2026 AAPC CRC PRACTICE EXAM 1
QUESTIONS AND ANSWERS
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
A. LCSW
B. CRNA
C. Podiatrist
D. Registered nurse - ANS-D. Registered nurse
Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
A. The number of years a patient has been covered under Medicare Advantage
B. Gender
C. Procedure codes
D. Place of service - ANS-A. The number of years a patient has been covered under
Medicare Advantage
Which medical record(s) can be submitted for HCC validation?
I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
A. I, II, and III
B. IV
C. I, II, III, and IV
D. I, II, III, IV, and V - ANS-A. I, II, and III
Which statement is coded as a history of condition?
A. Patient presents with a history of colon cancer. He is currently getting chemotherapy
administered by his oncologist.
B. Patient has a history of osteoarthritis currently taking celebrex.
C. Patient presents with CHF complaining of shortness of breath.
D. Patient has a history of breast cancer and sees her oncologist routinely. - ANS-D.
Patient has a history of breast cancer and sees her oncologist routinely.
, Which of the following general statements is NOT TRUE regarding Risk Adjustment
practices and Star Quality Ratings?
A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score
because the highest rating is a Five
B. From a data discovery perspective, risk adjustment and quality measures are
inseparable
C. Prospective members can review Medicare Advantage plans' Star Quality rating prior
to enrollment
D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical
record information that is collected in support of risk adjustment - ANS-B. From a data
discovery perspective, risk adjustment and quality measures are inseparable
Which risk adjustment model is used by Medicaid programs?
A. HCC
B. CDPS
C. ZIPC
D. MIPS - ANS-B. CDPS
Based on the review of the medical record, what discrepancy would a coder identify?
A. The list of medications was not documented which would affect coding
B. The provider did not document the chief complaint
C. The provider did not properly sign the documentation
D. There are no discrepancies with this documentation - ANS-A. The list of medications
was not documented which would affect coding
ANESTHESIA: General. PREOPERATIVE DIAGNOSIS: Diabetic ulcer right upper thigh
with exposed fat layer. POSTOPERATIVE DIAGNOSIS: Diabetic ulcer right upper thigh
with exposed fat layer. PROCEDURE: Debridement of ulcer, right upper thigh.
INDICATIONS: This 76-year-old female has developed an ulcer on the upper right thigh.
She is here for debridement. The patient has a current history of type 2 diabetes and
hypertension. DESCRIPTION OF PROCEDURE: Under general laryngeal mask
anesthesia, the patient was placed in left lateral decubitus position and the right lateral
thigh and hip was appropriately prepped and draped. Sharp Mayo scissor dissection
was used to debride skin, subcutaneous tissue and excise the edges of the wound
down to the tensor fascia. Some undermining with fat necrosis was also debrided. It
was covered with gauze and a dressing. She tolerated the procedure well. What
diagnosis coding should be reported? - ANS-E11.622, L97.112, I10
A 66-year-old male patient with AIDS presents with new onset of shortness of breath.
Tests confirm the patient has pneumocystis carinii pneumonia. What diagnosis coding
should be reported?
QUESTIONS AND ANSWERS
Which provider is NOT an approved provider for diagnosis code capture under the HCC
model?
A. LCSW
B. CRNA
C. Podiatrist
D. Registered nurse - ANS-D. Registered nurse
Which element would NOT be taken into consideration for predictive modeling in risk
adjustment?
A. The number of years a patient has been covered under Medicare Advantage
B. Gender
C. Procedure codes
D. Place of service - ANS-A. The number of years a patient has been covered under
Medicare Advantage
Which medical record(s) can be submitted for HCC validation?
I. Physician office progress note
II. Outpatient Hospital
III. Critical Access Hospital
IV. Laboratory test results
V. Diagnostic X-rays
A. I, II, and III
B. IV
C. I, II, III, and IV
D. I, II, III, IV, and V - ANS-A. I, II, and III
Which statement is coded as a history of condition?
A. Patient presents with a history of colon cancer. He is currently getting chemotherapy
administered by his oncologist.
B. Patient has a history of osteoarthritis currently taking celebrex.
C. Patient presents with CHF complaining of shortness of breath.
D. Patient has a history of breast cancer and sees her oncologist routinely. - ANS-D.
Patient has a history of breast cancer and sees her oncologist routinely.
, Which of the following general statements is NOT TRUE regarding Risk Adjustment
practices and Star Quality Ratings?
A. Health Care Plans with Four Star Quality Ratings can still improve their STARS score
because the highest rating is a Five
B. From a data discovery perspective, risk adjustment and quality measures are
inseparable
C. Prospective members can review Medicare Advantage plans' Star Quality rating prior
to enrollment
D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical
record information that is collected in support of risk adjustment - ANS-B. From a data
discovery perspective, risk adjustment and quality measures are inseparable
Which risk adjustment model is used by Medicaid programs?
A. HCC
B. CDPS
C. ZIPC
D. MIPS - ANS-B. CDPS
Based on the review of the medical record, what discrepancy would a coder identify?
A. The list of medications was not documented which would affect coding
B. The provider did not document the chief complaint
C. The provider did not properly sign the documentation
D. There are no discrepancies with this documentation - ANS-A. The list of medications
was not documented which would affect coding
ANESTHESIA: General. PREOPERATIVE DIAGNOSIS: Diabetic ulcer right upper thigh
with exposed fat layer. POSTOPERATIVE DIAGNOSIS: Diabetic ulcer right upper thigh
with exposed fat layer. PROCEDURE: Debridement of ulcer, right upper thigh.
INDICATIONS: This 76-year-old female has developed an ulcer on the upper right thigh.
She is here for debridement. The patient has a current history of type 2 diabetes and
hypertension. DESCRIPTION OF PROCEDURE: Under general laryngeal mask
anesthesia, the patient was placed in left lateral decubitus position and the right lateral
thigh and hip was appropriately prepped and draped. Sharp Mayo scissor dissection
was used to debride skin, subcutaneous tissue and excise the edges of the wound
down to the tensor fascia. Some undermining with fat necrosis was also debrided. It
was covered with gauze and a dressing. She tolerated the procedure well. What
diagnosis coding should be reported? - ANS-E11.622, L97.112, I10
A 66-year-old male patient with AIDS presents with new onset of shortness of breath.
Tests confirm the patient has pneumocystis carinii pneumonia. What diagnosis coding
should be reported?
