Risk Adjustment CRC Exam Questions
and Answers
Interactions - ANSWER-What are extra RA values or factors added when a patient has
more than one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - ANSWER-MIPS
Collection Types Categories
When are Star Ratings publicly published? - ANSWER-October of each year
HEDIS types of collection - ANSWER-Surveys, Medical Chart Reviews, Insurance
Claims, Medical Office Visits, Procedures
What does Abbreviation MAC stand for? - ANSWER-Medicare Administrative
Contractor
Each year, Medicare normalizes risk scores to maintain an average of what? -
ANSWER-1.0
Which type of documentation can be used to support diagnoses reported under risk
adjustment models? - ANSWER-Inpatient admission note
Risk adjustment models are used to: - ANSWER-Determine projected costs of health
care based on the condition(s) of patients
Patient with coronary arteriosclerosis disease (CAD) sees his cardiologist to discuss a
coronary artery bypass graft (CABG). This would be the patient's first CABG. What ICD-
10-CM code should be reported? - ANSWER-I25.10 Because Patient was there only to
discuss the CABG
A patient is being treated for diabetes with hypoglycemia and coma due to malignant
neoplasm of pancreas. The patient uses insulin routinely but is not dependent. What
ICD-10-CM codes should be reported? - ANSWER-C25.9, E08.641, Z79.4 Diabetes is
due to neoplasm. Use E08 code.
A patient is admitted after being found unresponsive at home. The patient had right-
sided hemiplegia and aphasia from a previous CVA. The physician documents a current
CVA as the final diagnosis and the patient is transferred for rehabilitation. What ICD-10-
CM code(s) should be reported? - ANSWER-I63.9, I69.351, I69.320
, A patient is coming in for follow up of his essential hypertension and cardiomegaly. Both
conditions are stable and he is told to continue with his medications. What ICD-10-CM
code(s) should be reported? - ANSWER-I11.9 (Remember to look at the Excludes Note)
73 year-old visits his primary care physician to discuss lap band procedure for his
morbid obesity. His BMI is currently 45. What ICD-10-CM code(s) should be reported? -
ANSWER-E66.01, Z68.42
Patient presents to her physician 10 weeks following a true posterior wall myocardial
infarction. The patient is still symptomatic and is receiving care related to the myocardial
infarction. What is the correct first-listed ICD-10-CM code for this condition? -
ANSWER-Z51.89 For encounters 4 wks later or more after MI and patient is still
receiving care and aftercare code is used.
Patient is seen in his physician's office and diagnosed with benign hypertension and
Stage 3 chronic kidney disease. Select the diagnosis codes. - ANSWER-I12.9, N18.30
A 65 year-old male presents to the office with history of ongoing diabetes which has
been controlled with insulin for follow-up exam with his family practice physician, during
this encounter the physician notes a chronic diabetic wound of his right greater toe and
determines gangrene has set in. After examination and testing the family practice
physician recommends the gentleman to be seen by a general surgeon for treatment of
his gangrene of his right great toe. What are the correct diagnoses to report for this
encounter? - ANSWER-E11.52, Z79.4 remember that DM & Gangrene is a combo code
and the z code is for the insulin use.
A 65 year-old male patient was admitted with ascending cellulitis and infection of a 2nd,
3rd, and 4th toes amputation site. What are the appropriate diagnosis codes for this? -
ANSWER-T87.40, L03.039
Which one of the following physician's assessment supports the correct coding for CKD
stage 2, code N18.2? - ANSWER-A/P: Mild CKD
Patient is admitted to the hospital for treatment of a Subarachnoid Hemorrhage. The
patient has hypertension and is being evaluated by Neurosurgery for possible surgical
intervention. Assign the correct ICD-10-CM code(s) for the admission. - ANSWER-I60.9,
I10
The provider sees a patient in the Emergency room for acute flank pain. The patient has
high blood pressure after serial BPs taken. The ultrasound shows acute pyelonephritis.
The provider documents acute pyelonephritis and secondary hypertension. Assign the
correct ICD-10-CM codes. - ANSWER-N10, I15.8 Remember this needs the
TRANSIENT HTN code.
A 77 year-old male presents for follow up with his primary care provider. The provider
documents a healed pressure ulcer of the right heel and hypertension. The Assessment
and Answers
Interactions - ANSWER-What are extra RA values or factors added when a patient has
more than one major significant dx identified in model ?
Quality, Promoting Interoperability, Improvement Activity, Cost - ANSWER-MIPS
Collection Types Categories
When are Star Ratings publicly published? - ANSWER-October of each year
HEDIS types of collection - ANSWER-Surveys, Medical Chart Reviews, Insurance
Claims, Medical Office Visits, Procedures
What does Abbreviation MAC stand for? - ANSWER-Medicare Administrative
Contractor
Each year, Medicare normalizes risk scores to maintain an average of what? -
ANSWER-1.0
Which type of documentation can be used to support diagnoses reported under risk
adjustment models? - ANSWER-Inpatient admission note
Risk adjustment models are used to: - ANSWER-Determine projected costs of health
care based on the condition(s) of patients
Patient with coronary arteriosclerosis disease (CAD) sees his cardiologist to discuss a
coronary artery bypass graft (CABG). This would be the patient's first CABG. What ICD-
10-CM code should be reported? - ANSWER-I25.10 Because Patient was there only to
discuss the CABG
A patient is being treated for diabetes with hypoglycemia and coma due to malignant
neoplasm of pancreas. The patient uses insulin routinely but is not dependent. What
ICD-10-CM codes should be reported? - ANSWER-C25.9, E08.641, Z79.4 Diabetes is
due to neoplasm. Use E08 code.
A patient is admitted after being found unresponsive at home. The patient had right-
sided hemiplegia and aphasia from a previous CVA. The physician documents a current
CVA as the final diagnosis and the patient is transferred for rehabilitation. What ICD-10-
CM code(s) should be reported? - ANSWER-I63.9, I69.351, I69.320
, A patient is coming in for follow up of his essential hypertension and cardiomegaly. Both
conditions are stable and he is told to continue with his medications. What ICD-10-CM
code(s) should be reported? - ANSWER-I11.9 (Remember to look at the Excludes Note)
73 year-old visits his primary care physician to discuss lap band procedure for his
morbid obesity. His BMI is currently 45. What ICD-10-CM code(s) should be reported? -
ANSWER-E66.01, Z68.42
Patient presents to her physician 10 weeks following a true posterior wall myocardial
infarction. The patient is still symptomatic and is receiving care related to the myocardial
infarction. What is the correct first-listed ICD-10-CM code for this condition? -
ANSWER-Z51.89 For encounters 4 wks later or more after MI and patient is still
receiving care and aftercare code is used.
Patient is seen in his physician's office and diagnosed with benign hypertension and
Stage 3 chronic kidney disease. Select the diagnosis codes. - ANSWER-I12.9, N18.30
A 65 year-old male presents to the office with history of ongoing diabetes which has
been controlled with insulin for follow-up exam with his family practice physician, during
this encounter the physician notes a chronic diabetic wound of his right greater toe and
determines gangrene has set in. After examination and testing the family practice
physician recommends the gentleman to be seen by a general surgeon for treatment of
his gangrene of his right great toe. What are the correct diagnoses to report for this
encounter? - ANSWER-E11.52, Z79.4 remember that DM & Gangrene is a combo code
and the z code is for the insulin use.
A 65 year-old male patient was admitted with ascending cellulitis and infection of a 2nd,
3rd, and 4th toes amputation site. What are the appropriate diagnosis codes for this? -
ANSWER-T87.40, L03.039
Which one of the following physician's assessment supports the correct coding for CKD
stage 2, code N18.2? - ANSWER-A/P: Mild CKD
Patient is admitted to the hospital for treatment of a Subarachnoid Hemorrhage. The
patient has hypertension and is being evaluated by Neurosurgery for possible surgical
intervention. Assign the correct ICD-10-CM code(s) for the admission. - ANSWER-I60.9,
I10
The provider sees a patient in the Emergency room for acute flank pain. The patient has
high blood pressure after serial BPs taken. The ultrasound shows acute pyelonephritis.
The provider documents acute pyelonephritis and secondary hypertension. Assign the
correct ICD-10-CM codes. - ANSWER-N10, I15.8 Remember this needs the
TRANSIENT HTN code.
A 77 year-old male presents for follow up with his primary care provider. The provider
documents a healed pressure ulcer of the right heel and hypertension. The Assessment
