Certified Risk Adjustment- AAPC EXAM
2026-2027 LATEST VERSION QUESTIONS
AND VERIFIED CORRECT ANSWER
Exam
This document includes the most current Certified Risk Adjustment (CRA) AAPC exam
questions for the 2026–2027 certification cycle, along with verified correct answers. It
covers essential risk-adjustment concepts such as HCC coding, documentation
requirements, ICD-10-CM guidelines, CMS-HCC models, and compliance considerations.
The material reflects updated AAPC standards and provides a complete study resource
for candidates preparing for the CRA exam.
1. A 67-year-old patient with Type 2 diabetes and chronic kidney
disease stage 3b is seen for follow-up. Which is the correct coding?
A. E11.22, N18.32
B. E11.9, N18.32
C. E11.21, N18.32
D. N18.32 only
Correct Answer: A
Rationale:
• Diabetes with CKD = E11.22.
• CKD stage 3b = N18.32.
, • E11.21 (diabetes with nephropathy) is not specific to CKD.
• Both conditions map to an HCC when coded together.
2. The physician documents “history of CHF, stable on medications.”
The heart failure is active and treated. How should this be coded?
A. Z86.79
B. I50.9
C. Z79.899
D. No code needed
Correct Answer: B
Rationale:
• “History of” sometimes means past, but when the provider
notes treatment (medications) or monitoring, it indicates
active chronic CHF, which requires coding.
• Z86.79 is for personal history of cardiovascular disease — not
correct here.
3. What documentation element is required for an HCC to be valid
for risk adjustment?
A. Treatment plan only
B. MEAT or TAMPER criteria
C. ICD-10-CM code only
D. Chronic condition status only
Correct Answer: B
Rationale:
, • HCCs require provider documentation demonstrating MEAT:
Monitor, Evaluate, Assess, Treat (or TAMPER equivalent).
• Codes alone without supporting provider documentation do
not risk-adjust.
4. A patient with COPD and acute lower respiratory infection. What
is the correct coding?
A. J44.1 only
B. J44.0, J22
C. J44.9, J22
D. J22 only
Correct Answer: B
Rationale:
• COPD with acute lower respiratory infection = J44.0.
• The specific infection (if unspecified) is coded with J22.
• J44.1 is COPD with acute exacerbation (not documented).
5. Provider documents “ESRD on long-term dialysis.” What codes
are needed?
A. N18.6 only
B. N18.6, Z99.2
C. Z99.2 only
D. N18.5, Z99.2
Correct Answer: B
Rationale:
, • ESRD = N18.6
• Dependence on renal dialysis = Z99.2
• Both are required to fully capture risk and HCC assignment.
6. Which of the following conditions carries over year to year and
still must be documented annually to risk-adjust?
A. History of cancer
B. Chronic major depressive disorder
C. Acute MI
D. Sprained ankle
Correct Answer: B
Rationale:
• Chronic MDD is a chronic active condition that has ongoing
impact and needs annual documentation.
• Conditions like acute MI or ankle sprain are temporary and do
not carry risk longitudinally.
7. Hypertensive heart disease with heart failure codes to:
A. I11.0
B. I11.9
C. I50.9 only
D. I11.0 + I50.9
Correct Answer: D
Rationale:
2026-2027 LATEST VERSION QUESTIONS
AND VERIFIED CORRECT ANSWER
Exam
This document includes the most current Certified Risk Adjustment (CRA) AAPC exam
questions for the 2026–2027 certification cycle, along with verified correct answers. It
covers essential risk-adjustment concepts such as HCC coding, documentation
requirements, ICD-10-CM guidelines, CMS-HCC models, and compliance considerations.
The material reflects updated AAPC standards and provides a complete study resource
for candidates preparing for the CRA exam.
1. A 67-year-old patient with Type 2 diabetes and chronic kidney
disease stage 3b is seen for follow-up. Which is the correct coding?
A. E11.22, N18.32
B. E11.9, N18.32
C. E11.21, N18.32
D. N18.32 only
Correct Answer: A
Rationale:
• Diabetes with CKD = E11.22.
• CKD stage 3b = N18.32.
, • E11.21 (diabetes with nephropathy) is not specific to CKD.
• Both conditions map to an HCC when coded together.
2. The physician documents “history of CHF, stable on medications.”
The heart failure is active and treated. How should this be coded?
A. Z86.79
B. I50.9
C. Z79.899
D. No code needed
Correct Answer: B
Rationale:
• “History of” sometimes means past, but when the provider
notes treatment (medications) or monitoring, it indicates
active chronic CHF, which requires coding.
• Z86.79 is for personal history of cardiovascular disease — not
correct here.
3. What documentation element is required for an HCC to be valid
for risk adjustment?
A. Treatment plan only
B. MEAT or TAMPER criteria
C. ICD-10-CM code only
D. Chronic condition status only
Correct Answer: B
Rationale:
, • HCCs require provider documentation demonstrating MEAT:
Monitor, Evaluate, Assess, Treat (or TAMPER equivalent).
• Codes alone without supporting provider documentation do
not risk-adjust.
4. A patient with COPD and acute lower respiratory infection. What
is the correct coding?
A. J44.1 only
B. J44.0, J22
C. J44.9, J22
D. J22 only
Correct Answer: B
Rationale:
• COPD with acute lower respiratory infection = J44.0.
• The specific infection (if unspecified) is coded with J22.
• J44.1 is COPD with acute exacerbation (not documented).
5. Provider documents “ESRD on long-term dialysis.” What codes
are needed?
A. N18.6 only
B. N18.6, Z99.2
C. Z99.2 only
D. N18.5, Z99.2
Correct Answer: B
Rationale:
, • ESRD = N18.6
• Dependence on renal dialysis = Z99.2
• Both are required to fully capture risk and HCC assignment.
6. Which of the following conditions carries over year to year and
still must be documented annually to risk-adjust?
A. History of cancer
B. Chronic major depressive disorder
C. Acute MI
D. Sprained ankle
Correct Answer: B
Rationale:
• Chronic MDD is a chronic active condition that has ongoing
impact and needs annual documentation.
• Conditions like acute MI or ankle sprain are temporary and do
not carry risk longitudinally.
7. Hypertensive heart disease with heart failure codes to:
A. I11.0
B. I11.9
C. I50.9 only
D. I11.0 + I50.9
Correct Answer: D
Rationale:
