CAMC Part 1 Exam common mistakes
CAMC Part 1 Exam · Understand the traps and how to avoid them.
Assigning an ICD-10-CM code to a symptom or sign when the documentation actually supports a definitive diagnosis, or the reverse-coding an unconfirmed diagnosis from a rule-out statement as if confirmed.
Candidates skim the impression section without reading the body of the note, and they have not internalized the guideline that a diagnosis documented as 'probable,' 'suspected,' 'rule out,' or 'working diagnosis' is coded to the presenting sign/symptom in the outpatient setting. Inpatient guidance differs, which adds to the confusion.
What to do instead
Build a habit: read the entire note, extract every documented condition, then classify each as confirmed, uncertain, or historical. Apply the outpatient rule (code signs/symptoms for unconfirmed conditions) versus inpatient rule (code as if established) explicitly, and cite the guideline section in your rationale so you verify the reasoning rather than the answer.
Failing to apply ICD-10-CM conventions in the correct order-skipping the Alphabetic Index-to-Tabular List path, ignoring instructional notes ('Excludes1', 'Excludes2', 'Code first', 'Use additional code'), or missing the seventh character or laterality requirement.
Candidates memorize code numbers from practice questions instead of learning the lookup workflow. Excludes1 (mutually exclusive) and Excludes2 (not included here, but both may be coded) look similar under time pressure, and laterality and 7th-character fields are easy to leave incomplete.
What to do instead
Practice the two-step lookup on unfamiliar codes weekly: locate in the Index, verify in the Tabular List, then walk every instructional note and character field before finalizing. Make a one-page reference contrasting Excludes1 and Excludes2 and drill cases where both conditions are documented to confirm which combination is permitted.
Selecting an ICD-10-PCS root operation or approach that does not match the operative report-for example coding a 'repair' when the surgeon performed a 'supplement,' or missing that an open procedure converted to percutaneous, or coding a diagnostic exploration as a therapeutic excision.
PCS is built on definitions of root operations rather than procedure names, so candidates pattern-match keywords in the report title instead of reading the objective of the procedure and the body system, device, and qualifier values. The 31 root operations are conceptually dense and easily conflated.
What to do instead
For each case, write the procedure's objective in one sentence, then map it to the root operation definition before touching the tables. Practice distinguishing the commonly confused pairs (excision vs. resection, release vs. division, repair vs. supplement, drainage vs. extirpation) with short operative excerpts until the definitions are automatic.
Undercoding or overcoding E/M level by counting elements mechanically-tallying history, exam, and MDM bullets-rather than applying the current medical decision-making or time-based framework, and ignoring total time documentation or the number/complexity of problems addressed.
Candidates trained on older 1995/1997 guidelines continue to count bullets, while current E/M rules for office/outpatient visits rely on MDM (problems, data, risk) or total time on the date of the encounter. Ambiguity about what counts as 'data reviewed' and 'risk' leads to inconsistent levels.
What to do instead
Choose one method per encounter (MDM or time) and document the basis. For MDM, explicitly identify the number and complexity of problems, the data category (minimal/none, limited, moderate, extensive), and the risk level, then take the highest two-of-three. For time, verify total time includes the date of the encounter and is documented as a specific number of minutes.
Treating reimbursement as a single number-confusing the payer's allowed amount with the provider's charge, the contractual adjustment, and the patient responsibility-and misapplying modifier or bundling edits that change payment.
Candidates learn code assignment but not the claim adjudication chain. They do not distinguish billed charges, fee schedule allowed amounts, contractual write-offs, deductible/coinsurance/copay, and secondary payer coordination, and they assume every line item is paid as submitted.
What to do instead
Work through a full claim example end to end: charge, allowed amount per fee schedule, contractual adjustment, patient responsibility split into deductible, coinsurance, and copay, then payment. Separately drill NCCI edits and the modifiers (e.g., 25, 59, 57) that legitimately bypass them, stating why each modifier is or is not supported.
Upcoding or unbundling to maximize payment-reporting a higher E/M level than documentation supports, adding separately billable services that are integral to a procedure, or reporting a modifier without documented justification.
Candidates conflate 'what could be coded' with 'what should be coded,' and may be influenced by productivity or revenue pressure narratives. They also do not recognize that unbundling and upcoding are specific fraud/abuse risk areas subject to audit and False Claims Act exposure.
What to do instead
Adopt a documentation-first rule: assign only what the record supports, and for every add-on code or modifier, write the supporting sentence from the note. Learn the distinction between honest error (compliance risk, correctable) and intentional misrepresentation (fraud), and practice identifying red flags in audit scenarios.
Breaching privacy or minimum-necessary rules in scenario questions-disclosing PHI to a family member, employer, or media without authorization, or releasing records in response to a subpoena without proper validation.
Candidates know HIPAA exists but not the specific permissions: treatment/payment/operations exceptions, authorization requirements, required disclosures, subpoena handling, and the difference between use and disclosure. Scenario wording is designed to make a plausible-sounding disclosure look acceptable.
What to do instead
Memorize the categories of permitted disclosure (TPO, required by law, public health, abuse reporting) versus those requiring authorization, and drill subpoena scenarios: valid court order versus attorney-issued subpoena with notice to the patient. For each scenario, state who is asking, why, and what authorization or legal process is present.
Coding from a superbill, problem list, or query response without confirming the documentation in the actual encounter note, and failing to issue a compliant physician query when the record is ambiguous.
Candidates want to 'find' the code quickly and treat the problem list as authoritative. They also do not know query mechanics-leading questions, multiple-choice formats, and the requirement that the provider's response be documented and that the query not suggest a diagnosis.
What to do instead
Always tie each code to a specific note section and date. Practice writing non-leading queries that present clinical indicators and ask for clarification without offering a diagnosis, and learn when a query is appropriate (conflicting, ambiguous, or incomplete documentation) versus when the coder must simply code what is documented.
Missing data-quality and integrity checks-unreported secondary diagnoses that affect severity or DRG, inconsistent laterality between diagnosis and procedure, or a procedure code with no corresponding diagnosis and vice versa.
Candidates code each field in isolation rather than reviewing the record as a whole. They overlook present-on-admission status, hospital-acquired conditions, and the impact of a missed comorbidity on DRG assignment and quality reporting.
What to do instead
Before finalizing a case, run a reconciliation pass: does every procedure have a supporting diagnosis, does every diagnosis have documentation, is laterality consistent, and is POA status assigned? Practice DRG impact exercises showing how adding a documented comorbidity changes the group and payment.
Missequencing principal diagnosis or principal procedure-choosing the condition that prompted admission incorrectly when two conditions meet the definition, or ignoring 'code first' and etiology/manifestation rules.
Candidates select the most dramatic-sounding diagnosis rather than applying the definition of principal diagnosis (the condition after study chiefly responsible for admission). Etiology/manifestation pairs and combination codes require knowing which code carries the manifestation.
What to do instead
For each inpatient case, state in one sentence which condition, after study, occasioned the admission, and verify against the 'code first' notes in the Tabular List. Drill etiology/manifestation pairs (e.g., diabetic complications, hypertensive heart disease) until you can state which code is principal and which is secondary without looking.