ICD-10 Code Visibility in Patient Chart and Lab Orders

In SigmaMD, you can add problems to a member’s chart using any ICD-10 code. However, when you add a diagnosis to a lab or imaging order or to an invoice item, only billable codes can be selected. This ensures that only eligible codes are used, reducing the risk of billing issues.

ICD-10 Code Usage in SigmaMD

• Patient Chart > Problems: All ICD-10 codes can be added to a patient's chart.

• Patient Chart > Lab Order: Only billable ICD-10 codes can be selected to ensure accurate claims processing. The same applies to imaging orders, lab panels and invoice items.

  

How the ICD-10 List Is Ordered

Wherever you search for a diagnosis, SigmaMD shows one list in this order:

• Codes you've starred as favorites
• Codes from the patient's active problems, with the On problem list icon
• All other matching ICD-10 codes

Where only billable codes can be selected, non-billable favorites and problem-list codes appear greyed out with the Not billable icon and can't be selected.

Understanding Billable and Non-Billable ICD-10 Codes

ICD-10 codes classify diseases, conditions, and procedures for medical billing. However, not all codes are considered billable. Understanding the distinction is crucial for accurate claims and reimbursements.

What Makes a Code Billable?

A billable ICD-10 code can be submitted for reimbursement by an insurance provider. These codes represent complete and specific diagnoses or procedures that meet insurance criteria for payment.

What Makes a Code Non-Billable?

A non-billable ICD-10 code:

• Is too broad and requires additional specificity.
• May not be eligible for reimbursement under insurance guidelines.

How to Identify Billable vs. Non-Billable Codes

1. Code Specificity: Some broad ICD-10 codes require additional details before they become billable.
2. Payer Policies: Insurance providers have unique reimbursement rules—always check payer-specific guidelines.
3. Billable Indicators: Many coding tools, including SigmaMD, highlight billable codes or provide tooltips to confirm eligibility.
4. Cross-Reference with Resources: Use official ICD-10 coding manuals, insurance provider guidelines, or coding software to verify billability.

SigmaMD ensures that only billable ICD-10 codes are used in lab and imaging orders and invoice items to prevent billing errors. For best practices, always verify code specificity and payer policies when adding diagnoses to patient charts.