One of the most frequent requests we have is for Cheat Sheets of commonly used codes and combinations of codes. We do not have one to offer you and we have no plans to offer one. They really do sound like a great idea – we admit it – but they result in very poor coding, reduced revenue, denials and payment take-backs. If you can get past all of that, maybe they are a good idea.
The Cheat Sheet concept skips the most important step in the coding process – looking at your code book. We prefer Decision Health’s Coding Manual. Other coders have their own preferences. Regardless of the book that you use, a true coder never codes without one.
There are still agencies who have field clinicians do their own coding. In hospice, it is rare to find anyone but the field staff coding. Very few are nurses have have the training to code appropriately. In order to code well, you have to have the education and experience. Like most other skills, repetition builds competence. If a field nurse is doing one to two re-certifications and an average of four admissions per week, it is probable that inaccurate codes are being placed on your claims. For this reason most agencies hire full time coders, outsource their coding or design a combination of both.
On August 1, home health agencies will begin dual coding with both ICD-9 and ICD-10 codes, All claims for hospice beginning October 1 will require ICD-10 codes. When ICD-10 is implemented, it will be near impossible to develop a cheat sheet that could be of even minimal assistance. The number of codes will multiply as the focus of each code is narrowed considerably so as to leave no question regarding how and where the patient is affected.
This means that in order to be ready for the August or October implementation date, agencies, including hospice providers must have in place a system that results in accurate coding. Our preference is that you call us. More important to you is simply taking the time to think about it now.
If you will be using in house coders, invest in the training they need. This is not a simple ‘translation’ process where you find a new code to replace old codes. There are new rules and conventions and it is grossly unfair to any coder to ask them to perform post ICD-10 implementation if you haven’t devoted the resources for education and the time for practice. If you are outsourcing, keep in mind that even the best coding company must fully integrate with your processes and there will be a period of adjustment. Do you want that period to begin concurrently with ICD-10 implementation?
We have contracts with home health agencies and hospice providers that have in house coding so they can offload coding as needed because of backlogs, vacations, illnesses, etc. This keeps their billing current and the agency has a chance to compare their in-house coding with the coding of a professional coding company.
Regardless of who you use, there are some decisions that must be made now while you have the time to pick and choose. That is a much better use of your time than trying to create a cheat sheet for coding because we flat out refuse. We’re too busy getting ready for ICD-10.
Great article – and so agree with your comments. This was ALWAYS taught to never rely on anything more than your book! It’s amazing how managers will want to cut their costs by allowing anyone off the street to code for them, and never think about how the codes will affect revenue! Thanks for alerting everyone about the importance of a registered coder!
Thank you for the kind words.