Will ICD-10 End the Paper Superbill?

To a regular person, the idea of doing away with something called a superbill might sound alluring. I, for one, would love to trash the supersized energy bill I received after running my air conditioner throughout the month of August in Phoenix. For healthcare providers, however, the term “superbill” has a whole different meaning: it’s “a form used by medical practitioners and clinicians so they can quickly complete and submit the procedure(s) and diagnosis(s) for a patient visit for reimbursement,” explains the American Academy of Professional Coders (AAPC).

Many ICD-10 prep resources—including ICD10forPT—have encouraged providers to create ICD-10 versions of their current ICD-9 superbills, an exercise that:

  1. Helps practitioners get comfortable with navigating the ICD-10 code set, and
  2. Produces a helpful ICD-10 resource specific to each individual practice.

But while converting your ICD-9 superbill to ICD-10 is a great way to learn the ICD-10 ropes, it definitely shouldn’t be your only training activity. Furthermore, keep in mind that paper superbills won’t carry nearly as much weight in the post-ICD-9 world. In fact, relying on a superbill to guide your practice’s coding decisions likely will be a losing strategy with ICD-10. Here’s why:

1. Many ICD-9 superbills contain general codes.

In the interest of saving space, most superbills feature a hefty portion of “unspecified” or “not otherwise specified” ICD-9 codes. And while those codes might be enough to generate payment now, they’re just not going to cut it after the big switch. After all, one of the driving forces behind the move to ICD-10 is the global call for greater detail when coding patient diagnoses. For that reason, “ICD-10 requires you to code to the highest possible level of specificity,” explains this blog post. But mapping one general code to another defeats the purpose of the transition—and, more importantly, puts your practice at risk for denied payments.

2. Crosswalking tools often map ICD-9 codes to non-specific ICD-10 equivalents.

For the superbill conversion strategy to work well in practice, you’d need to find a single ICD-10 code to sub in for each ICD-9 code. And I hate to be the bearer of bad news, but you don’t have a snowball’s chance in the Sonoran Desert of doing that—at least not in a way that would meet the aforementioned specificity standard. In fact, in many cases, the quest to find a one-to-one match for a fairly specific ICD-9 code will actually lead to a less-specific ICD-10 code. The AAPC offers the following example to illustrate this point: CMS’s crosswalk maps the ICD-9 code 845.00, Sprained/strained ankle, unspecified, to both S93.409A, Sprain of unspecified ligament of unspecified ankle, initial encounter, and S93.409D, Sprain of unspecified ligament of unspecified ankle, subsequent encounter. “However, this is incomplete because it does not include a code for a strained ankle,” the article points out.  

3. More coding specificity means more codes.

Superbills are meant to be quick resources, and the ones currently in use probably don’t have enough room to accommodate all relevant ICD-10 codes. That’s because, as this ICD10forPT article states, “…for each ICD-9 code, there could be dozens—sometimes even hundreds—of possible ICD-10 equivalents.” And there’s no way to know which one to use until you have a real, live patient in front of you, because you’ll need to have a complete picture of the patient’s situation in order to select the code that most accurately represents his or her specific diagnosis. So, while your incumbent superbill might fit nicely on one page, your ICD-10 version could explode to nearly ten pages—or even more. As Gayl Kirkpatrick, a solution sales executive for 3M HIS Consulting Services, tells Government Health IT in this article, “We took a two-page superbill in ICD-9 and translated that into ICD-10…It became a 48-page superbill.”

4. Paper is so last-millenium.

The transition to ICD-10 represents a huge step forward for the entire US healthcare industry. This is the code set of the future (of the present, actually—after all, we’re the last major country in the world to take the ICD-10 plunge). It’s not just about us; it’s about collecting and analyzing data to raise the bar for patient care on a global scale. And to do that, we have to move away from the paper systems of old and embrace the technology that will usher us into a new age of health care. Who needs a printed list of codes when they have innovative, intuitive coding tools at their fingertips—tools that allow them to approach coding in a wholly patient-centric way? When you think about it that way, paper just can’t compete.


While paper superbills probably won’t disappear as fast as popsicles at an Arizona summer picnic, they will become less useful—and less reliable—come October 1. Looking for a better way to streamline diagnosis code selection? Click here to see a solution that puts paper superbills to shame.