Free Certified Risk Adjustment Coder (CRC) Exam Questions and Answers

A 68-year-old woman is seen for a follow-up visit. The assessment and plan read: 1. Type 2 diabetes mellitus. A1c 7.4%. Continue metformin 1000 mg twice daily. 2. Chronic kidney disease, stage 3b. eGFR 41. Repeat basic metabolic panel in 3 months. The provider does not state a cause for the kidney disease and does not say that it is unrelated to the diabetes. Which codes should be reported?

• AA. E11.22, N18.32, Z79.84
• BB. E11.22, N18.30, Z79.84
• CC. E11.22, N18.32, Z79.4
• DD. E11.9, N18.32, Z79.84

The assessment section of a cardiology progress note lists the following: 1. NSTEMI, s/p PCI to LAD 2 weeks ago 2. HFrEF, EF 30%, continue sacubitril-valsartan 3. A-fib on apixaban 4. CKD stage 4 Which option correctly expands NSTEMI, HFrEF and A-fib as they are used in this note?

• AA. Non-ST-elevation myocardial infarction; heart failure with reduced ejection fraction; atrial flutter
• BB. ST-elevation myocardial infarction; heart failure with reduced ejection fraction; atrial fibrillation
• CC. Non-ST-elevation myocardial infarction; heart failure with preserved ejection fraction; atrial fibrillation
• DD. Non-ST-elevation myocardial infarction; heart failure with reduced ejection fraction; atrial fibrillation

A Medicare Advantage plan reports that 62% of its members with diabetes had a hemoglobin A1c below 8.0% in the measurement year. This HEDIS result contributes to the plan's STAR rating. Which statement correctly describes how this result differs from the plan's HCC risk scores?

• AA. The HEDIS result sets the capitation payment for each member, while HCC risk scores rate the quality of care delivered to members
• BB. The HEDIS result validates the diagnoses submitted for payment, while HCC risk scores report the rate of preventive screening completed
• CC. The HEDIS result is calculated from demographic factors only, while HCC risk scores are calculated from clinical quality measures
• DD. The HEDIS result reflects the quality of care delivered, while HCC risk scores predict expected costs from members' diagnoses and demographics

A plan analyst is calculating a member's raw CMS-HCC risk score. Which set of inputs is used?

• AA. Age, sex, place of service, original reason for entitlement, and HCCs from submitted procedures
• BB. Age, sex, plan premium tier, Medicaid dual status, and HCCs from submitted diagnoses
• CC. Age, sex, number of visits with each provider, Medicaid dual status, and HCCs from submitted claims
• DD. Age, sex, Medicaid dual status, original reason for entitlement, and HCCs from submitted diagnoses

Office visit, 74-year-old male HPI: Mr. Alvarez presents with 3 days of worsening cough, wheezing and increased sputum. He uses albuterol and tiotropium daily. He quit smoking in 2015. He denies fever. PMH: Type 2 diabetes mellitus. Chronic systolic heart failure. Left leg DVT in 2019, completed 6 months of anticoagulation, no current symptoms. Prostate cancer treated with prostatectomy in 2017, no evidence of recurrence, no current treatment. Medications: metformin, carvedilol, tiotropium, albuterol. Exam: BP 128/76, HR 88, SpO2 92% on room air. Diffuse expiratory wheezes bilaterally. Heart regular, 1+ ankle edema. Left leg without swelling or tenderness. Assessment and plan: 1. COPD with acute exacerbation. Start prednisone 40 mg daily for 5 days, continue tiotropium. 2. Type 2 diabetes mellitus. A1c 7.1% last month. Continue metformin. 3. Chronic systolic heart failure, EF 35%. Continue carvedilol, daily weights. 4. Probable pneumonia. Chest x-ray ordered. Which set of codes should be reported for the risk-adjusting conditions supported at this encounter?

• AA. E11.9, I50.9, J44.1
• BB. E11.9, I50.22, J44.1
• CC. E11.9, J18.9, J44.1
• DD. C61, E11.9, J44.1

A member's risk score is built from the following factors: Demographic factor (age, sex, dual status): 0.412 HCC for heart failure: 0.331 HCC for diabetes with chronic complications: 0.302 HCC for diabetes without complications (same hierarchy as the diabetes HCC above): 0.105 Diabetes and heart failure interaction: 0.121 Both diabetes codes were submitted from valid encounters during the data collection year. What is the member's raw risk score?

• AA. 0.754
• BB. 1.045
• CC. 1.166
• DD. 1.271

A health plan submitted C34.11 for a beneficiary, and the diagnosis is selected for validation in a RADV audit. The only record supplied is a 2024 oncology follow-up note: "Adenocarcinoma of right upper lobe, status post lobectomy in 2021. No adjuvant therapy given. CT chest shows no evidence of recurrence. Repeat surveillance imaging in 6 months." What is the most likely RADV finding?

• AA. Validated, because the diagnosis appears in the assessment of a face-to-face visit with an oncologist during the data collection year
• BB. Not validated, because the record does not give a cancer stage, which is required before a malignancy HCC can be supported
• CC. Validated, because the surveillance imaging counts as monitoring of an active lung malignancy at the encounter
• DD. Not validated, because the cancer is no longer active and the condition should have been reported as a personal history of malignancy

A coder reviews a face-to-face visit for a Medicare Advantage member. The assessment documents the following, each with supporting evaluation and treatment: severe obesity due to excess calories, chronic systolic heart failure, chronic obstructive pulmonary disease, stage 2 chronic kidney disease, and hyperlipidemia. Which set of codes includes only diagnoses that map to a payment HCC in the CMS-HCC model (V28)?

• AA. I50.22, J44.9, E78.5
• BB. E66.01, I50.22, N18.2
• CC. E66.01, J44.9, E78.5
• DD. E66.01, I50.22, J44.9

Office Visit Note Patient: 68-year-old male. Chief complaint: follow-up of chronic conditions. History: Patient reports no new complaints. Home blood glucose readings range 120 to 170 mg/dL. Takes metformin 1000 mg twice daily and lisinopril 20 mg daily. Reports no chest pain or shortness of breath. Past surgical history includes radical prostatectomy in 2015 for prostate cancer; PSA has been undetectable on yearly checks and no cancer treatment has been given since surgery. Exam: BP 138/82, HR 76, BMI 29.4. Lungs clear. No peripheral edema. Data: HbA1c 7.8%. Creatinine 1.7 mg/dL, eGFR 41 mL/min/1.73 m2, stable compared with the last three results. Assessment and Plan: 1. Type 2 diabetes mellitus. A1c 7.8%. Continue metformin, recheck in 3 months. 2. Chronic kidney disease, stage 3b. eGFR stable. Avoid NSAIDs, repeat BMP in 3 months. 3. Hypertension. BP at goal. Continue lisinopril. 4. History of prostate cancer, s/p prostatectomy, no evidence of recurrence. Annual PSA. Which set of ICD-10-CM codes is correctly reported for this encounter?

• AA. E11.22, I12.9, N18.32, Z79.84, Z85.46
• BB. E11.22, I12.9, N18.30, Z79.84, Z85.46
• CC. E11.22, I12.9, N18.32, Z79.84, C61
• DD. E11.9, I10, N18.32, Z79.84, Z85.46

A coder is abstracting a face-to-face office note for a 70-year-old Medicare Advantage member whose problem list includes several chronic conditions that are all addressed in the plan. Which of the following diagnosis codes maps to a payment HCC in the CMS-HCC model (V28)?

• AA. I10 Essential (primary) hypertension
• BB. K21.9 Gastro-esophageal reflux disease without esophagitis
• CC. I48.91 Unspecified atrial fibrillation
• DD. E78.5 Hyperlipidemia, unspecified