CCA (ASA) common mistakes
CCA · Understand the traps and how to avoid them.
Assigning the principal/first-listed diagnosis from the face sheet, discharge summary line, or the alphabetic index entry alone, then stopping when a code is found.
Candidates treat the index as the answer key and use the briefest summary in the record, because reading a full chart under time pressure feels inefficient. They also skip the UHDDS definition of principal diagnosis when the admitting diagnosis differs from what was finally treated.
What to do instead
Before coding, read history and physical, operative/procedure reports, pathology, and discharge instructions in full. Write the UHDDS definition ("condition after study shown to have occasioned the admission") on scratch paper and select the principal diagnosis from the body of the record, then verify each code in the tabular list. Practise 10 records where the admitting and discharge diagnoses conflict.
Treating Excludes1 and Excludes2 notes as interchangeable, and ignoring 'code first', 'use additional code', 'with', and NEC/NOS conventions in the tabular list.
The index is memorised but the instructional notes that govern the codes are skimmed or skipped, because the notes look like fine print rather than coding rules. Excludes1 (never coded together) and Excludes2 (may be coded together when clinically distinct) look nearly identical on a quick read.
What to do instead
Adopt a fixed two-pass routine: index lookup for the candidate code, then tabular list for the full entry plus every note attached to that code, its category, and its chapter. Keep a one-page study card that defines Excludes1, Excludes2, code first, use additional code, and the 'with' convention, and drill 20 questions per note type until the distinction is automatic.
Coding a condition documented as 'probable', 'suspected', 'rule out', or 'working diagnosis' as if confirmed in the outpatient setting, or choosing a vague code instead of issuing a physician query for an unclear inpatient diagnosis.
The diagnosis appears in the record, so it feels documented. Candidates also avoid queries because they are unsure of the rules on when a query is appropriate and how it must be worded.
What to do instead
Memorise the setting rule: outpatient encounters code only confirmed diagnoses; inpatient encounters may code 'probable' as if established. When documentation is ambiguous, incomplete, or contradictory in the inpatient record, write a non-leading query naming the clinical indicators and offering reasonable options. Practise drafting three queries from operative reports and compare them to the AHIMA query practice guidance for clarity and non-leading wording.
Applying modifiers by habit rather than by rule - attaching modifier 25 to an E/M visit without a separately identifiable service, using 59 where an X{EPSU} modifier is required, or omitting/duplicating 26 and TC.
Modifier use is learned from a handful of examples, so candidates pattern-match the diagnosis or the visit type instead of checking whether the modifier's definition is actually satisfied by the documentation.
What to do instead
For every modifier you plan to use, state out loud the documentation element that satisfies the definition (for 25: a significant, separately identifiable E/M service above and beyond the procedure). Build a modifier table with definition, common misuse, and the replacement X-modifier equivalents, and review the case only after deciding whether the modifier condition is met.
Confusing surgical suffixes and combining forms - reading -otomy as -ectomy or -ostomy, and misreading plural forms such as -itis/-itides or -oma/-omata.
The suffixes look alike, are learned as a list rather than as meanings, and under exam timing the eye completes the familiar pattern without decoding it.
What to do instead
Build a suffix card set grouped by meaning (-otomy = cutting into, -ectomy = excision, -ostomy = creating an opening, -plasty = repair, -pexy = fixation) and cover the suffix on each drill word, saying the meaning aloud before reading the whole term. Do 15 terms a day and add the plural rules (-itis to -itides, -oma to -omata, -us to -i) to the same card set.
Coding an operative or pathology report to a general anatomic site code when the report names a more specific structure, or missing laterality and the digit/segment specified in the procedure note.
Candidates read for the procedure and diagnosis but do not translate the anatomical wording (antecubital, hallux, thenar, fundus, jejunum) into the site the code descriptor actually requires, and laterality is easily lost when it appears once in a narrative.
What to do instead
Before selecting a code, underline the named structure and laterality in the report and match it word-for-word to the code descriptor's site and side. Use blank body-cavity diagrams for self-testing and label structures from memory, then map five operative reports per session from anatomical term to specific code, confirming each character's meaning in the tabular list.
Not knowing what constitutes a complete health record - which reports, signatures, and authentications are required, what the legal health record is, or the difference between record retention, amendment, and correction.
This domain is studied as background reading rather than as testable specifics, so candidates answer from general impressions of 'the chart' and cannot distinguish required content from nice-to-have documentation.
What to do instead
Create a checklist of required record components for acute, ambulatory, and long-term care settings, plus the rules for authentication (who may sign, timeliness), late entries, and amendments. Test yourself by reviewing a sample record and listing every deficiency with the standard it violates, then verify against the medical staff bylaws or record-completion policy.
Mixing up HIPAA Privacy Rule and Security Rule requirements, applying the minimum necessary standard to disclosures where it does not apply, or missing special protections such as psychotherapy notes and 42 CFR Part 2 substance use records.
Both rules are learned as one HIPAA block, so questions distinguishing use, disclosure, safeguards, and permitted exceptions collapse into a single vague memory.
What to do instead
Maintain a two-column table: Privacy (who/what may be used or disclosed, patient rights, minimum necessary) versus Security (administrative, physical, and technical safeguards for ePHI). Add a third column for exceptions and special categories, and note where minimum necessary does not apply (treatment, disclosures to the patient, authorized disclosures). Drill by classifying 20 scenario statements into the correct column.
Using the wrong prospective payment system for the setting - applying MS-DRG logic to an outpatient claim, computing payment from the wrong base rate, or confusing the case-mix index with a payment amount.
Inpatient and outpatient methodologies are studied close together and share vocabulary (DRG, APC, base rate, conversion factor), so the setting-specific mechanics blur; arithmetic steps are also skipped under time pressure.
What to do instead
Write the formulas separately and keep them visible while practising: inpatient MS-DRG payment = DRG relative weight x hospital base rate (+/- adjustments); outpatient APC payment = APC relative weight x conversion factor; physician payment under RBRVS = (RVU work + PE + MP) x GPCI x conversion factor. Work three full calculations per session, labelling the setting first, and explain the case-mix index in words (a relative measure of resource intensity, not a dollar figure) before choosing an answer.
Treating IT questions generically - confusing an audit trail with a data backup, not knowing the role of the master patient index, or failing to recognise encryption, access controls, and health information exchange as distinct concepts.
IT is often reviewed last and skimmed, so terms are recognised but not defined; candidates pick the option that 'sounds technical' rather than the one that matches the function described in the stem.
What to do instead
Build a function-first glossary: for each term, write one sentence on what it does and one on what it does not do (audit trail records who accessed what and when - it is not a backup copy; the MPI is the patient identity index, not the clinical data repository). Add a security-safeguard table mapping each control to administrative, physical, or technical category, and quiz yourself by matching functions to terms rather than definitions to terms.