The Family Practice Superbill form, derived from the American Academy of Family Practice (AAFP), serves as a comprehensive billing tool for healthcare providers in family practices. It meticulously outlines services rendered during a patient's visit, including diagnostic procedures, office visits, laboratory services, and additional treatments, aiming to streamline the billing process. Encompassing a vast array of codes and categories, this template ensures accurate and efficient charge capture for services provided.
To get started with filling out the Family Practice Superbill form, click the button below.
In the fast-paced world of family practice management, the Family Practice Superbill form stands as a crucial tool, designed to streamline billing processes and enhance the efficiency of medical practices. Created by the American Academy of Family Practice (AAFP), this comprehensive documentation aids healthcare providers in capturing all necessary billing information in one consolidated form. Covering a wide array of services—from office visits and procedures to laboratory tests and preventive services—the Superbill template is carefully crafted to include codes for common family practice services and diagnoses, thus simplifying the coding and billing process. It supports practices in ensuring that all services are accounted for, facilitating swift and accurate reimbursement for services rendered. Moreover, the inclusion of details like patient information, insurance data, and a spectrum of medical services, aims to mitigate billing errors and enhance operational efficiency. As healthcare providers strive to provide quality care while managing the administrative burdens of practice management, the Family Practice Superbill emerges as a key asset in optimizing financial workflows and enhancing the overall efficiency of family practices.
Family Practice Management Superbill Template
From the American Academy of Family Practice (AAFP) Family Practice Management Toolkit (http://www.aafp.org/fpm/20060900/43inse.html)
Date of service:
Waiver? l
Patient name:
Insurance:
Subscriber name:
Address:
Group #:
Previous balance:
Copay:
Today’s charges:
Phone:
Account #:
Today’s payment: check#
DOB:
Age: Sex:
Physician name:
Balance due:
RANK
Office visit
New
Est
Office procedures
Laboratory
Minimal
99211
Anoscopy
46600
Venipuncture
36415
Problem focused
99201
99212
Audiometry
92551
Blood glucose, monitoring device
82962
Expanded problem focused
99202
99213
Cerumen removal
69210
Blood glucose, visual dipstick
82948
Detailed
99203
99214
Colposcopy
57452
CBC, w/ auto differential
85025
Comprehensive
99204
99215
Colposcopy w/biopsy
57455
CBC, w/o auto differential
85027
Comprehensive (new patient)
99205
ECG, w/interpretation
93000
Cholesterol
82465
Significant, separate service
-25
ECG, rhythm strip
93040
Hemoccult, guaiac
82270
Well visit
Endometrial biopsy
58100
Hemoccult, immunoassay
82274
< 1 y
99381
99391
Flexible sigmoidoscopy
45330
Hemoglobin A1C
85018
1-4 y
99382
99392
Flexible sigmoidoscopy w/biopsy
45331
Lipid panel
80061
5-11 y
99383
99393
Fracture care, cast/splint
29_____
Liver panel
80076
12-17 y
99384
99394
Site: ____________________
KOH prep (skin, hair, nails)
87220
18-39 y
99385
99395
Nebulizer
94640
Metabolic panel, basic
80048
40-64 y
99386
99396
Nebulizer demo
94664
Metabolic panel, comprehensive
80053
65 y +
99387
99397
Spirometry
94010
Mononucleosis
86308
Medicare preventive services
Spirometry, pre and post
94060
Pregnancy, blood
84703
Pap
Q0091
Tympanometry
92567
Pregnancy, urine
81025
Pelvic & breast
G0101
Vasectomy
55250
Renal panel
80069
Prostate/PSA
G0103
Skin procedures
Units
Sedimentation rate
85651
Tobacco counseling/3-10 min
99406
Burn care, initial
16000
Strep, rapid
86403
Tobacco counseling/>10 min
99407
Foreign body, skin, simple
10120
Strep culture
87081
Welcome to Medicare exam
G0344
Foreign body, skin, complex
10121
Strep A
87880
ECG w/Welcome to Medicare exam
G0366
I&D, abscess
10060
TB
86580
G0104
I&D, hematoma/seroma
10140
UA, complete, non-automated
81000
G0107
Laceration repair, simple
120____
UA, w/o micro, non-automated
81002
Flu shot
G0008
Site: __________ Size: _____
UA, w/ micro, non-automated
81003
Pneumonia shot
G0009
Laceration repair, layered
Urine colony count
87086
Consultation/preop clearance
Urine culture, presumptive
87088
99242
Lesion, biopsy, one
11100
Wet mount/KOH
87210
99243
Lesion, biopsy, each add’l
11101
Vaccines
Comprehensive/mod complexity
99244
Lesion, destruct., benign, 1-14
17110
DT, <7 y
90702
Comprehensive/high complexity
99245
Lesion, destruct., premal., single
17000
DTP
90701
Other services
Lesion, destruct., premal., ea. add’l
17003
DtaP, <7 y
90700
After posted hours
99050
Lesion, excision, benign
114____
Flu, 6-35 months
90657
Evening/weekend appointment
99051
Flu, 3 y +
90658
Home health certification
G0180
Lesion, excision, malignant
116____
Hep A, adult
90632
Home health recertification
G0179
Hep A, ped/adol, 2 dose
90633
Post-op follow-up
99024
Lesion, paring/cutting, one
11055
Hep B, adult
90746
Prolonged/30-74 min
99354
Lesion, paring/cutting, 2-4
11056
Hep B, ped/adol 3 dose
90744
Special reports/forms
99080
Lesion, shave
113____
Hep B-Hib
90748
Disability/Workers comp
99455
Hib, 4 dose
90645
Radiology
Nail removal, partial
11730
HPV
90649
Nail removal, w/matrix
11750
IPV
90713
Skin tag, 1-15
11200
MMR
90707
Diagnoses
Medications
Pneumonia, >2 y
90732
1
Ampicillin, up to 500mg
J0290
Pneumonia conjugate, <5 y
90669
2
B-12, up to 1,000 mcg
J3420
Td, >7 y
90718
3
Epinephrine, up to 1ml
J0170
Varicella
90716
4
Kenalog, 10mg
J3301
Immunizations & Injections
Next office visit
Lidocaine, 10mg
J2001
Allergen, one
95115
Recheck
Prev
PRN
_______
D W
M Y
Normal saline, 1000cc
J7030
Allergen, multiple
95117
Instructions:
Phenergan, up to 50mg
J2550
Imm admin, one
90471
Progesterone, 150mg
J1055
Imm admin, each add’l
90472
Rocephin, 250mg
J0696
Imm admin, intranasal, one
90473
Testosterone, 200mg
J1080
Imm admin, intranasal, each add’l
90474
Referral
Tigan, up to 200 mg
J3250
Injection, joint, small
20600
To:
Toradol, 15mg
J1885
Injection, joint, intermediate
20605
Miscellaneous services
Injection, joint, major
20610
Injection, ther/proph/diag
90772
Injection, trigger point
20552
Physician signature
Supplies
X ____________________________________________________
Infectious & Parasitic Diseases
B00.9 Herpesviral infection, unspecified
A60.9 Anogenital herpesviral infection
B02.9 Zoster without complications
B27.00 Gammaherpesviral mononucleosis without complication
B27.01 Gammaherpesviral mononucleosis with polyneuropathy
B27.02 Gammaherpesviral mononucleosis with meningitis
B27.09 Gammaherpesviral mononucleosis with other complications
B27.10 Cytomegaloviral mononucleosis without complications
B27.11 Cytomegaloviral mononucleosis with polyneuropathy
B27.12 Cytomegaloviral mononucleosis with meningitis
B27.19 Cytomegaloviral mononucleosis with other complication
B27.80 Other infectious mononucleosis without complication
B27.81 Other infectious mononucleosis with polyneuropathy
B27.82 Other infectious mononucleosis with meningitis
B27.89 Other infectious mononucleosis with other complication
B27.90 Infectious mononucleosis, unspecified without complication
B27.91 Infectious mononucleosis, unspecified with polyneuropathy
B27.92 Infectious mononucleosis, unspecified with meningitis
B27.99 Infectious mononucleosis, unspecified with other complication
J02.0 Streptococcal pharyngitis
J03.00 Acute streptococcal tonsillitis, unspecified
J03.01 Acute recurrent streptococcal tonsillitis
J02.0 Streptococcal sore throat
B97.8 Other viral agents as the cause of diseases classified elsewhere
B07 Viral warts
Neoplasms Benign Neoplasms
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D23.9 Other benign neoplasm of skin, unspecified
Endocrine, Nutritional & Metabolic Disorders
Endocrine
E10.8 Type 1 diabetes mellitus with unspecified complications
E10.9 Type 1 diabetes mellitus without complications
E11.8 Type 2 diabetes mellitus with unspecified complications
E11.9 Type 2 diabetes mellitus without complications
E05.90 Thyrotoxicosis, unspecified without thyrotoxic crisis or storm
E03.9 Hypothyroidism, unspecified
Metabolic/Other
M10.9
Gout, unspecified
E78.0
Pure hypercholesterolemia
E78.2
Mixed hyperlipidemia
E66.1
Drug-induced obesity
E66.9
Obesity, unspecified
E66.3
Overweight
E66.09
Other obesity due to excess calories
Blood Diseases
D64.9
Anemia, unspecified
Mental Disorders
F41.9 Anxiety disorder, unspecified
F90.0 Attention-deficit hyperactivity disorder, predominantly inattentive type
F90.9 Attention-deficit hyperactivity disorder, unspecified type
F03 Unspecified dementia
F33.9 Major depressive disorder, recurrent, unspecified
Nervous System & Sense Organ Disorders
Nervous System Diseases
G56.00 Carpal tunnel syndrome, unspecified side
G56.01 Carpal tunnel syndrome, right side
G56.02 Carpal tunnel syndrome, left side
G40.90 Epilepsy, unspecified, not intractable
G40.901 Epilepsy, unspecified, not intractable, with status epilepticus
G40.909 Epilepsy, unspecified, not intractable, without status epilepticus
G43.90 Migraine, unspecified, not intractable
G44.039 Episodic paroxysmal hemicrania, not intractable Episodic paroxysmal hemicrania NOS
G44.049 Chronic paroxysmal hemicrania, not intractable Chronic paroxysmal hemicrania NOS
Eye Diseases
H10.9 Unspecified conjunctivitis
H53.10 Unspecified subjective visual disturbances
H53.11 Day blindness
Ear Diseases
H61.20 Impacted cerumen, unspecified ear
H61.21 Impacted cerumen, right ear
H61.22 Impacted cerumen, left ear
H61.23 Impacted cerumen, bilateral
H60.00 Abscess of external ear, unspecified ear
H60.01 Abscess of right external ear
H60.02 Abscess of left external ear
H60.03 Abscess of external ear, bilateral
H60.10 Cellulitis of external ear, unspecified ear
H60.11 Cellulitis of right external ear
H60.12 Cellulitis of left external ear
H60.13 Cellulitis of external ear, bilateral
H60.311 Diffuse otitis externa, right ear
H60.312 Diffuse otitis externa, left ear
H60.313 Diffuse otitis externa, bilateral
H60.319 Diffuse otitis externa, unspecified ear
H60.32 Hemorrhagic otitis externa
H60.321 Hemorrhagic otitis externa, right ear
H60.322 Hemorrhagic otitis externa, left ear
H60.323 Hemorrhagic otitis externa, bilateral
H60.329 Hemorrhagic otitis externa, unspecified ear
H60.391 Other infective otitis externa, right ear
H60.392 Other infective otitis externa, left ear
H60.393 Other infective otitis externa, bilateral
H60.399 Other infective otitis externa, unspecified ear
H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
H66.009 Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear
Circulatory System
Arrythmias
I48.0 Atrial fibrillation
Cardiac
I20.8 Other forms of angina pectoris
I20.9 Angina pectoris, unspecified
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I50.9 Heart failure, unspecified
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I39 Endocarditis and heart valve disorders in diseases classified elsewhere
I25.9 Chronic ischemic heart disease, unspecified
Vascular
R03.0 Elevated blood-pressure reading, without diagnosis of hypertension
I10 Essential (primary) hypertension
I95.1 Orthostatic hypotension
I73.9 Peripheral vascular disease, unspecified
I80.9 Phlebitis and thrombophlebitis of unspecified site
I87.2 Venous insufficiency (chronic) (peripheral)
I87.9 Disorder of vein, unspecified
Respiratory System
Lower Respiratory Tract
J45.909
Unspecified asthma, uncomplicated
J45.998
Other asthma
J20.0
Acute bronchitis due to Mycoplasma
pneumoniae
J20.1
Acute bronchitis due to Hemophilus
influenzae
J20.2
Acute bronchitis due to streptococcus
J20.3
Acute bronchitis due to coxsackievirus
J20.4
Acute bronchitis due to parainfluenza
virus
J20.5
Acute bronchitis due to respiratory
syncytial virus
J20.6
Acute bronchitis due to rhinovirus
J20.7
Acute bronchitis due to echovirus
J20.8
Acute bronchitis due to other specified
organisms
J20.9
Acute bronchitis, unspecified
J44.9
Chronic obstructive pulmonary disease,
unspecified
J18.8
Other pneumonia, unspecified
organism
J18.9
Pneumonia, unspecified organism
Upper Respiratory Tract
J02.8 Acute pharyngitis due to other specified organisms
J02.9 Acute pharyngitis, unspecified
J30.0 Vasomotor rhinitis
J30.9 Allergic rhinitis, unspecified
J01.90 Acute sinusitis, unspecified
J01.91 Acute recurrent sinusitis, unspecified
J01.80 Other acute sinusitis
J01.81 Other acute recurrent sinusitis
J06.9 Acute upper respiratory infection, unspecified
Digestive System
K92.1
Melena
K59.00
Constipation, unspecified
K57.30
Diverticulosis of large intestine without
perforation or abscess without bleeding
K57.50
Diverticulosis of both small and large
intestine without perforation or abscess
without bleeding
K57.90
Diverticulosis of intestine, part
unspecified, without perforation or
abscess without bleeding
K57.20
Diverticulitis of large intestine with
perforation and abscess without
bleeding
K57.40
Diverticulitis of both small and large
intestine with perforation and abscess
K57.52
K57.80
Diverticulitis of intestine, part
unspecified, with perforation and
K57.92
K29.70
Gastritis, unspecified, without bleeding
K29.90
Gastroduodenitis, unspecified, without
K52.8
Other specified noninfective
gastroenteritis and colitis
K52.9
Noninfective gastroenteritis and colitis,
K21.9
Gastro-esophageal reflux disease
without esophagitis
I84.20
Unspecified hemorrhoids without
complication
K58.0
Irritable bowel syndrome with diarrhea
K58.9
Irritable bowel syndrome without
diarrhea
Genitourinary System Urinary System Diseases
N20.2 Calculus of kidney with calculus of ureter
N20.9 Urinary calculus, unspecified
N30.00 Acute cystitis without hematuria
N30.01 Acute cystitis with hematuria
R31.0 Gross hematuria
R31.1 Benign essential microscopic hematuria
R31.2 Other microscopic hematuria
R31.9 Hematuria, unspecified
N28.9 Disorder of kidney and ureter, unspecified
N29 Other disorders of kidney and ureter in diseases classified elsewhere
N39.0 Urinary tract infection, site not specified
Male Genital Organ Diseases
N52.01 Erectile dysfunction due to arterial insufficiency
N52.02 Corporo-venous occlusive erectile dysfunction
N52.03 Combined arterial insufficiency and corporo-venous occlusive erectile dysfunction
N52.1 Erectile dysfunction due to diseases classified elsewhere
N52.2 Drug-induced erectile dysfunction
N52.31 Erectile dysfunction following radical prostatectomy
N52.32 Erectile dysfunction following radical cystectomy
N52.33 Erectile dysfunction following urethral surgery
N52.34 Erectile dysfunction following simple prostatectomy
N52.39 Other post-surgical erectile dysfunction
N53.8 Other male sexual dysfunction
N53.9 Unspecified male sexual dysfunction
F52.21 Male erectile disorder
N41.9 Inflammatory disease of prostate, unspecified
Breast Diseases
N63 Unspecified lump in breast
Female Genital Organ Diseases
Z87.44 Personal history of cervical dysplasia
N72 Inflammatory disease of cervix uteri
N87.9 Dysplasia of cervix uteri, unspecified
N76.0 Acute vaginitis
N76.1 Subacute and chronic vaginitis
N76.2 Acute vulvitis
N76.3 Subacute and chronic vulvitis
N76.4 Abscess of vulva
Disorders of Menstruation
N91.0 Primary amenorrhea
N91.1 Secondary amenorrhea
N91.2 Amenorrhea, unspecified
N95.9 Unspecified menopausal and perimenopausal disorder
N92.0 Excessive and frequent menstruation with regular cycle
N92.1 Excessive and frequent menstruation with irregular cycle
N94.4 Primary dysmenorrhea
N94.5 Secondary dysmenorrhea
N94.6 Dysmenorrhea, unspecified
Pregnancy, Childbirth
O46.90 Antepartum hemorrhage, unspecified, unspecified trimester
Z39.2 Encounter for routine postpartum follow-up
Z33.1 Pregnant state, incidental
Z34.00 Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.01 Encounter for supervision of normal first pregnancy, unspecified trimester
Z34.02 Encounter for supervision of normal first pregnancy, second trimester
Z34.03 Encounter for supervision of normal first pregnancy, third trimester
V22.1 Prenatal care, normal, other pregnancy
Z34.80 Encounter for supervision of other normal pregnancy, unspecified trimester
Z34.81 Encounter for supervision of other normal pregnancy, first trimester
Z34.82 Encounter for supervision of other normal pregnancy, second trimester
Z34.83 Encounter for supervision of other normal pregnancy, third trimester
Z34.90 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
Z34.91 Encounter for supervision of normal pregnancy, unspecified, first trimester
Z34.92 Encounter for supervision of normal pregnancy, unspecified, second trimester
Z34.93 Encounter for supervision of normal pregnancy, unspecified, third trimester
Skin, Subcutaneous Tissue
L70.0 Acne vulgaris
L70.1 Acne conglobata
L70.3 Acne tropica
L70.4 Infantile acne
L70.5 Acné excoriée des jeunes filles
L70.8 Other acne
L70.9 Acne, unspecified
L73.0 Acne keloid
L57.0 Actinic keratosis
L03.90 Cellulitis, unspecified
L03.91 Acute lymphangitis, unspecified
L03.129 Acute lymphangitis of unspecified part of limb
L03.119 Cellulitis of unspecified part of limb
L98.3 Eosinophilic cellulitis [Wells]
L23.9 Allergic contact dermatitis, unspecified cause
L24.9 Irritant contact dermatitis, unspecified cause
L25.9 Unspecified contact dermatitis, unspecified cause
L30.0 Nummular dermatitis
L30.2 Cutaneous autosensitization
L30.8 Other specified dermatitis
L30.9 Dermatitis, unspecified
L20.8 Other atopic dermatitis
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.83 Infantile (acute) (chronic) eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L20.9 Atopic dermatitis, unspecified
L21.8 Other seborrheic dermatitis
L60.0 Ingrowing nail
B35.1 Tinea unguium
L44.9 Papulosquamous disorder, unspecified
L45 Papulosquamous disorders in diseases classified elsewhere
L98.9 Disorder of the skin and subcutaneous tissue, unspecified
L40.0 Psoriasis vulgaris
L40.1 Generalized pustular psoriasis
L40.2 Acrodermatitis continua
L40.3 Pustulosis palmaris et plantaris
L40.4 Guttate psoriasis
L40.8 Other psoriasis
L40.9 Psoriasis, unspecified
L71.0 Perioral dermatitis
L71.1 Rhinophyma
L71.8 Other rosacea
L71.9 Rosacea, unspecified
L72.0 Epidermal cyst
L72.1 Trichodermal cyst
L72.2 Steatocystoma multiplex
L72.8 Other follicular cysts of the skin and subcutaneous tissue
L72.9 Follicular cyst of the skin and subcutaneous tissue, unspecified
L82.0 Inflamed seborrheic keratosis
L82.1 Other seborrheic keratosis
L98.491 Non-pressure chronic ulcer of skin of other sites limited to breakdown of skin
L98.492 Non-pressure chronic ulcer of skin of other sites with fat layer exposed
L98.493 Non-pressure chronic ulcer of skin of other sites with necrosis of muscle
L98.494 Non-pressure chronic ulcer of skin of other sites with necrosis of bone
L98.499 Non-pressure chronic ulcer of skin of other sites with unspecified severity
L50.9 Urticaria, unspecified
Musculoskeletal & Connective Tissue
General
M12.9 Arthropathy, unspecified
M60.80 Other myositis, unspecified site
M60.811 Other myositis, right shoulder
M60.812 Other myositis, left shoulder
M60.819 Other myositis, unspecified shoulder
M60.821 Other myositis, right upper arm
M60.822 Other myositis, left upper arm
M60.829 Other myositis, unspecified upper arm
M60.831 Other myositis, right forearm
M60.832 Other myositis, left forearm
M60.839 Other myositis, unspecified forearm
M60.841 Other myositis, right hand
M60.842 Other myositis, left hand
M60.849 Other myositis, unspecified hand
M60.851 Other myositis, right thigh
M60.852 Other myositis, left thigh
M60.859
Other myositis, unspecified thigh
M60.861
Other myositis, right lower leg
M60.862
Other myositis, left lower leg
M60.869
Other myositis, unspecified lower leg
M60.871
Other myositis, right ankle and foot
M60.872
Other myositis, left ankle and foot
M60.879
Other myositis, unspecified ankle and
foot
M60.88
Other myositis, Other site
M60.89
Other myositis, multiple sites
M60.9
Myositis, unspecified
M79.1
Myalgia
M79.7
Fibromyalgia
M15.9
Polyosteoarthritis, unspecified
M19.90
Unspecified osteoarthritis, unspecified
site
M81.8
Other osteoporosis without current
pathological fracture
M05.70
Rheumatoid arthritis with rheumatoid
factor of unspecified site without organ
or systems involvement
M05.71
factor of shoulder without organ or
systems involvement
M05.711
factor of right shoulder without organ or
M05.712
factor of left shoulder without organ or
M05.719
factor of unspecified shoulder without
organ or systems involvement
M05.721
factor of right elbow without organ or
M05.722
factor of left elbow without organ or
M05.729
factor of unspecified elbow without
M05.73
factor of wrist without organ or systems
involvement
M05.731
factor of right wrist without organ or
M05.732
factor of left wrist without organ or
M05.739
factor of unspecified wrist without organ
M05.74
factor of hand without organ or systems
M05.741
factor of right hand without organ or
M05.742
factor of left hand without organ or
M05.749
factor of unspecified hand without
M05.75
factor of hip without organ or systems
M05.751
factor of right hip without organ or
M05.752
factor of left hip without organ or
M05.759
factor of unspecified hip without organ
M05.76 Rheumatoid arthritis with rheumatoid factor of knee without organ or systems involvement
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.769 Rheumatoid arthritis with rheumatoid factor of unspecified knee without organ or systems involvement
M05.77 Rheumatoid arthritis with rheumatoid factor of ankle and foot without organ or systems involvement
M05.771 Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement
M05.772 Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement
M05.779 Rheumatoid arthritis with rheumatoid factor of unspecified ankle and foot without organ or systems involvement
M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
M05.80 Other rheumatoid arthritis with rheumatoid factor of unspecified site
M05.811 Other rheumatoid arthritis with rheumatoid factor of right shoulder
M05.812 Other rheumatoid arthritis with rheumatoid factor of left shoulder
M05.819 Other rheumatoid arthritis with rheumatoid factor of unspecified shoulder
M05.82 Other rheumatoid arthritis with rheumatoid factor of elbow
M05.821 Other rheumatoid arthritis with rheumatoid factor of right elbow
M05.822 Other rheumatoid arthritis with rheumatoid factor of left elbow
M05.829 Other rheumatoid arthritis with rheumatoid factor of unspecified elbow
M05.83 Other rheumatoid arthritis with rheumatoid factor of wrist
M05.831 Other rheumatoid arthritis with rheumatoid factor of right wrist
M05.832 Other rheumatoid arthritis with rheumatoid factor of left wrist
M05.839 Other rheumatoid arthritis with rheumatoid factor of unspecified wrist
M05.84 Other rheumatoid arthritis with rheumatoid factor of hand
M05.841 Other rheumatoid arthritis with rheumatoid factor of right hand
M05.842 Other rheumatoid arthritis with rheumatoid factor of left hand
M05.849 Other rheumatoid arthritis with rheumatoid factor of unspecified hand
M05.85 Other rheumatoid arthritis with rheumatoid factor of hip
M05.851 Other rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Other rheumatoid arthritis with rheumatoid factor of left hip
M05.859 Other rheumatoid arthritis with rheumatoid factor of unspecified hip
M05.86 Other rheumatoid arthritis with rheumatoid factor of knee
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M05.869 Other rheumatoid arthritis with rheumatoid factor of unspecified knee
M05.87 Other rheumatoid arthritis with rheumatoid factor of ankle and foot
M05.871
Other rheumatoid arthritis with
M06.219
Rheumatoid bursitis, unspecified
M06.83
Other specified rheumatoid arthritis,
rheumatoid factor of right ankle and
shoulder
wrist
M06.22
Rheumatoid bursitis, elbow
M06.831
M05.872
M06.221
Rheumatoid bursitis, right elbow
right wrist
rheumatoid factor of left ankle and foot
M06.222
Rheumatoid bursitis, left elbow
M06.832
Other specified rheumatoid arthritis, left
M05.879
M06.229
Rheumatoid bursitis, unspecified elbow
rheumatoid factor of unspecified ankle
M06.23
Rheumatoid bursitis, wrist
M06.839
and foot
M06.231
Rheumatoid bursitis, right wrist
unspecified wrist
M05.89
M06.232
Rheumatoid bursitis, left wrist
M06.84
rheumatoid factor of multiple sites
M06.239
Rheumatoid bursitis, unspecified wrist
hand
M05.9
M06.24
Rheumatoid bursitis, hand
M06.841
factor, unspecified
M06.241
Rheumatoid bursitis, right hand
right hand
M06.00
Rheumatoid arthritis without
M06.242
Rheumatoid bursitis, left hand
M06.842
rheumatoid factor, unspecified site
M06.249
Rheumatoid bursitis, unspecified hand
M06.01
M06.25
Rheumatoid bursitis, hip
M06.849
rheumatoid factor, shoulder
M06.251
Rheumatoid bursitis, right hip
unspecified hand
M06.011
M06.252
Rheumatoid bursitis, left hip
M06.85
Other specified rheumatoid arthritis, hip
rheumatoid factor, right shoulder
M06.259
Rheumatoid bursitis, unspecified hip
M06.851
M06.012
M06.26
Rheumatoid bursitis, knee
right hip
rheumatoid factor, left shoulder
M06.261
Rheumatoid bursitis, right knee
M06.852
M06.019
M06.262
Rheumatoid bursitis, left knee
hip
rheumatoid factor, unspecified shoulder
M06.269
Rheumatoid bursitis, unspecified knee
M06.859
M06.021
M06.27
Rheumatoid bursitis, ankle and foot
unspecified hip
rheumatoid factor, right elbow
M06.271
Rheumatoid bursitis, right ankle and
M06.86
M06.022
knee
rheumatoid factor, left elbow
M06.272
Rheumatoid bursitis, left ankle and foot
M06.861
M06.029
M06.279
Rheumatoid bursitis, unspecified ankle
right knee
rheumatoid factor, unspecified elbow
M06.862
M06.03
M06.28
Rheumatoid bursitis, vertebrae
rheumatoid factor, wrist
M06.29
Rheumatoid bursitis, multiple sites
M06.869
M06.031
M06.30
Rheumatoid nodule, unspecified site
unspecified knee
rheumatoid factor, right wrist
M06.31
Rheumatoid nodule, shoulder
M06.87
M06.032
M06.311
Rheumatoid nodule, right shoulder
ankle and foot
rheumatoid factor, left wrist
M06.312
Rheumatoid nodule, left shoulder
M06.871
M06.039
M06.319
Rheumatoid nodule, unspecified
right ankle and foot
rheumatoid factor, unspecified wrist
M06.872
M06.04
M06.32
Rheumatoid nodule, elbow
left ankle and foot
rheumatoid factor, hand
M06.321
Rheumatoid nodule, right elbow
M06.879
M06.041
M06.322
Rheumatoid nodule, left elbow
unspecified ankle and foot
rheumatoid factor, right hand
M06.329
Rheumatoid nodule, unspecified elbow
M06.88
M06.042
M06.33
Rheumatoid nodule, wrist
M06.89
rheumatoid factor, left hand
M06.331
Rheumatoid nodule, right wrist
multiple sites
M06.049
M06.332
Rheumatoid nodule, left wrist
M06.9
Rheumatoid arthritis, unspecified
rheumatoid factor, unspecified hand
M06.339
Rheumatoid nodule, unspecified wrist
M65.9
Synovitis and tenosynovitis,
M06.05
M06.34
Rheumatoid nodule, hand
rheumatoid factor, hip
M06.341
Rheumatoid nodule, right hand
M06.051
M06.342
Rheumatoid nodule, left hand
Lower Extremity
rheumatoid factor, right hip
M06.349
Rheumatoid nodule, unspecified hand
M79.601
Pain in right arm
M06.052
M06.352
Rheumatoid nodule, left hip
M79.602
Pain in left arm
rheumatoid factor, left hip
M06.359
Rheumatoid nodule, unspecified hip
M79.603
Pain in arm, unspecified
M06.059
M06.36
Rheumatoid nodule, knee
M79.604
Pain in right leg
rheumatoid factor, unspecified hip
M06.361
Rheumatoid nodule, right knee
M79.605
Pain in left leg
M06.06
M06.362
Rheumatoid nodule, left knee
M79.606
Pain in leg, unspecified
rheumatoid factor, knee
M06.369
Rheumatoid nodule, unspecified knee
M79.609
Pain in unspecified limb
M06.061
M06.37
Rheumatoid nodule, ankle and foot
M79.621
Pain in right upper arm
rheumatoid factor, right knee
M06.371
Rheumatoid nodule, right ankle and
M79.622
Pain in left upper arm
M06.062
M79.629
Pain in unspecified upper arm
rheumatoid factor, left knee
M06.372
Rheumatoid nodule, left ankle and foot
M79.631
Pain in right forearm
M06.069
M06.379
Rheumatoid nodule, unspecified ankle
M79.632
Pain in left forearm
rheumatoid factor, unspecified knee
M79.639
Pain in unspecified forearm
M06.07
M06.38
Rheumatoid nodule, vertebrae
M79.641
Pain in right hand
rheumatoid factor, ankle and foot
M06.39
Rheumatoid nodule, multiple sites
M79.642
Pain in left hand
M06.071
M06.80
M79.643
Pain in unspecified hand
rheumatoid factor, right ankle and foot
unspecified site
M79.644
Pain in right finger(s)
M06.072
M06.81
M79.645
Pain in left finger(s)
rheumatoid factor, left ankle and foot
M79.646
Pain in unspecified (s)
M06.079
M06.811
M79.651
Pain in right thigh
rheumatoid factor, unspecified ankle
right shoulder
M79.652
Pain in left thigh
M06.812
M79.659
Pain in unspecified thigh
M06.08
M79.661
Pain in right lower leg
rheumatoid factor, vertebrae
M06.819
M79.662
Pain in left lower leg
M06.09
unspecified shoulder
M79.669
Pain in unspecified lower leg
rheumatoid factor, multiple sites
M06.82
M79.671
Pain in right foot
M06.1
Adult-onset Still's disease
elbow
M79.672
Pain in left foot
M06.2
Rheumatoid bursitis
M06.821
M79.673
Pain in unspecified foot
M06.20
Rheumatoid bursitis, unspecified site
right elbow
M79.674
Pain in right toe(s)
M06.21
Rheumatoid bursitis, shoulder
M06.822
M79.675
Pain in left toe(s)
M06.211
Rheumatoid bursitis, right shoulder
M79.676
Pain in unspecified toe(s)
M06.212
Rheumatoid bursitis, left shoulder
M06.829
unspecified elbow
5
Spine/Torso
G44.321
Chronic post-traumatic headache,
S93.409A Sprain of unspecified ligament of
M54.14
Radiculopathy, thoracic region
intractable
unspecified ankle; initial encounter
M54.15
Radiculopathy, thoracolumbar region
G44.329
Chronic post-traumatic headache, not
S93.409D Sprain of unspecified ligament of
M54.16
Radiculopathy, lumbar region
unspecified ankle; subsequent
M54.17
Radiculopathy, lumbosacral region
G44.40
Drug-induced headache, not
encounter
M51.14
Intervertebral disc disorders with
elsewhere classified, not intractable
S96.919A Strain of unspecified muscle and
radiculopathy, thoracic region
G44.41
tendon at ankle and foot level,
M51.15
elsewhere classified, intractable
unspecified side; initial encounter
radiculopathy, thoracolumbar region
G44.51
Hemicrania continua
S96.919D Strain of unspecified muscle and
M51.16
G44.52
New daily persistent headache
radiculopathy, lumbar region
(NDPH)
unspecified side; subsequent
M51.17
G44.53
Primary thunderclap headache
radiculopathy, lumbosacral region
G44.59
Other complicated headache
S93.609A
Unspecified sprain of unspecified foot;
M53.9
Dorsopathy, unspecified
syndrome
initial encounter
G44.81
Hypnic headache
S93.609D Unspecified sprain of unspecified foot;
Upper Extremity
G44.82
Headache associated with sexual
subsequent encounter
M75.10
Rotator cuff syndrome, unspecified
activity
S63.90A
Initial encounter; Sprain of
G44.83
Primary cough headache
unspecified part of unspecified wrist
M75.11
Rotator cuff syndrome, right shoulder
G44.84
Primary exertional headache
and hand
M75.12
Rotator cuff syndrome, left shoulder
G44.85
Primary stabbing headache
S63.90D
Subsequent encounter; Sprain of
G44.89
Other headache syndrome
Perinatal (Infant)
R32
Unspecified urinary incontinence
P92.0
Vomiting of newborn
R22.0
Localized swelling, mass and lump,
S63.509A
Initial encounter; Unspecified sprain
P92.1
Regurgitation and rumination of
head
of unspecified wrist
newborn
R22.1
S63.509D Subsequent encounter; Unspecified
P92.2
Slow feeding of newborn
neck
sprain of unspecified wrist
P92.3
Underfeeding of newborn
R22.2
S66.919A Strain of unspecified muscle, fascia
P92.4
Overfeeding of newborn
trunk
and tendon at wrist and hand level of
P92.5
Neonatal difficulty in feeding at breast
R22.30
unspecified side; Initial encounter
P92.8
Other feeding problems of newborn
upper limb, unspecified side
S66.919D Strain of unspecified muscle, fascia
P92.9
Feeding problem of newborn,
R22.31
right upper limb
unspecified side; Subsequent
R22.32
Signs & Symptoms
left upper limb
S83.90A
R10.0
Acute abdomen
R22.33
unspecified site of knee, unspecified
R10.83
Colic
upper limb, bilateral
side
R10.9
Unspecified abdominal pain
R22.40
S83.90D
R87.619
Unspecified abnormal cytological
lower limb, unspecified side
findings in specimens from cervix
R22.41
S86.919A
Initial encounter; Strain of
uteri
right lower limb
unspecified muscle(s) and tendon(s)
M25.50
Pain in unspecified joint
R22.42
at lower leg level, unspecified leg
K62.5
Hemorrhage of anus and rectum
left lower limb
S86.919D Subsequent encounter; Strain of
R07.81
Pleurodynia
R22.43
R07.82
Intercostal pain
lower limb, bilateral
R07.89
Other chest pain
R22.9
S16.1A
Initial encounter; Strain of muscle,
R07.9
Chest pain, unspecified
fascia and tendon at neck level
R05
Cough
R59.0
Localized enlarged lymph nodes
S16.1D
Subsequent encounter; Strain of
R19.7
Diarrhea, unspecified
R59.1
Generalized enlarged lymph nodes
muscle, fascia and tendon at neck
R42
Dizziness and giddiness
R59.9
Enlarged lymph nodes, unspecified
level
R13.10
Dysphagia, unspecified
R53.0
Neoplastic (malignant) related fatigue
S13.4A
Initial encounter; Sprain of ligaments
R13.11
Dysphagia, oral phase
R53.1
Weakness
of cervical spine
R13.12
Dysphagia, oropharyngeal phase
R53.2
Functional quadriplegia
S13.4D
R13.13
Dysphagia, pharyngeal phase
R53.81
Other malaise
ligaments of cervical spine
R13.14
Dysphagia, pharyngoesophageal
R53.83
Other fatigue
S13.8A
Initial encounter; Sprain of joints and
phase
G93.3
Postviral fatigue syndrome
ligaments of other parts of neck
R13.19
Other dysphagia
R11.1
Nausea alone
S13.8D
R30.0
Dysuria
R11.0
Nausea with vomiting
joints and ligaments of other parts of
R30.9
Painful micturition, unspecified
M25.561
Pain in right knee
R60.0
Localized edema
M25.562
Pain in left knee
S43.409A
R60.1
Generalized edema
M25.569
Pain in unspecified knee
of unspecified shoulder joint
R60.9
Edema, unspecified
M54.5
Low back pain
S43.409D Subsequent encounter; Unspecified
R63.3
Feeding difficulties
R00.2
Palpitations
sprain of unspecified shoulder joint
R50.2
Drug induced fever
R35.8
Other polyuria
S43.90A
R50.8
Other specified fever
R21
Rash and other nonspecific skin
unspecified parts of shoulder girdle,
R50.9
Fever, unspecified
eruption
unspecified side
E74.9
Disorder of carbohydrate metabolism,
R20.1
Hypoesthesia of skin
S43.90D
R20.2
Paresthesia of skin
G44.10
Vascular headache, not elsewhere
R20.3
Hyperesthesia
classified, not intractable
R20.8
Other disturbances of skin sensation
S46.919A
Strain of unspecified muscle, fascia
G44.11
R20.9
Unspecified disturbances of skin
and tendon at shoulder and upper
classified, intractable
sensation
arm level, unspecified arm; Initial
G44.301
Post-traumatic headache,
R06.02
Shortness of breath
unspecified, intractable
R55
Syncope and collapse
S46.919D Strain of unspecified muscle, fascia
G44.309
R35.0
Frequency of micturition
unspecified, not intractable
R11.2
Projectile vomiting
arm level, unspecified arm;
G44.311
Acute post-traumatic headache,
R11.3
Other vomiting without nausea
Subsequent encounter
R63.4
Abnormal weight loss
G44.319
Acute post-traumatic headache, not
Other Trauma, Adverse Effects
Intractable
Injuries & Adverse Effects
S00.01A
Abrasion of scalp; Initial encounter
Dislocations, Sprains & Strains
6
S00.01D
Abrasion of scalp; Subsequent
S30.817D Abrasion of anus; Subsequent
S00.531D Contusion of lip; Subsequent
S00.219A
Abrasion of unspecified eyelid and
S40.219A
Abrasion of unspecified shoulder;
S00.532A
Contusion of oral cavity; Initial
periocular area; Initial encounter
Initial encounter
S00.219D Abrasion of unspecified eyelid and
S40.219D Abrasion of unspecified shoulder;
S00.532D Contusion of oral cavity; Subsequent
periocular area; Subsequent
S40.819A
Abrasion of unspecified upper arm;
S10.0A
Contusion of throat; Initial encounter
S00.31A
Abrasion of nose; Initial encounter
S10.0D
Contusion of throat; Subsequent
S00.31D
Abrasion of nose; Subsequent
S40.819D Abrasion of unspecified upper arm;
S10.83A
Contusion of other part of neck; Initial
S00.419A
Abrasion of unspecified ear; Initial
S50.319A
Abrasion of unspecified elbow; Initial
S10.83D
Contusion of other part of necks;
S00.419D Abrasion of unspecified ear;
S50.319D Abrasion of unspecified elbow;
S10.93A
Contusion of unspecified part of neck;
S00.511A
Abrasion of lip; Initial encounter
S50.819A
Abrasion of unspecified forearm;
S00.511D Abrasion of lip; Subsequent
S10.93D
S50.819D Abrasion of unspecified forearm;
S00.512A
Abrasion of oral cavity; Initial
S20.00A
Contusion of breast, unspecified
S60.319A
Abrasion of unspecified thumb; Initial
breast; Initial encounter
S00.512D Abrasion of oral cavity; Subsequent
S20.00D
S60.319D Abrasion of unspecified thumb;
breast; Subsequent encounter
S10.11A
Abrasion of throat; Initial encounter
S20.219A
Contusion of unspecified front wall of
S10.11D
Abrasion of throat; Subsequent
S60.419A
Abrasion of unspecified finger; Initial
thorax; Initial encounter
S20.219D Contusion of unspecified front wall of
S10.81A
Abrasion of other part of neck; Initial
S60.419D Abrasion of unspecified finger;
thorax; Subsequent encounter
S20.229A Contusion of unspecified back wall of
S10.81S
Abrasion of other part of necks
S60.519A
Abrasion of unspecified hand; Initial
S20.229D Contusion of unspecified back wall of
S10.91A
Abrasion of unspecified part of neck;
S60.519D Abrasion of unspecified hand;
S30.00A
Contusion of lower back and pelvis;
S10.91D
S60.819A
Abrasion of unspecified wrist; Initial
S30.00D
S20.119A Abrasion of breast, unspecified
S60.819D Abrasion of unspecified wrist;
S30.1A
Contusion of abdominal wall; Initial
S20.119D Abrasion of breast, unspecified
S70.219A
Abrasion, unspecified hip; Initial
S30.1D
Contusion of abdominal wall;
S20.319A Abrasion of unspecified front wall of
S70.219D Abrasion, unspecified hip;
S30.21A
Contusion of penis; Initial encounter
S20.319D Abrasion of unspecified front wall of
S70.319A
Abrasion, unspecified thigh; Initial
S30.21D
Contusion of penis; Subsequent
S20.419A Abrasion of unspecified back wall of
S70.319D Abrasion, unspecified thigh;
S30.22A
Contusion of scrotum and testes;
S20.419D Abrasion of unspecified back wall of
S80.219A
Abrasion, unspecified knee; Initial
S30.22D
S20.91A
Abrasion of unspecified parts of
S80.219D Abrasion, unspecified knee;
S30.23A
Contusion of vagina and vulva; Initial
S20.91D
S90.413A
Abrasion, unspecified great toe; Initial
S30.23D
Contusion of vagina and vulva;
S30.810A Abrasion of lower back and pelvis;
S90.413D Abrasion, unspecified great toe;
S30.201A Contusion of unspecified external
genital organs, male; Initial encounter
S30.810D Abrasion of lower back and pelvis;
S90.416A
Abrasion, unspecified lesser toe(s);
S30.201D Contusion of unspecified external
genital organs, male; Subsequent
S30.811A
Abrasion of abdominal wall; Initial
S90.416D Abrasion, unspecified lesser toe(s);
S30.202A Contusion of unspecified external
S30.811D Abrasion of abdominal wall;
S90.519A
Abrasion, unspecified ankle; Initial
genital organs, female; Initial
S30.812A
Abrasion of penis; Initial encounter
S90.519D Abrasion, unspecified ankle;
S30.202D Contusion of unspecified external
S30.812D Abrasion of penis; Subsequent
genital organs, female; Subsequent
S90.819A
Abrasion, unspecified foot; Initial
S30.813A
Abrasion of scrotum and testes; Initial
S30.3A
Contusion of anus; Initial encounter
S90.819D Abrasion, unspecified foot;
S30.3D
Contusion of anus; Subsequent
S30.813D Abrasion of scrotum and testes;
S00.03A
Contusion of scalp; Initial encounter
S40.019A
Contusion of unspecified shoulder;
S30.814A
Abrasion of vagina and vulva; Initial
S00.03D
Contusion of scalp; Subsequent
S40.019D Contusion of unspecified shoulder;
S30.814D Abrasion of vagina and vulva;
S00.19A
Contusion of unspecified eyelid and
S40.029A
Contusion of unspecified upper arm;
S30.815A
Abrasion of unspecified external
S00.19D
S40.029D Contusion of unspecified upper arm;
S30.815D Abrasion of unspecified external
S00.33A
Contusion of nose; Initial encounter
S50.00A
Contusion of unspecified elbow; Initial
S00.33D
Contusion of nose; Subsequent
S30.816A Abrasion of unspecified external
S50.00D
Contusion of unspecified elbow;
S00.439A
Contusion of unspecified ear; Initial
S50.10A
Contusion of unspecified forearm;
S30.816D Abrasion of unspecified external
S00.439D Contusion of unspecified ear;
S50.10D
S00.531A
Contusion of lip; Initial encounter
S30.817A
Abrasion of anus; Initial encounter
S60.019
Contusion of unspecified thumb; Initial
7
Contusion of unspecified thumb;
S10.96D
Insect bite of unspecified part of neck;
S40.269D Insect bite of unspecified shoulder;
S60.00A
Contusion of unspecified finger
S20.161A
Insect bite of breast, right breast;
S40.869A
Insect bite of unspecified upper arm;
without damage to nail; Initial
S20.161D Insect bite of breast, right breast;
S40.869D Insect bite of unspecified upper arm;
S60.00D
without damage to nail; Subsequent
S20.162A
Insect bite of breast, left breast; Initial
S50.369A
Insect bite of unspecified elbow; Initial
S60.229A
Contusion of unspecified hand; Initial
S20.162D Insect bite of breast, left breast;
S50.369D Insect bite of unspecified elbow;
S60.229D Contusion of unspecified hand;
S20.169A
Insect bite of breast, unspecified
S50.869A
Insect bite of unspecified forearm;
S60.211A
Contusion of right wrist; Initial
S20.169D Insect bite of breast, unspecified
S50.869D Insect bite of unspecified forearm;
S60.211D Contusion of right wrist; Subsequent
S20.361A
Insect bite of right front wall of thorax;
S60.369A
Insect bite of unspecified thumb;
S60.212A
Contusion of left wrist; Initial
S20.361D Insect bite of right front wall of thorax;
S60.369D Insect bite of unspecified thumb;
S60.212D Contusion of left wrist; Subsequent
S20.361S
S60.468A
Insect bite of other finger; Initial
S60.219A
Contusion of unspecified wrist; Initial
S20.362A
Insect bite of left front wall of thorax;
S60.468D Insect bite of other finger; Subsequent
S60.219D Contusion of unspecified wrist;
S20.362D Insect bite of left front wall of thorax;
S60.469A
Insect bite of unspecified finger; Initial
S70.00A
Contusion, unspecified hip; Initial
S20.369A
Insect bite of unspecified front wall of
S60.469D Insect bite of unspecified finger;
S70.00D
Contusion, unspecified hip;
S20.369D Insect bite of unspecified front wall of
S60.569A
Insect bite of unspecified hand; Initial
S70.10A
Contusion, unspecified thigh; Initial
S20.461A
Insect bite of right back wall of thorax;
S60.569D Insect bite of unspecified hand;
S70.10D
Contusion, unspecified thigh;
S20.461D Insect bite of right back wall of thorax;
S60.869A
Insect bite of unspecified wrist; Initial
S80.00A
Contusion, unspecified knee; Initial
S20.462A
Insect bite of left back wall of thorax;
S60.869D Insect bite of unspecified wrist;
S80.00D
Contusion, unspecified knee;
S20.462D Insect bite of left back wall of thorax;
S70.269A
Insect bite, unspecified hip; Initial
S90.11A
Contusion, unspecified great toe;
S20.469A
Insect bite of unspecified back wall of
S70.269D Insect bite, unspecified hip;
S90.11D
S20.469D Insect bite of unspecified back wall of
S70.369A
Insect bite, unspecified thigh; Initial
S90.129A
Contusion, unspecified lesser toe(s);
S20.96A
Insect bite of unspecified parts of
S70.369D Insect bite, unspecified thigh;
S90.129D Contusion, unspecified lesser toe(s);
S20.96D
S80.269A
Insect bite, unspecified knee; Initial
S90.00A
Contusion, unspecified ankle; Initial
S30.860A
Insect bite of lower back and pelvis;
S80.269D Insect bite, unspecified knee;
S90.00D
Contusion, unspecified ankle;
S30.860D Insect bite of lower back and pelvis;
S90.463A
Insect bite, unspecified great toe;
S00.06A
Insect bite of scalp; Initial encounter
S30.861A
Insect bite of abdominal wall; Initial
S90.463D Insect bite, unspecified great toe;
S00.06D
Insect bite of scalp; Subsequent
S30.861D Insect bite of abdominal wall;
S90.466A
Insect bite, unspecified lesser toe(s);
S00.269A
Insect bite of unspecified eyelid and
S30.862A
Insect bite of penis; Initial encounter
S90.466D Insect bite, unspecified lesser toe(s);
S00.269D Insect bite of unspecified eyelid and
S30.862D Insect bite of penis; Subsequent
S90.569A
Insect bite, unspecified ankle; Initial
S30.863A Insect bite of scrotum and testes;
S00.36A
Insect bite of nose; Initial encounter
S90.569D Insect bite, unspecified ankle;
S00.36D
Insect bite of nose; Subsequent
S30.863D Insect bite of scrotum and testes;
S90.869A
Insect bite, unspecified foot; Initial
S00.469A
Insect bite of unspecified ear; Initial
S30.864A
Insect bite of vagina and vulva; Initial
S90.869D Insect bite, unspecified foot;
S00.469D Insect bite of unspecified ear;
S30.864D Insect bite of vagina and vulva;
S71.009A Unspecified open wound, unspecified
S00.561A
Insect bite of lip; Initial encounter
S30.865A
Insect bite of unspecified external
hip; Initial encounter
S00.561D Insect bite of lip; Subsequent
S71.009D Unspecified open wound, unspecified
S30.865D Insect bite of unspecified external
hip; Subsequent encounter
S00.562A
Insect bite of oral cavity; Initial
S71.109A
Unspecified open wound, unspecified
thigh; Initial encounter
S00.562D Insect bite of oral cavity; Subsequent
S30.866A
S71.109D Unspecified open wound, unspecified
thigh; Subsequent encounter
S10.16A
Insect bite of throat; Initial encounter
S41.009A
Unspecified open wound of
S10.16D
Insect bite of throat; Subsequent
S30.866D Insect bite of unspecified external
unspecified shoulder; Initial encounter
S41.009D Unspecified open wound of
S10.86A
Insect bite of other part of neck; Initial
unspecified shoulder; Subsequent
S30.867A
Insect bite of anus; Initial encounter
S10.86S
Insect bite of other part of necks;
S30.867D Insect bite of anus; Subsequent
S41.109A Unspecified open wound of
unspecified upper arm; Initial
S10.96A
S40.269A
Insect bite of unspecified shoulder;
8
S41.109D Unspecified open wound of unspecified upper arm; Subsequent encounter
S51.009A Unspecified open wound of unspecified elbow; Initial encounter
S51.009D Unspecified open wound of unspecified elbow; Subsequent encounter
S51.809A Unspecified open wound of unspecified forearm; Initial encounter
S51.809D Unspecified open wound of unspecified forearm; Subsequent encounter
Supplemental Classification
Z30.011 Encounter for initial prescription of contraceptive pills
Z30.013 Encounter for initial prescription of
injectable contraceptive
Z30.018 Encounter for initial prescription of other contraceptives
Z30.019 Encounter for initial prescription of contraceptives, unspecified
Z48.01 Encounter for change or removal of
surgical wound dressing
Z20.9 Contact with and exposure to unspecified communicable disease
Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings
Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear
Z23 Encounter for immunization
Z30.2 Encounter for sterilization
Z00.00 Encounter for general adult medical examination without abnormal findings
Z00.01 Encounter for general adult medical examination with abnormal findings
Z00.10 Encounter for routine child health examination without abnormal findings
Z00.11 Encounter for routine child health examination with abnormal findings
9
Filling out a Family Practice Superbill form is a crucial step in the medical billing process that ensures healthcare providers are compensated for their services. This form captures all the details of a patient's visit, from personal information to services rendered, making it easier for practices to submit claims to insurance companies. Following these steps carefully can help streamline patient billing and reduce errors that might delay payment.
Once completed, this document not only facilitates patient billing and insurance claims but also serves as an essential record for both the medical practice and patient. Accuracy in filling out this form ensures proper billing and is vital for the healthcare provider's revenue cycle.
What is a Family Practice Superbill and who uses it?
A Family Practice Superbill is a comprehensive form used by healthcare providers in family practice to compile and record all chargeable services during a patient's visit. It includes details such as procedures, laboratory tests, vaccinations, and any other services provided. This document is essential for billing and insurance purposes, utilized by physicians, administrative staff, and medical billers.
How is the information entered on a Superbill used for insurance purposes?
The information on a Superbill is critical for insurance claim processing. Each service and procedure listed on the form is assigned a specific code, including CPT (Current Procedural Terminology) codes for medical procedures and ICD (International Classification of Diseases) codes for diagnoses. These codes are used by insurance companies to determine the coverage and reimbursement for the rendered services.
Can patients understand the details listed on a Superbill?
While Superbills are primarily designed for healthcare providers and insurance companies, patients can also use them to understand the services they received during their visit. However, the technical nature of the coding might require further explanation from the provider to ensure the patient fully understands the details, such as procedures performed and the corresponding charges.
What is the significance of the "-25" modifier listed next to certain procedures?
The "-25" modifier is used to indicate that a significant, separately identifiable evaluation and management service was performed by the same physician on the same day of the procedure or other service. It is essential for billing purposes, signaling to the insurance company that a distinct service, warranting additional payment, was provided in addition to other services listed on the Superbill.
How do healthcare providers determine which codes to use on a Superbill?
Healthcare providers determine which codes to use based on the specific services rendered during the patient's visit. They rely on their knowledge of coding standards, such as the most current CPT and ICD codes, to accurately document each service. Providers often use coding resources and software to assist in selecting the appropriate codes to ensure compliance with billing and insurance requirements.
Are Superbills the same across all family practices?
While the basic structure of a Superbill is similar across family practices, the specific details and codes can vary significantly. Each practice may customize its Superbill to reflect the unique services it provides, the common conditions treated, and the preferences of its healthcare providers. The goal is to accurately and efficiently document all billable services offered to patients.
What happens if there is a mistake on the Superbill?
If there is a mistake on the Superbill, it can lead to issues with insurance claims, such as delays or denials. When errors are identified, healthcare providers or their administrative staff must correct the information and resubmit the Superbill or insurance claim. This process emphasizes the importance of accuracy and thoroughness when initially completing the Superbill.
Can a Superbill be revised after submission?
Yes, a Superbill can be revised after submission. If errors are detected or if additional information is needed, the healthcare provider can update the Superbill and resubmit it to the insurance company. This is a common practice in medical billing to ensure that all services are accurately documented and billed accordingly.
Filling out a Family Practice Superbill form from the American Academy of Family Practice (AAFP) seems straightforward, but simple mistakes can lead to big headaches down the road. From ensuring patient information is accurate to correctly identifying the service codes, precision is key. Let's dive into nine common mistakes to avoid for a smoother process.
1. Incomplete or Incorrect Patient Information: The basics matter. It's surprisingly common for people to skip fields or enter inaccurate information regarding the patient's name, date of birth (DOB), or insurance details. Every piece is crucial for billing and insurance purposes. A simple typo could delay processing or result in a denied claim.
2. Mismatched Insurance and Subscriber Information: When the insurance subscriber is not the patient (for example, a parent or spouse), it's essential to distinguish between the two clearly. Failing to specify the subscriber's name and relationship to the patient can confuse the billing process and possibly delay coverage verification.
3. Incorrect or Omitted Date of Service: Each service provided must have an associated date. Unfortunately, dates can sometimes be entered incorrectly or not at all. This oversight can lead to confusion and potentially cause the insurance company to reject the claim due to the lack of temporal context for the billed service.
4. Not Specifying Services with Appropriate Codes: Medical services and procedures listed without the correct Current Procedural Terminology (CPT) codes are a common error. These codes communicate to insurers the specific services provided, and incorrect or missing codes can result in unpaid claims.
5. Neglecting Modifiers: Modifiers are critical. They provide additional information about a procedure, such as -25 for a significant, separate service. Not including these where necessary can lead to underpayment or denial of claims, as insurers might not understand the full context of the service rendered.
6. Failing to Document Co-payment Collection: If a copayment was collected at the time of the visit but wasn't recorded on the superbill, this could result in inaccuracies in patient account balances. It's essential to meticulously document copays to ensure accurate financial records.
7. Office Visit and Procedure Rank Confusion: The superbill often requires ranking for office visits and procedures based on their complexity and necessity. Mixing up these ranks or misrepresenting the service's complexity can lead to incorrect billing amounts and potential claim rejections or audits.
8. Overlooking Medicare Preventive Services: Medicare covers specific preventive services under certain conditions. However, if these services are coded incorrectly or not flagged appropriately on the superbill, patients could be wrongfully charged, or the practice might not receive reimbursement from Medicare.
9. Inaccurate Diagnoses codes: Each service on the superbill needs to be matched with a diagnosis code that justifies the need for the service. Mistakes in these codes can lead to claim denials, as the insurance may not see the medical necessity of the billed service. Accurately coding the diagnosis is critical for a smooth reimbursement process.
Correctly filling out a Family Practice Superbill requires attention to detail across several areas. While the task may seem daunting, understanding these common pitfalls can help avoid unnecessary delays or denials in insurance claims processing. Always double-check submissions for accuracy and completeness to maintain streamlined billing operations.
When managing patient care and billing within a family practice setting, the Family Practice Superbill form from the American Academy of Family Practice (AAFP) plays a crucial role in streamlining billing processes. However, integrating this form with other essential documents can further optimize both patient care and administrative efficiency. Below is a brief overview of additional forms and documents frequently utilized alongside the Family Practice Superbill form:
Together, these documents form a comprehensive administrative protocol that complements the Family Practice Superbill form. By ensuring that all these elements are in place and properly utilized, family practice facilities can provide a higher level of care and efficiency. This holistic approach not only enhances the patient experience but also supports the healthcare provider in delivering quality care efficiently and effectively.
The Encounter Forms used in medical practices closely align with the Family Practice Superbill form in their function of capturing the details of a patient visit for billing purposes. Encounter forms often include patient demographics, service date, diagnosis codes, and procedures performed, much like the Superbill, serving as a critical document for ensuring accurate billing and record-keeping.
Medical Invoices share similarities with the Family Practice Superbill form, as both include detailed lists of services provided, associated costs, and patient information. However, while the Superbill often focuses on the medical coding necessary for insurance claims, invoices might be more focused on the direct financial transaction between the patient and the provider.
Procedure Coding Sheets are akin to the Superbill in that they detail the medical procedures performed during a patient's visit, using CPT (Current Procedural Terminology) codes. Both documents are vital for translating the healthcare services provided into standardized codes necessary for billing and insurance purposes.
Insurance Claim Forms, such as the CMS-1500, resemble the Superbill in their purpose of submitting medical services for insurance reimbursement. Both documents require accurate procedure and diagnosis codes to ensure the healthcare provider receives payment from insurance companies for services rendered to patients.
Patient Registration Forms, while primarily used for collecting patient demographic and insurance information at the outset of a visit, overlap with the Superbill regarding the collection of essential billing information. The Superbill takes this a step further by integrating clinical data from the visit into the billing process.
Health Maintenance Reminders, though more clinical in focus, share the intent of the Superbill to enhance patient care. Where the Superbill documents services provided for accurate billing, health maintenance reminders track necessary preventive services and follow-up care, contributing to the overall healthcare management of a patient.
Electronic Health Records (EHR) Documentation systems encompass the functionalities of a Superbill within a digital framework, facilitating the recording of diagnoses, procedures, and other billing information directly through the provider's clinical workflow. This integration streamlines the billing process by directly linking clinical care with coding and billing requirements.
Laboratory Requisition Forms, necessary for ordering tests, share the Superbill's feature of recording clinical services requested for a patient. Both documents are integral to the patient care process, ensuring that clinical decisions translate into actionable healthcare services, whether diagnostic or therapeutic.
Prescription Pads, while distinctly focused on medication orders, coincide with the Superbill's role in the healthcare process by translating clinical decisions into specific actions. In this case, the action is the dispensing of medication, whereas the Superbill encapsulates a broader range of clinical services for billing purposes.
Completing the Family Practice Superbill form accurately is crucial for ensuring that billing and insurance claims are processed efficiently and correctly. Here are some do's and don’ts to guide you through the process:
Do:
Don't:
Following these guidelines can help to minimize errors, reduce claims denials, and expedite the billing process.
When discussing the Family Practice Superbill form, numerous misconceptions often emerge. Here are ten common misunderstandings and explanations to provide clarity.
The Superbill is only for insurance companies. While it's true that the Superbill is primarily used for insurance billing, it also serves as a valuable tool for patient records, detailing services rendered during a visit. This comprehensive overview can help patients understand their care and facilitate communication between healthcare providers.
Superbills are standardized across all healthcare practices. Although the Superbill includes common elements recommended by the American Academy of Family Practice (AAFP), each practice customizes its Superbill to fit the specific services they offer. This means that Superbills can vary significantly from one practice to another.
A Superbill is the same as an invoice or bill. A Superbill provides detailed information about the services provided during a patient visit, including diagnosis codes and prices. However, unlike an invoice, it's designed primarily for insurance companies to process claims, not as a final bill for the patient.
Superbills are only used for family practice clinics. While the term "Family Practice Superbill" might imply that it's exclusive to family practice clinics, many types of healthcare providers use Superbills. They are adapted to the specific services offered by a practice, whether it's in family medicine, pediatrics, or specialized care.
Patients do not need to understand their Superbill. Ensuring that patients understand their Superbill can actually enhance the care process, empowering them to manage their health expenses better and facilitating smoother communication with insurance providers.
Electronic Health Records (EHRs) have made Superbills obsolete. Even with the widespread adoption of EHRs, Superbills remain an important part of the billing process. EHRs can simplify generating and managing Superbills, but the document itself is still crucial for insurance billing and patient records.
Superbills cover only the codes and costs of services rendered. Beyond codes and costs, Superbills include valuable information such as patient demographics, date of service, physician name, and insurance details. This comprehensive document assists in the accurate processing of healthcare claims.
There's no need to update Superbills regularly. In reality, Superbills should be updated regularly to ensure they include the most current billing codes and accurately reflect the services the practice offers. This helps prevent billing errors and rejected insurance claims.
Any staff member can create and manage Superbills without training. Properly managing Superbills requires a good understanding of medical billing codes and insurance processes. Training staff members responsible for Superbills can improve billing accuracy and reduce the risk of errors.
Superbills are only beneficial for practices that accept insurance. Even practices that primarily operate on a cash basis can find Superbills useful. They provide patients with the necessary documentation to seek reimbursement from their insurance companies for out-of-network services.
Addressing these misconceptions can help improve the understanding and use of Superbills in family practices, ultimately facilitating a smoother billing process and enhancing patient satisfaction.
Understanding how to properly fill out and use the Family Practice Superbill form is crucial for ensuring accurate billing and reimbursement for medical services. Here are seven key takeaways that can help guide you through this process:
Correctly completing and utilizing the Family Practice Superbill form supports efficient billing processes, aids in quicker reimbursement from insurance companies, and maintains accurate financial records for healthcare providers.
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