The Family Practice Superbill is a crucial document used by healthcare providers to capture patient visit details, including services rendered and associated charges. This form helps streamline billing and ensures accurate insurance claims processing. To effectively manage your healthcare billing, fill out the Family Practice Superbill by clicking the button below.
The Family Practice Superbill is a vital tool for healthcare providers, streamlining the billing process and ensuring accurate documentation of services rendered. This form captures essential patient information, including the date of service, patient and subscriber details, and insurance information. It also outlines various services provided, ranging from office visits and procedures to laboratory tests and immunizations. Each service is accompanied by a specific code, allowing for efficient billing and reimbursement from insurance companies. Additionally, the Superbill includes sections for recording patient payments, balances due, and physician signatures, which are crucial for maintaining financial records. By utilizing this comprehensive form, family practices can enhance their operational efficiency, reduce billing errors, and improve overall patient care.
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
Filling out the Family Practice Superbill form is essential for ensuring accurate billing and record-keeping. Follow these steps carefully to complete the form correctly.
Once you have filled out the form, it will be ready for submission to the insurance provider for billing purposes. Ensure that all information is accurate to avoid delays in processing claims.
What is a Family Practice Superbill?
A Family Practice Superbill is a document used by healthcare providers to itemize services rendered to patients during a visit. It serves as a detailed record of the patient's encounter, including the date of service, patient information, and the specific procedures or diagnoses associated with that visit. This form is essential for billing purposes and helps ensure accurate reimbursement from insurance companies.
What information is included on a Superbill?
The Superbill typically includes the patient's name, date of birth, insurance details, and the physician's name. It also lists various services provided, such as office visits, procedures, and laboratory tests, along with corresponding codes and charges. Additionally, it may include copayment amounts, previous balances, and total charges for the visit.
How do I fill out a Superbill?
To complete a Superbill, start by entering the patient's personal information, including their name, date of birth, and insurance details. Next, document the services provided during the visit by selecting the appropriate codes from the list. Ensure that each service is accurately recorded, including any applicable modifiers. Finally, calculate the total charges and any payments made at the time of service.
What are the coding systems used on the Superbill?
The Superbill utilizes various coding systems, primarily the Current Procedural Terminology (CPT) codes for procedures and services, and the International Classification of Diseases (ICD) codes for diagnoses. These codes are essential for billing and must be accurate to ensure proper reimbursement from insurance companies.
Why is the Superbill important for billing?
The Superbill is crucial for billing as it provides a comprehensive record of the services rendered. Insurance companies rely on this document to process claims and determine reimbursement amounts. An accurately filled Superbill helps prevent delays in payment and reduces the likelihood of claim denials.
Can patients receive a copy of their Superbill?
Yes, patients can request a copy of their Superbill after their visit. This document can be helpful for patients who wish to submit claims to their insurance companies or keep a record of their medical expenses for tax purposes. Providers typically offer a copy upon request or may provide it as part of their billing process.
What should I do if there is an error on the Superbill?
If an error is discovered on the Superbill, it is important to address it promptly. Patients should contact the healthcare provider's office to report the mistake. The office can then issue a corrected Superbill, ensuring that the correct information is submitted to the insurance company for reimbursement.
How does the Superbill relate to insurance claims?
The Superbill is a foundational document for insurance claims. It contains all the necessary information regarding the services provided, which is required for the claims process. When a claim is submitted to an insurance company, the information from the Superbill is used to determine coverage and reimbursement amounts.
Are there different types of Superbills for various services?
Yes, there can be different types of Superbills tailored for specific services or specialties. For example, a Family Practice Superbill may differ from a Superbill used in a specialty practice, such as pediatrics or cardiology. Each Superbill is designed to reflect the unique services and coding requirements of that particular medical field.
How often should the Superbill be updated?
The Superbill should be updated regularly to reflect any changes in coding guidelines, billing practices, or services offered. It is advisable to review and revise the Superbill at least annually or whenever significant changes occur in the practice. Keeping the Superbill current helps ensure compliance and accuracy in billing.
Filling out the Family Practice Superbill form can be a straightforward process, but several common mistakes can lead to complications. One frequent error is neglecting to include the patient's date of birth. This detail is crucial for identifying the patient and ensuring accurate billing. Without it, claims may be denied or delayed.
Another common oversight is failing to specify the insurance information. Accurate insurance details, including the subscriber's name and group number, are essential for processing claims. Incomplete or incorrect information can result in billing issues that may inconvenience both the provider and the patient.
Many individuals also forget to indicate the date of service. This date is vital for tracking the visit and aligning it with the appropriate billing cycle. Omitting this information can lead to confusion and potential disputes regarding the services rendered.
Inaccurate coding is another significant mistake. Each procedure and diagnosis must be coded correctly according to the provided guidelines. Errors in coding can lead to claim denials, necessitating additional time and effort to rectify the situation.
Some people overlook the importance of documenting copay amounts and previous balances. These figures are essential for accurate billing and ensure that patients are informed about their financial responsibilities. Neglecting to include these amounts can lead to misunderstandings and dissatisfaction.
Additionally, not signing the form can be a critical error. The physician's signature is a necessary component that validates the services provided. Without it, the form may be deemed incomplete, causing delays in the billing process.
Lastly, failing to double-check the contact information can create barriers to communication. Accurate phone numbers and addresses are crucial for follow-up and ensuring that patients receive timely notifications regarding their claims. Ensuring this information is correct can prevent unnecessary complications in the future.
The Family Practice Superbill form is a critical document for healthcare providers, facilitating efficient billing and coding for services rendered. Along with this form, several other documents are commonly utilized to support the billing process, ensure compliance, and maintain accurate records. Below is a list of these important forms and documents.
These forms and documents play a vital role in the healthcare billing process. They help ensure that providers are reimbursed for their services while maintaining compliance with regulations and safeguarding patient information. Proper use of these documents contributes to a smoother experience for both patients and healthcare providers.
When filling out the Family Practice Superbill form, it’s important to follow certain guidelines to ensure accuracy and efficiency. Here’s a list of things you should and shouldn't do:
Many people believe that the Superbill serves solely as a billing tool. In reality, it also acts as a comprehensive record of the services provided during a patient visit, ensuring accurate documentation of care.
This is not true. Different practices may customize their Superbill templates to fit their specific needs and the services they offer. Variations can occur based on specialties and local regulations.
While it may seem complex, patients can benefit from understanding the Superbill. Familiarity with the form can help them verify charges and understand their healthcare services better.
While the Superbill is essential for insurance claims, it also serves as a valuable tool for practices to track patient care, outcomes, and billing accuracy. It plays a role in quality assurance and practice management.
Not every possible code is included on a Superbill. Instead, it typically features the most commonly used codes relevant to the practice. Providers may need to use additional codes not listed on the Superbill.
Although both documents are important, they serve different purposes. The medical record contains detailed information about a patient's health history, while the Superbill summarizes the services rendered during a specific visit.
In fact, healthcare providers, including physicians and nurses, often play a role in completing the Superbill. Their input ensures that the services provided are accurately represented.
This misconception overlooks the Superbill's role in tracking patient services and outcomes. Accurate completion can lead to better care coordination and improved patient management.
Filling out and using the Family Practice Superbill form can significantly enhance the efficiency of patient billing and insurance claims. Here are key takeaways to consider: