Home Health ICD-9/ICD-10 Alert

Complacency is the biggest pitfall to coding reference sheets

Do your coders have "cheat sheets" that look like they've been through the wringer, while their coding books collect dust? If so, the time has come to rethink your approach.
 
Coding reference sheets - commonly called "cheat sheets" - can be an extremely helpful tool for coders. However, everyone should remember that the cheat sheet is only a tool, not a shortcut, experts urge.
 
Key idea: "The main thing is for coders not to depend strictly on reference sheets, but to use them as a kind of a prodder to show the way to go," says Margaret Rush, RHIA, HCS-D, OASIS and coding coordinator for Alacare Home Health & Hospice in Birmingham, AL.

Think of Cheat Sheets as Cliff's Notes for Coders

Coders who use cheat sheets should always use them in addition to, not instead of, the coding book, insists Rush. They're just like the Cliff's Notes some people used in college: They can be helpful as an extra tool, but you're sure to fail your test if you read them instead of the book.

Remember: Cheat sheets can never provide the full dose of information you need to code correctly. If they could, there would be no need for coding books in the first place. "The ICD-9 book has so many subcategories and notes that if you don't read them, you may be miscoding," Rush reminds coders.

Use Cheat Sheets Carefully or Not at All

If you're going to use a cheat sheet, use it only as a guide to the correct section of the ICD-9 book, and then code directly from the book. "Some coders may rely too heavily on only those codes on the cheat sheet," warns Rita Rich, RN, CCS, manager of coding compliance for LifePoint Hospitals Inc. in Brentwood, TN. "They are at risk for either overcoding or undercoding," she says.

 A note about inexperienced coders: Green coders should use cheat sheets even less than experienced coders, if they're allowed to use them at all. That's because inexperienced coders are most likely to lean too heavily on the cheat sheet, notes Rich.
 
New coders should spend more time than others with their nose in the ICD-9 book, according to Rich. Otherwise, they'll miss out on fundamental coding knowledge.
 
"It is important for anyone who is coding to have a thorough understanding of how to look up diagnoses in the ICD-9 book and what different conventions mean," says Joan Usher, RHIA, COS-C, president of JLU Health Record Systems in Pembroke, MA. 
 
And new coders should receive their training from experienced coders - not from a cheat sheet, Rich insists.

Be Vigilant About Coding Updates

You must be extremely diligent about regularly updating reference sheets to reflect coding changes, experts agree. Using an outdated cheat sheet is asking for trouble.
 
Make sure you alert all coders in your agency when you've updated a cheat sheet. Otherwise, there's a strong chance some old sheets will fly under your radar screen. "An agency can't keep control over outdated cheat sheets that may be stuck in the pocket of someone's car door," point out Karen Vance, OTR, senior consultant with BKD in Springfield, MO.

Final thought: Cheat sheets might not be the best route for your agency to take at all, according to some industry insiders. Often, "the time it would take to develop and maintain an accurate, updated cheat sheet could be spent in getting familiar enough with the coding manual so that a cheat sheet wouldn't be necessary," notes Vance.