalmology lists ICD-9 codes with appropriate conversions to ICD-10 and features coding clues such as laterality and staging. This book also contains an alphabetical index as well as a tabular list to help confirm that all additional characters are included. Be sure to also check out the entire library of ICD-10 quick reference guides, organized by subspecialty.
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About the authors: Sue Vicchrilli, COT, OCS, is the Academy’s director of coding and reimbursement and the author of EyeNet’s “Savvy Coder” column and AAOE’s Coding Bulletin, Ophthalmic Coding Coach and Ophthalmic Coding series. Jenny Edgar, CPC, CPCO, OCS, is the Academy’s coding specialist. She oversees the Academy’s Chart Auditing Service and is also a contributing author to the Ophthalmic Coding Coach and Ophthalmic Coding series.