This audit set out to review the accuracy of coding in a Head and Neck Cancer centre and systematically identify ways to improve it. Coding Information, subsequent grouper (HRG) code and the final tariff paid was obtained. Changes were made to the operation note and documentation, and Complex Head and Neck procedures list and tariff. Losses of over £150,000 through coding inaccuracies were identified. Changes made triggered the correct tariff in 93% of cases after three audit cycles. This turned the Otolaryngology Speciality Business Unit (SBU) into one of the best performing in the hospital. Reviewing Complex Head and Neck procedures and implementing simple systems to improve the clinician-coder relationship, including a theatre coding checklist, vastly increases specialty income.