RISK ADJUSTMENT CRC 2026/2027 TEST PAPER EXAM
QUESTIONS AND SOLUTIONS RATED A+
✔✔What does the abbreviation RAPS indicate? - ✔✔Risk Adjustment Processing
System
✔✔What is a disease Hierarchy? - ✔✔combination of multiple ICD-9-CM/ICD-10-CM
diagnosis codes that address multiple levels of severity for a disease with varying levels
of associated medical costs
✔✔Which risk adjustment model incorporates high, medium, and low risk in the numeric
value? - ✔✔CDPS
✔✔Which statement is TRUE regarding the HCC blended model? - ✔✔Eases the
transition from one year's model to the next because of potential lost values
✔✔Which element of the documentation includes the provider's objective findings? -
✔✔Exam
✔✔What is the purpose of collecting diagnoses in risk adjustment coding? - ✔✔Risk
adjustment factor
✔✔What does the acronym MEAT stand for? - ✔✔Monitor, Evaluate, Assess, Treat
✔✔What is the reporting period for risk adjustment coding? - ✔✔January to December
✔✔An addendum is used to include information about what was done to the patient and
should be added within a reasonable time frame, which is usually capped at a maximum
of how many days after the encounter. - ✔✔60 days
✔✔A patient presents with a lump in her left breast. She has a history of breast cancer
of her right breast and has completed all her treatments. What diagnosis coding is
reported? - ✔✔N63.20, Z85.3
✔✔Which one of the following is an acceptable signature for risk adjustment? -
✔✔Electronic signature/authentication, Accepted by - Acknowledged by - Approved by-
Authenticated by -
✔✔According to the ICD-10-CM guidelines, when are coding signs and symptoms
acceptable? - ✔✔Assign when a diagnosis has not been established by the provider
✔✔When does Medicare require the provider to sign the medical record - ✔✔CMS
requires the provider to sign the on a timely basis.
, ✔✔What is the Joint Commission rule concerning entries in the medical record? -
✔✔Medical record needs to be signed, dated, and timed.
✔✔Which one of the following is NOT allowable for coding in the outpatient setting? -
✔✔"Consistent with" which means the same as suspected and is not acceptable, use of
up and down arrows, and reporting the diagnosis code alone (must report diagnosis
code with description of code.
✔✔locate the diagnosis codes for the following condition:
Chronic non-intractable common migraine headache with status migrainosis -
✔✔Migraine (idiopathic)/common directs you to see Migraine, without aura.
Migraine/without aura/chronic/not intractable/with status migrainosus directs you to code
G43.701.
✔✔locate the diagnosis codes for the following condition:
Chlamydial inflammation of the testes - ✔✔look for Inflammation, inflamed,
inflammatory/testes, which directs you to see Orchitis. Orchitis is the inflammation of the
testes. Look for Orchitis/chlamydial or Chlamydia. A56.19
✔✔Code, Acute cholecystitis with chronic cholecystitis - ✔✔K81.2,
Cholecystitis/acute/with/chronic cholecystitis. You are referred to K81.2. (do not use two
codes as this code covers both)
✔✔Code Right eyebrow laceration, subsequent encounter - ✔✔Laceration/eyebrow and
you are directed to see Laceration, eyelid. Look for Laceration/eyelid, and you are
referred to S01.111D (remember to add 7th cat character, D for subsequent encounter.
✔✔NEC (not elsewhere classified) - ✔✔Represents "other specified", when a specific
code is not available for a conditon, alpha index directs you to "other specified"
✔✔NOS - ✔✔"Not otherwise specified" equivalent to unspecified.
✔✔combination code - ✔✔single code used to classify two dx or dx with associated
secondary process or complication.
✔✔Excludes 1 - ✔✔"Not coded here", code exluded should never be used at the same
time as the code above, whe two conditons cannot occur together.
✔✔Excludes 2 - ✔✔Not included here, not part of the condition represented by the
code, but a patient may have both conditions at the same time, acceptable to use both
the code and excluded code together.
✔✔And - ✔✔interpreted to mean either "and" or "or" when it appears
QUESTIONS AND SOLUTIONS RATED A+
✔✔What does the abbreviation RAPS indicate? - ✔✔Risk Adjustment Processing
System
✔✔What is a disease Hierarchy? - ✔✔combination of multiple ICD-9-CM/ICD-10-CM
diagnosis codes that address multiple levels of severity for a disease with varying levels
of associated medical costs
✔✔Which risk adjustment model incorporates high, medium, and low risk in the numeric
value? - ✔✔CDPS
✔✔Which statement is TRUE regarding the HCC blended model? - ✔✔Eases the
transition from one year's model to the next because of potential lost values
✔✔Which element of the documentation includes the provider's objective findings? -
✔✔Exam
✔✔What is the purpose of collecting diagnoses in risk adjustment coding? - ✔✔Risk
adjustment factor
✔✔What does the acronym MEAT stand for? - ✔✔Monitor, Evaluate, Assess, Treat
✔✔What is the reporting period for risk adjustment coding? - ✔✔January to December
✔✔An addendum is used to include information about what was done to the patient and
should be added within a reasonable time frame, which is usually capped at a maximum
of how many days after the encounter. - ✔✔60 days
✔✔A patient presents with a lump in her left breast. She has a history of breast cancer
of her right breast and has completed all her treatments. What diagnosis coding is
reported? - ✔✔N63.20, Z85.3
✔✔Which one of the following is an acceptable signature for risk adjustment? -
✔✔Electronic signature/authentication, Accepted by - Acknowledged by - Approved by-
Authenticated by -
✔✔According to the ICD-10-CM guidelines, when are coding signs and symptoms
acceptable? - ✔✔Assign when a diagnosis has not been established by the provider
✔✔When does Medicare require the provider to sign the medical record - ✔✔CMS
requires the provider to sign the on a timely basis.
, ✔✔What is the Joint Commission rule concerning entries in the medical record? -
✔✔Medical record needs to be signed, dated, and timed.
✔✔Which one of the following is NOT allowable for coding in the outpatient setting? -
✔✔"Consistent with" which means the same as suspected and is not acceptable, use of
up and down arrows, and reporting the diagnosis code alone (must report diagnosis
code with description of code.
✔✔locate the diagnosis codes for the following condition:
Chronic non-intractable common migraine headache with status migrainosis -
✔✔Migraine (idiopathic)/common directs you to see Migraine, without aura.
Migraine/without aura/chronic/not intractable/with status migrainosus directs you to code
G43.701.
✔✔locate the diagnosis codes for the following condition:
Chlamydial inflammation of the testes - ✔✔look for Inflammation, inflamed,
inflammatory/testes, which directs you to see Orchitis. Orchitis is the inflammation of the
testes. Look for Orchitis/chlamydial or Chlamydia. A56.19
✔✔Code, Acute cholecystitis with chronic cholecystitis - ✔✔K81.2,
Cholecystitis/acute/with/chronic cholecystitis. You are referred to K81.2. (do not use two
codes as this code covers both)
✔✔Code Right eyebrow laceration, subsequent encounter - ✔✔Laceration/eyebrow and
you are directed to see Laceration, eyelid. Look for Laceration/eyelid, and you are
referred to S01.111D (remember to add 7th cat character, D for subsequent encounter.
✔✔NEC (not elsewhere classified) - ✔✔Represents "other specified", when a specific
code is not available for a conditon, alpha index directs you to "other specified"
✔✔NOS - ✔✔"Not otherwise specified" equivalent to unspecified.
✔✔combination code - ✔✔single code used to classify two dx or dx with associated
secondary process or complication.
✔✔Excludes 1 - ✔✔"Not coded here", code exluded should never be used at the same
time as the code above, whe two conditons cannot occur together.
✔✔Excludes 2 - ✔✔Not included here, not part of the condition represented by the
code, but a patient may have both conditions at the same time, acceptable to use both
the code and excluded code together.
✔✔And - ✔✔interpreted to mean either "and" or "or" when it appears
