Why Cheat Sheets Should be Illegal for ICD-10-CM Coders

How many times have medical billers or coders in private practice offices relied on the infamous “cheat sheet” to get their job done? Oh, if only I had a dollar for every “cheat sheet” I reviewed that was outdated, incomplete or just plain wrong in every way imaginable…

I know everybody has one but I refuse to call them “cheat sheets”. The very name implies that it is accurate and holds exactly what you need to know to code for claim submission. Pulling out the “cheat sheet” is what typically happens when new-hires arrive at an office or facility and it’s used as a way to train. Of course, that new-hire has little to no experience because doctors won’t pay for a trained biller/coder. If they stay on they’ll use that tattered piece of paper and just re-type it or copy it year after year instead of reviewing it for accuracy and updating it.

Take hypertension or HTN – how many coder/billers automatically think 401.9? I’ll be watching a medical show of some kind or Bizarre ER (LOVE that show!) and whenever I hear hypertension I immediately think 401.9. With ICD-10 the familiarity and confidence which comes from knowing 401.9 is forever gone… How we’ll miss that beloved code!

I propose that the phrase “cheat sheet” be replaced with REFERENCE SHEET beginning October 1 as well. Say it again – slowly – R E F E R E N C E   S H E E T…. Doesn’t that phrase invite a feeling of not being the end all-be all? Or better yet, doesn’t that phrase imply how it’s a starting point to actually accomplishing something?

So many companies are offering “cheat sheets” for doctors to buy which promise to convert their existing diagnosis codes to the ICD-10 equivalent. If you are familiar with ICD-10 at all, you know how impossible that is. I recently came across one comparison for a Primary Care practice and their one page superbill listing ICD-9 codes was converted to 9 pages with the ICD-10-CM! Paperless office, indeed!

What needs to happen is that doctors need to actually read all 180+ pages of the ICD-10-CM Guidelines in order to understand the complexities of this new system. A critical thinker with a solid background in medical terminology and anatomy is necessary to realize when one code may be affected by another guideline. The days of hiring your neighbor’s daughter because she needs a job are over.

Doctors and practice managers must also take heed and realize how saving a few dollars per hour for “a billing girl” will end up costing much, much more overall if they are not properly trained in ICD-10-CM and it would behoove your practice to send staff to a training course as soon as possible and – heaven forbid – attend one yourself!

Positions held by medical billers and coders are complex and intricate. It’s not just picking a code and entering it in the right box. You must know and understand everything about coding along with carrier-specific guidelines, rules and regulations. As an in or out of network provider, you are contracted to abide by those rules and will face audits, penalties or exclusions if you don’t.


Many times when I consult for a practice and review an old and aged AR, those claims were typically billed with outdated or invalid codes. Staff couldn’t figure out why they weren’t paid, even though they resubmitted them over and over. I’ll point out the inaccurate and invalid codes to the doctor and his/her response will be “Can you just make us a new cheat sheet real quick?”

On the inside I shudder and roll my eyes but on the outside I’ll just smile and say “Of course, and while I do that, why don’t you make me a cheat sheet for treating all the patients you may or may not see this week?”


About Heidi Kollmorgen

My passion and interest involves anything related to medical billing, coding and health information management. I love to share what I learn and educate others so you have definitely come to the right place! ICD-10-CM is set to become mandatory beginning October 1, 2015. As an AHIMA ICD-10-CM Trainer also carrying the title of CCS-P (Certified Coding Specialist - Physician Based) you can be assured that quality care of your patients is the ultimate goal of my work as a consultant. HD Medical Solutions is dedicated to providing you with all your Revenue Cycle Management needs.
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