As I’m beginning to code charts, everybody was talking about Super Bills. I had no idea what a Super Bill was nor what to do with it. A Super Bill is something you send to your biller, right? Come to find out, it’s more than just a document for your biller, it can be a good cheat sheet for the coder!

The difference between a Super Bill and, what I’m going to call, a Coding Cheat Sheet is very minor and I’ll often use them interchangeably in this post. A Coding Cheat Sheet is a limited list of ICD-9 Codes and their discription. A Super Bill is the same thing but may also have payment costs for each code, a payment total, and I’ve seen some with the provider’s payment address. The theory is that a physician fills out a Super Bill while charting the patient’s visit; that Super Bill then gets routed over to the biller who just types what’s on the page, into a computer, and sends the bill to the insurance companies. (Please don’t think that I’m minimizing a biller’s worth; see my first comment below.)

At first, I was using a lot of different websites and a lot of different pieces of paper in order to keep up with the ICD-9 codes. I have settled on the web service findacode.com; their service is easy to use and they have a freemium business model.  I had also collected a lot of Super Bills, a lot of other people’s Coding Cheat Sheets, as well as my own chicken scratch.  Reducing all this down to one useful tool is where my Coding Cheat Sheet comes in!

There’s no shortage of Super Bills found on the web. Some have their diagnosis listed in alphabetical order. Some lists in numerical diagnosis code order. Most come in categories such as “complaint of pain”, “pulmonary”, “cardiovascular”, “allergy/independent”, “gastrointestinal”, “abnormal test”, “Procedures”, “supplies”, “immunization”, and “laboratory”. For me being untrained in medical procedures, most of these categories are mind-boggling but I am learning.

The best Super Bills for me has come from other doctor’s offices that focus on homebound visits. It lists the levels of patient visit, about 30 diagnosis, about 15 procedures, and about 10 labs. So these are the types of Super Bills I’ll mimic.

My Cheat Sheet will have high-level categories such as the level of the visit, labs, diagnoses, and a few procedures. My office doesn’t do many procedures in the field so therefore my procedure list will be very thin.

I’ve only coded about 50 charts to date but what I’m finding is that I’m using the same codes over and over again. The doctor sees the same kind of geriatric patients and they all typically have the same ailments being that they are 65+ years old. For example, I have been told I don’t need the details such as “HTN Benign” or “HTN NOS” or “HTN Kidney Disease”. All these patients are typically “HTN malignant”. There are exceptions to every rule but for the vast majority of these patients, 401.0 will be the code I use for HTN.

Some billing codes list names for sites on the body; on my cheat sheet, I re-write those descriptions in the terms that my physician uses. An example is 715.95 “Osteoarthritis, unspecified whether generalize or localized, pelvic region and thigh.” My physician calls this OA Lumbar. Now let’s try a hard code, PAD: In all my searching, I could not get this one on my own. Turns out, the ICD-9 code is 447.8 “other specified disorders of arteries and arterials”. My point is, each physician has their own language. Although it would be ideal if they followed the language of the ICD-9 book, that’s never the case. So my Coding Cheat Sheet will list 447.8 as PAD.

Here is my super bill.  Click on it to download the PDF version of it:

Medical Coding Cheat Sheet Download

 

So here is how I code for each chart:

I make a list 1, 2, 3, 4, & 5, for each step in the upper left corner of each patient chart. (Actually, each chart is in a PDF so I put these steps as well as the coding information into a Comment.)

Step 1 – I decide what Level the visit is based on the information supplied in the patient chart and from my previous post “Home Health Medicare payments for Established Patient Visits (CPT 99347-99350)“.

Step 2 – I look to see if any procedures were done.  If not, I skip this step.

Step 3 – I code the Chief Complaint for the chart.  I follow that with any symptoms that I can code from the HPI.  These are listed in priority order because the billing software wants to know what codes most accurately describes the patient’s visit. The free billing software I’ve been given will take a maximum of 3 codes. Note: Diagnosis codes from Step 5 can also be used in here.

Step 4 – I then code any lab results.  Although I put the abnormal value ranges directly on my cheat sheet, it find it easiest to look up the actual lab and scan for abnormalities from there.  I’ll admit, to code labs is something I made up for myself.  I looked at the ICD-9 codes, they had a way to report abnormal labs, thus I am reporting abnormal labs!  No one else has ever talked about reporting labs.  I hope someone with real knowledge will tell me if this is something that should be coded, should NOT be coded, or is indifferent about coding.

Step 5 – The last bit of coding is just regular or previous diagnoses of the patient.  I have been told to code at least 5.  A true biller would would enter them in the descending order of cost reimbursement.  First, I have not seen anywhere where there is a cost assigned to ICD-9 codes.  Second, I haven’t seen when the order of ICD-9 codes returns a greater or lessor payment from the insurance companies.  I hope a real Biller will enlighten me on this subject in a comment.

Once 1 thru 5 is completed, it’s a no brainer to type the codes into the billing software. I’m sure a real Biller could go straight from the patient chart into the billing software; maybe someday I’ll get that good.

Rob

This original post is located: http://blog.rdstokes.com/?p=278