RA EXAM REVIEW QUESTIONS AND ANSWERS
What information is required when submitting documentation to support a diagnosis for a RADV/IVA? -
CORRECT ANSWER✅✅A single DOS for outpatient records and the full inpatient set for hospital records
Which type of audit evaluates appropriate risk scores of patients? - CORRECT ANSWER✅✅RADV
Retrospective audits should include the following attributes:
I. Provider signatures
II. Supporting documentation of the patient's diagnoses
III. DOS - CORRECT ANSWER✅✅I, II and III
Which of the following records would be a good source for a retrospective chart audit? - CORRECT
ANSWER✅✅Cardiologist records
Which of the following are reported by a provider for beneficiaries in a Medicare Advantage Plan? -
CORRECT ANSWER✅✅I and IV
The definition of a best medical record for a RADV audit is: - CORRECT ANSWER✅✅Documentation that
validates the requested HCC plus validates an additional HCC, contains all the necessary documentation
elements, but is missing the provider signature, for which a signed CMS attestation was provided but
not signed by the provider
Breast Cancer Treatement - CORRECT ANSWER✅✅Anastrozole is used to treat breast cancer in women
who have gone through menopause. It works by lowering estrogen hormone levels to help shrink
tumors and slow their growth. Tamoxifen is prescribed for women who have breast cancer with tumors
fueled by estrogen. The medication blocks the action of estrogen.
What is the code assignment requirement for chronic kidney disease requiring dialysis? - CORRECT
ANSWER✅✅Diagnosed with CKD and is on chronic dialysis/receiving kidney transplants
Which of the following medications are prescribed to cancer patients to eradicate the cancer or for
prophylaxis?
,I. Tamoxifen
II. Anastrozole
III. Januvia
IV. Crestor - CORRECT ANSWER✅✅I and II
Joey is prescribed Oxycodone for a back injury by his orthopedic surgeon two years ago. The surgeon
documents he would like to try another medication to dull the pain. Joey attempts to change to the
newer medication but there is breakthrough pain and he goes back to the Oxycodone. Would code from
category F11.2 be appropriate? - CORRECT ANSWER✅✅No, the surgeon did not document that Joey
was dependent on the Oxycodone
Patient is here for follow up after her dialysis yesterday. What is the ICD-10-CM code for presence of an
AV fistula for dialysis? - CORRECT ANSWER✅✅Z99.2
Diagnoses must be based on face-to face encounters between members and an MD, PA, or NP and
status conditions like a below knee amputation, must be assessed and documented in order for
payment adjustments to be received. How often should a provider see and assess a patient in a calendar
year to validate amputation status? - CORRECT ANSWER✅✅Once a year
A PEG Tube is:
I. Percutaneous Endoscopic Gastrostomy
II. G tube
III. Gastrostomy
IV. Colostomy - CORRECT ANSWER✅✅I, II, and III
Patient is here for follow up. She was seen in the ER two weeks ago where she had an MRI of the brain
which showed significant cerebral arteriosclerosis. She was diagnosed with a TIA. She has been
experiencing slight memory loss. Select the correct code(s). - CORRECT ANSWER✅✅I67.2 Cerebral
atherosclerosis is the correct primary ICD-10-CM code. The personal history TIA code Z86.73 is reported
as the second code. Memory loss (R41.3) would not be reported as it is a symptom of cerebral
arteriosclerosis.
,Today a 54 year-old man presents for his routine follow up after renal transplant two years ago. The
patient has CKD stage 2 and reports no other complaints. Assign the correct ICD-10-CM code(s). -
CORRECT ANSWER✅✅N18.2, Z94.0
ICD-10-CM guideline I.C.14.a.2, indicates that the presence of CKD after a transplant alone does not
constitute a transplant complication. Also, there is an instructional note below code category N18 in the
Tabular List indicating to use additional code to report transplant status.
A patient presents for a routine checkup for his hypertensive heart failure. He is to continue with his
current medication and diet. Select the diagnosis code(s). - CORRECT ANSWER✅✅I11.0, I50.9
Whenever there is a causal relationship between hypertension and heart failure report code I11.0. The
heart failure is reported as a second code, because of the instructional note under code I11.0 which
indicates to "use additional code to identify type of heart failure (I50.-)."
Type 2 diabetic presents with an insulin pump malfunction. What are the correct codes? - CORRECT
ANSWER✅✅T85.694A, E11.9, Z79.4
ICD-10-CM guideline I.C.4.a.5, indicates insulin pump malfunctions are coded to T85.6-. Insulin pump
malfunction can be an under dose or overdose of medication. With documentation that is non-specific
such as this, the only known element is pump malfunction.
What is the correct ICD-10-CM code for an uncertain gastrointestinal stromal tumor? - CORRECT
ANSWER✅✅In the Alphabetic Index look for Tumor/stromal/gastrointestinal/uncertain behavior.
Coders are referred to D48.1.
What is the correct ICD-10-CM code for a patient with COPD exacerbation? - CORRECT
ANSWER✅✅J44.1
To locate the correct code, look in the ICD-10-CM Alphabetic Index for Disease,
diseased/pulmonary/chronic obstructive/with/exacerbation.
The patient had hip replacement surgery three days ago. The provider documents the patient has had a
"iatrogenic cerebrovascular infarction due to recent hip replacement surgery during her current hospital
, stay." Assign the appropriate ICD-10-CM code for the cardiovascular event. - CORRECT
ANSWER✅✅I97.821
ICD-10-CM guideline I.C.9.c., indicates cerebrovascular infarction that occurs as a result of medical
intervention is coded based on whether it was intraoperative or postprocedural. This was
postprocedural. Look in the in the ICD-10-CM Alphabetic Index for Stroke/postprocedural/following
other sugery referring you to I97.821. The Tabular List for subcategory I97.8 indicates to use an
additional code, if applicable, to further specify the disorder. We have not been given further
information such the location of the infarct, so no other code is required.
What is/are the correct code(s) for a nursing home patient with severe dementia often caught
wandering off from the floor? - CORRECT ANSWER✅✅F03.90, Z91.83
In the ICD-10-CM Alphabetic Index look for Dementia/with behavioral disturbance. The behavioral
disturbance is the wandering. There is an instructional note under code Z91.83 indicates to code first
underlying disorder.
Patient presents to OB for routine obstetric care. The nurse takes the patient's blood pressure and it
reads 140/80. The physician sees the patient and documents the following in the assessment and plan:
"A/P: Hypertension, Transient, Check BP at home daily and return to clinic in two days for nurse BP
check ". Assign the correct ICD-10-CM code(s). - CORRECT ANSWER✅✅Conditions listed on the problem
list for a diabetic patient are coded as complications of the diabetes
ICD-10-CM guideline I.C.9.a.7, indicates to assign a code from category O13 for transient hypertension in
pregnancy. The trimester and the weeks of gestation are not documented resulting in use of unspecified
codes.
A 66 year-old male patient with AIDS presents with new onset of shortness of breath. Tests confirm the
patient has pneumocystis carinii pneumonia. Select the appropriate diagnosis code(s). - CORRECT
ANSWER✅✅B20, B59
The Official ICD-10-CM guideline I.C.1.a.2., indicates if a patient is admitted with an HIV-related
condition you first sequence B20 followed the code for the HIV-related condition. Shortness of breath is
a symptom of the pneumonia and not reported (ICD-10-CM guideline I.B.5).
What information is required when submitting documentation to support a diagnosis for a RADV/IVA? -
CORRECT ANSWER✅✅A single DOS for outpatient records and the full inpatient set for hospital records
Which type of audit evaluates appropriate risk scores of patients? - CORRECT ANSWER✅✅RADV
Retrospective audits should include the following attributes:
I. Provider signatures
II. Supporting documentation of the patient's diagnoses
III. DOS - CORRECT ANSWER✅✅I, II and III
Which of the following records would be a good source for a retrospective chart audit? - CORRECT
ANSWER✅✅Cardiologist records
Which of the following are reported by a provider for beneficiaries in a Medicare Advantage Plan? -
CORRECT ANSWER✅✅I and IV
The definition of a best medical record for a RADV audit is: - CORRECT ANSWER✅✅Documentation that
validates the requested HCC plus validates an additional HCC, contains all the necessary documentation
elements, but is missing the provider signature, for which a signed CMS attestation was provided but
not signed by the provider
Breast Cancer Treatement - CORRECT ANSWER✅✅Anastrozole is used to treat breast cancer in women
who have gone through menopause. It works by lowering estrogen hormone levels to help shrink
tumors and slow their growth. Tamoxifen is prescribed for women who have breast cancer with tumors
fueled by estrogen. The medication blocks the action of estrogen.
What is the code assignment requirement for chronic kidney disease requiring dialysis? - CORRECT
ANSWER✅✅Diagnosed with CKD and is on chronic dialysis/receiving kidney transplants
Which of the following medications are prescribed to cancer patients to eradicate the cancer or for
prophylaxis?
,I. Tamoxifen
II. Anastrozole
III. Januvia
IV. Crestor - CORRECT ANSWER✅✅I and II
Joey is prescribed Oxycodone for a back injury by his orthopedic surgeon two years ago. The surgeon
documents he would like to try another medication to dull the pain. Joey attempts to change to the
newer medication but there is breakthrough pain and he goes back to the Oxycodone. Would code from
category F11.2 be appropriate? - CORRECT ANSWER✅✅No, the surgeon did not document that Joey
was dependent on the Oxycodone
Patient is here for follow up after her dialysis yesterday. What is the ICD-10-CM code for presence of an
AV fistula for dialysis? - CORRECT ANSWER✅✅Z99.2
Diagnoses must be based on face-to face encounters between members and an MD, PA, or NP and
status conditions like a below knee amputation, must be assessed and documented in order for
payment adjustments to be received. How often should a provider see and assess a patient in a calendar
year to validate amputation status? - CORRECT ANSWER✅✅Once a year
A PEG Tube is:
I. Percutaneous Endoscopic Gastrostomy
II. G tube
III. Gastrostomy
IV. Colostomy - CORRECT ANSWER✅✅I, II, and III
Patient is here for follow up. She was seen in the ER two weeks ago where she had an MRI of the brain
which showed significant cerebral arteriosclerosis. She was diagnosed with a TIA. She has been
experiencing slight memory loss. Select the correct code(s). - CORRECT ANSWER✅✅I67.2 Cerebral
atherosclerosis is the correct primary ICD-10-CM code. The personal history TIA code Z86.73 is reported
as the second code. Memory loss (R41.3) would not be reported as it is a symptom of cerebral
arteriosclerosis.
,Today a 54 year-old man presents for his routine follow up after renal transplant two years ago. The
patient has CKD stage 2 and reports no other complaints. Assign the correct ICD-10-CM code(s). -
CORRECT ANSWER✅✅N18.2, Z94.0
ICD-10-CM guideline I.C.14.a.2, indicates that the presence of CKD after a transplant alone does not
constitute a transplant complication. Also, there is an instructional note below code category N18 in the
Tabular List indicating to use additional code to report transplant status.
A patient presents for a routine checkup for his hypertensive heart failure. He is to continue with his
current medication and diet. Select the diagnosis code(s). - CORRECT ANSWER✅✅I11.0, I50.9
Whenever there is a causal relationship between hypertension and heart failure report code I11.0. The
heart failure is reported as a second code, because of the instructional note under code I11.0 which
indicates to "use additional code to identify type of heart failure (I50.-)."
Type 2 diabetic presents with an insulin pump malfunction. What are the correct codes? - CORRECT
ANSWER✅✅T85.694A, E11.9, Z79.4
ICD-10-CM guideline I.C.4.a.5, indicates insulin pump malfunctions are coded to T85.6-. Insulin pump
malfunction can be an under dose or overdose of medication. With documentation that is non-specific
such as this, the only known element is pump malfunction.
What is the correct ICD-10-CM code for an uncertain gastrointestinal stromal tumor? - CORRECT
ANSWER✅✅In the Alphabetic Index look for Tumor/stromal/gastrointestinal/uncertain behavior.
Coders are referred to D48.1.
What is the correct ICD-10-CM code for a patient with COPD exacerbation? - CORRECT
ANSWER✅✅J44.1
To locate the correct code, look in the ICD-10-CM Alphabetic Index for Disease,
diseased/pulmonary/chronic obstructive/with/exacerbation.
The patient had hip replacement surgery three days ago. The provider documents the patient has had a
"iatrogenic cerebrovascular infarction due to recent hip replacement surgery during her current hospital
, stay." Assign the appropriate ICD-10-CM code for the cardiovascular event. - CORRECT
ANSWER✅✅I97.821
ICD-10-CM guideline I.C.9.c., indicates cerebrovascular infarction that occurs as a result of medical
intervention is coded based on whether it was intraoperative or postprocedural. This was
postprocedural. Look in the in the ICD-10-CM Alphabetic Index for Stroke/postprocedural/following
other sugery referring you to I97.821. The Tabular List for subcategory I97.8 indicates to use an
additional code, if applicable, to further specify the disorder. We have not been given further
information such the location of the infarct, so no other code is required.
What is/are the correct code(s) for a nursing home patient with severe dementia often caught
wandering off from the floor? - CORRECT ANSWER✅✅F03.90, Z91.83
In the ICD-10-CM Alphabetic Index look for Dementia/with behavioral disturbance. The behavioral
disturbance is the wandering. There is an instructional note under code Z91.83 indicates to code first
underlying disorder.
Patient presents to OB for routine obstetric care. The nurse takes the patient's blood pressure and it
reads 140/80. The physician sees the patient and documents the following in the assessment and plan:
"A/P: Hypertension, Transient, Check BP at home daily and return to clinic in two days for nurse BP
check ". Assign the correct ICD-10-CM code(s). - CORRECT ANSWER✅✅Conditions listed on the problem
list for a diabetic patient are coded as complications of the diabetes
ICD-10-CM guideline I.C.9.a.7, indicates to assign a code from category O13 for transient hypertension in
pregnancy. The trimester and the weeks of gestation are not documented resulting in use of unspecified
codes.
A 66 year-old male patient with AIDS presents with new onset of shortness of breath. Tests confirm the
patient has pneumocystis carinii pneumonia. Select the appropriate diagnosis code(s). - CORRECT
ANSWER✅✅B20, B59
The Official ICD-10-CM guideline I.C.1.a.2., indicates if a patient is admitted with an HIV-related
condition you first sequence B20 followed the code for the HIV-related condition. Shortness of breath is
a symptom of the pneumonia and not reported (ICD-10-CM guideline I.B.5).
