David Letterman probably wasn't the first ever to create a Top Ten list, but he's turned it into an art, and given people a reason to stay awake past the nightly news. His lists are meant to be humorous, but they are also topical, insightful, and full of hidden meanings.

Coders can learn from Top Ten lists, too, and often see these lists posted on Web sites or in magazines. Even Coding Edge, the American Academy of Professional Coder's monthly magazine for members, has instituted a monthly Top Ten mini-poster, featuring topics like Top 10 Tips for Successful Internet Research, Top Ten Modifier Errors, and Top Ten Rules for Proper ICD-9-CM Coding.

We all take the time to read a Top Ten list because the format is simple and the message is in small bites that are easy to digest. In widely published Top Ten lists, there usually are one or two tidbits that are new or interesting to one reader, but that is often enough.

Coders have a vast amount of information to process every day. Using code "cheat sheets" - whether homemade or purchased - is one way we remember all we need to know. Using Top Ten lists can be another way for coders to keep abreast of all the evolving rules of reimbursement and accurate code selection.

Coding mangers can put the popularity of Top Ten lists to work in their medical offices. Communicating through Top Ten lists can produce effective results. If you take the time to determine the critical problems in your office, then post a list and discuss solutions in staff meetings, you may precipitate a reduction in error rates. A customized Top Ten can "speak" to your staff more effectively and with less intimidation than other methods. What follows is a sampling of Top Ten topics that can be created to facilitate change in your physician practice or facility.

Top Ten reasons for denied claims. These may include duplicates, unbundling, medical necessity issues, eligibility of patient, use modifiers, or keying errors.

Top Ten front office errors affecting denial rates. Is the Medicare patient's name misrepresented? Is the birth date right? Ensuring that the data you present on the patient matches the payer's is essential for prompt payment.

Top Ten payment-related issues to audit when reviewing. Does a particular payer tend to downcode certain E/M services routinely? Are modifiers added or deleted from codes by other payers? Knowing where your postpayment review watchdogs should focus, and having that posted in writing, can enhance their recoveries.

Top Ten common billing rules that vary greatly according to payer. Which private payers have adopted which Medicare payment rules for HCPCS vs. CPT coding? How are multiple procedure modifiers handled by the top payers? 

Top Ten reliable resources for coding questions. As a coding manager, who do you trust? Is your staff clear on what is considered an acceptable source of regulatory or clinical information? Make sure your coders are going to the most reliable sources before they code their claims.

Top Ten documentation omissions costing our practice money. Don't limit your lists to the administrative staff. Ensure that your clinicians are also embracing a Top Ten philosophy, and reviewing their documentation for the most common errors. Is the type of diabetes listed? Has the medical necessity of the procedure been well documented?  Are all drugs or other supplies administered during the encounter listed with quantity in the patient record? For inpatient, are diagnoses being documented as present on admission?

Top Ten under-coding errors costing our practice money. Is the coder assuming radiological supervision or other procedures are incidental when, in fact, they can be reimbursed separately? Are they too conservative in their E/M coding or misunderstanding the rules surrounding new vs. established patients?

These are just a few ideas. Your goal should be to customize a list that captures your own practice's issues with insight and precision. You may want to focus on productivity, for example, rather than accuracy. Each practice has its own challenges. Your practice may have a need for only one Top Ten list. Other practices may want to create a monthly or quarterly Top Ten.

Top Ten lists can be communicated in many ways: through bulleted emails; as printed memos, or "dressed up" like a poster or certificate for posting in the reader's cubicle. The trick is to create a message that is short, compelling and targeted, and to keep your staff aware of the issues important to the practice, and to their job performance.

Sheri Poe Bernard, CPC, CPC-H, CPC-P, is vice president of clinical coding content at the American Academy of Professional Coders (AAPC), the nation's largest education and credentialing association for medical coders. AAPC provides certified credentials to medical coders in physician offices, hospitals and outpatient centers. The three certifications AAPC offers are CPC, CPC-H and CPC-P and represent the gold standard certification for medical coding.