Cheat sheets come with a warning label. To help ensure your coding complies with ICD-9 guidelines, there are several tactics you can use: 1. Always read the notes in the ICD-9 manual that apply to the code you're considering, says Denae M. Merrill, CPC, HCC coding specialist in Michigan. 2. Read the ICD-9 official guidelines that apply to your "specialty periodically as a refresher. If we only read them when the codes change once a year, it is difficult to absorb and retain that information for an entire year," says Lisa S. Martin, CPC, CIMC, CPC-I, chargemaster specialist for OSF Healthcare System in Peoria, Ill. 3. Don't be afraid to write a lot of notes and make good use of your highlighters, says Martin. "I even make notes in the index because where you initially expect to find something is where you will search again in the future." 4. After using your usual coding resource, occasionally switch to a different resource to see if you come to the same conclusion about the proper code, says Martin. 5. Take care when using cheat sheets, says Merrill. They can be helpful as long as you don't rely on them too heavily. And you absolutely must be sure you update them regularly, she says. 6. The last point in number 5 bears repeating and applies across the board. "Regardless of the resource, the most important factor is that it is up to date," says Martin. Using an invalid code will trigger a denial. With that in mind, be sure everyone in the office follows through on updates. Consider the example of an office where a cheat sheet is copied and passed out to multiple coders. If any of the codes become invalid, the office will instantly have multiple coders at risk of reporting codes that payers won't accept.