CRC (Court Reporting Certifications) common mistakes
CRC · Understand the traps and how to avoid them.
Coding a chronic condition such as diabetes or COPD from the problem list or a prior year's chart without confirming that the provider documented and evaluated it during the current encounter.
Candidates treat the problem list as a diagnosis source because it is easy to see and seems authoritative. They also carry forward diagnoses from previous notes to save time, not realizing that risk adjustment requires the condition to be assessed, managed, or otherwise addressed in the current face-to-face visit.
What to do instead
For every HCC you report, locate the provider's current note and verify that the condition is explicitly documented and evaluated (for example, a plan, medication change, or monitoring). If only the problem list or an old note mentions it, do not code it. When reviewing charts, flag such cases as documentation gaps for provider education rather than reporting the HCC.
Reporting a diabetes code without specifying the type (E11.9 instead of E11.65, or E10.9 instead of E10.65) and without linking documented complications such as diabetic retinopathy or neuropathy.
Candidates default to the unspecified code because it is familiar and they fear making a mistake. They also overlook the causal link required by ICD-10-CM, failing to read the note for phrases like 'diabetic retinopathy' or 'due to diabetes' and therefore missing combination codes.
What to do instead
Always scan the assessment for the diabetes type and any complications. Use combination codes when the note links the complication to diabetes (e.g., E11.319 for diabetic retinopathy). If the type or complication is not documented, query the provider. Practice with the ICD-10-CM diabetes guideline that assumes a causal link when both conditions are present, unless the documentation states otherwise.
Ignoring the distinction between major HCC models (e.g., CMS-HCC, HHS-HCC, RxHCC) and applying the wrong model's rules, such as using CMS-HCC hierarchies for an ACA risk adjustment question.
Candidates memorize one model's hierarchy examples and assume they apply universally. They also skip the exam's model-specific instructions because the conditions look similar.
What to do instead
Create a comparison table of the models you are likely to see: population, payment year, condition categories, and hierarchy rules. For each practice question, first identify the model named or implied, then apply only that model's logic. When reviewing, write down which model each error involved and why the hierarchy differed.
Failing to apply HCC hierarchies correctly-for example, reporting both a lower and a higher-ranked HCC in the same hierarchy when only the highest should count, or missing that a higher HCC suppresses a lower one.
Candidates either do not know the hierarchy rules or apply them mechanically without checking the specific disease hierarchy. They may also confuse hierarchies with combination codes, leading to over- or under-counting.
What to do instead
Study the CMS-HCC hierarchy tables for the conditions tested (diabetes, renal, cardiovascular). For each case, list all candidate HCCs, then cross off any that are trumped by a higher HCC in the same hierarchy. Practice with examples where two conditions in the same hierarchy are documented and verify which one survives.
Assuming that a documented history of a condition (e.g., 'history of MI' or 'history of COPD') is equivalent to an active diagnosis for risk adjustment.
Candidates see the word 'history' and think it means the condition is still relevant. They also confuse personal history codes with active condition codes because the terms sound similar.
What to do instead
Differentiate between 'history of' (which typically maps to a Z code and does not carry an HCC) and active conditions that are currently being managed. For each condition, ask: is the provider treating or monitoring it now? If the note says 'history of' and gives no evidence of active management, do not assign the HCC. Use the ICD-10-CM index to confirm the correct code for history versus active disease.
Coding from the impression or plan section alone without confirming that the diagnosis is supported by the assessment and medical record as a whole.
Candidates skim for keywords and code from a single line, missing conflicting statements or lack of clinical support elsewhere in the note. This leads to overcoding or coding conditions that are not clinically validated.
What to do instead
Read the entire note-history, exam, and assessment/plan-before assigning codes. Confirm that the diagnosis is consistent with the documented findings. If the impression lists a condition but the assessment does not support it, treat it as a documentation gap and query the provider rather than coding it.
Overlooking the need to capture all documented chronic conditions that carry HCCs, such as major depression, rheumatoid arthritis, or chronic kidney disease stage 3, because the focus is on the primary reason for the visit.
Candidates concentrate on the chief complaint and miss secondary chronic conditions that are documented and managed during the same encounter. They may also think only the primary diagnosis matters for risk adjustment.
What to do instead
Develop a checklist of common chronic conditions that map to HCCs and review each note for them. Remember that risk adjustment captures the full burden of illness; if a condition is documented and managed, it should be coded. Practice with chart reviews where multiple HCCs are present and count how many you captured versus the answer key.
Misunderstanding risk score calculation mechanics-for example, thinking that each HCC adds a fixed number of points regardless of interactions, or ignoring demographic factors and disease interactions.
Candidates simplify the model to 'one HCC equals one score' and forget that coefficients vary by HCC, age, sex, and interactions. They may also confuse risk scores with quality scores.
What to do instead
Review the structure of the risk score formula: demographic factors, HCC coefficients, and interaction terms. Practice with simple examples where two HCCs interact and see how the score changes. When answering questions, identify which factors are included in the calculation and which are not.
Failing to recognize documentation gaps that require a provider query, such as an unclear diabetes type or an undocumented complication, and instead coding the unspecified code without follow-up.
Candidates want to finish the case and avoid appearing uncertain. They may also not know what constitutes a queryable gap versus a codeable condition.
What to do instead
Learn the criteria for a compliant query: the documentation is ambiguous, incomplete, or contradictory, and the clarification affects code assignment or risk adjustment. Practice writing queries that are non-leading and include the clinical indicators. In exam questions, if the note lacks specificity, the correct action is often to query, not to code unspecified.
Ignoring the impact of ICD-10-CM coding guidelines (e.g., 'code also', 'use additional code', sequencing rules) when assigning multiple codes for a single condition.
Candidates focus on the condition itself and skip the instructional notes in the tabular list. They may also not realize that sequencing can affect which code is principal and whether an HCC is captured.
What to do instead
For each condition, check the tabular list for instructional notes. Practice with common scenarios like COPD with exacerbation, where sequencing matters. When reviewing audits, verify that all 'code also' and 'use additional code' notes were followed and that the principal diagnosis is correct.