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Risk Adjustment CRC exam questions with
answers
What are extra RA values or factors added when a patient has more than one major significant dx identified in model? - CORRECT ANSWERS ✔✔Interactions MIPS Collection Types Categories - CORRECT ANSWERS ✔✔Quality, Promoting Interoperability, Improvement Activity, Cost October of each year - CORRECT ANSWERS ✔✔When are Star Ratings publicly published? Surveys, Medical Chart Reviews, Insurance Claims, Medical Office Visits, Procedures - CORRECT ANSWERS ✔✔HEDIS types of collection Medicare Administrative Contractor - CORRECT ANSWERS ✔✔What does Abbreviation MAC stand for? 1.0 - CORRECT ANSWERS ✔✔Each year, Medicare normalizes risk scores to maintain an average of what?
Inpatient admission note - CORRECT ANSWERS ✔✔Which type of documentation can be used to support diagnoses reported under risk adjustment models? Determine projected costs of health care based on the condition(s) of patients - CORRECT ANSWERS ✔✔Risk adjustment models are used to: Yes, additional current diagnoses not included on claims data may be approved during the audit. - CORRECT ANSWERS ✔✔When submitting records for RADV audit, will additional current diagnoses that were not originally reported be considered when documentation is submitted for the audit? Current year's known diagnoses - CORRECT ANSWERS ✔✔For commercial plans, funding is allocated based on Failure to code for a chronic condition the patient has may result in an inaccurate RAF. - CORRECT ANSWERS ✔✔What is the impact on reimbursement under the risk adjustment model if chronic conditions are not coded properly? To evaluate the appropriateness of risk scores to patients. - CORRECT ANSWERS ✔✔What is the purpose of a RADV 5 - CORRECT ANSWERS ✔✔How many records are submitted by health plans per patient in a RADV audit?
provider signature, credentials, and two patient ID's. The printed provider name is only necessary when the signature is illegible and there is a need to identify the provider. - CORRECT ANSWERS ✔✔RADV/IVA audit submissions typically require: 1.Can be performed by internal employees. 2.Can be performed by external consultants who sign a business agreement
- Performed after data was submitted - CORRECT ANSWERS ✔✔Which statements are TRUE regarding retrospective audits? provider is queried and an addendum/late entry is created to address the conflicting information. - CORRECT ANSWERS ✔✔If a medical record has conflicting information documented, how is it resolved? E43 - CORRECT ANSWERS ✔✔Patient diagnosed with severe protein calorie malnutrition. What is the appropriate diagnosis coding? F98.8 - CORRECT ANSWERS ✔✔Which ICD-10-CM code(s) is/are reported when the provider diagnoses the patient with adult attention deficit disorder (ADD)? T86.49, C80.2, C22.8 - CORRECT ANSWERS ✔✔Patient is being seen in the Outpatient clinic today for liver cancer of a transplanted liver. Select the correct code(s).
I25.10 - CORRECT ANSWERS ✔✔What is the proper way to code coronary artery disease with no history of prior coronary artery bypass? J95.851 - CORRECT ANSWERS ✔✔A patient is diagnosed with VAP. Select the diagnosis code(s) L89.622, L89.611 - CORRECT ANSWERS ✔✔A 69 year-old male presents for follow up wound care for his bilateral pressure ulcers. His right heel shows a stage one ulcer and left heel shows a stage two ulcer with dark scabbing. The provider orders Betadine painting for both ulcers. Assign the correct ICD-10-CM code(s) for this visit. J84.10 - CORRECT ANSWERS ✔✔Patient is seen today for follow up of cirrhosis of the lung found on a thoracic CT. What ICD-10- CM code is reported? Characterized by blank staring and subtle body movements that begin and end abruptly. It may cause a brief loss of consciousness. - CORRECT ANSWERS ✔✔Which sentence below, best describes the attributes of an Absence seizure (petit mal)? L97.219, L97.329 - CORRECT ANSWERS ✔✔A 67 year-old male is brought in by his daughter for evaluation of two wounds on the legs. The provider exams the skin and finds two skin ulcers. One ulcer is on the right calf and the second ulcer is on the left ankle. The provider orders the nurse to clean both ulcers and for the
C25.9, E08.641, Z79.4 Diabetes is due to neoplasm. Use E code. - CORRECT ANSWERS ✔✔A patient is being treated for diabetes with hypoglycemia and coma due to malignant neoplasm of pancreas. The patient uses insulin routinely but is not dependent. What ICD-10-CM codes should be reported? I63.9, I69.351, I69.320 - CORRECT ANSWERS ✔✔A patient is admitted after being found unresponsive at home. The patient had right-sided hemiplegia and aphasia from a previous CVA. The physician documents a current CVA as the final diagnosis and the patient is transferred for rehabilitation. What ICD-10-CM code(s) should be reported? I11.9 (Remember to look at the Excludes Note) - CORRECT ANSWERS ✔✔A patient is coming in for follow up of his essential hypertension and cardiomegaly. Both conditions are stable and he is told to continue with his medications. What ICD-10-CM code(s) should be reported? E66.01, Z68.42 - CORRECT ANSWERS ✔✔73 year-old visits his primary care physician to discuss lap band procedure for his morbid obesity. His BMI is currently 45. What ICD-10-CM code(s) should be reported? Z51.89 For encounters 4 wks later or more after MI and patient is still receiving care and aftercare code is used. - CORRECT ANSWERS ✔✔Patient presents to her physician 10 weeks following a true posterior wall myocardial infarction. The patient is still symptomatic and is receiving care related to the
myocardial infarction. What is the correct first-listed ICD-10-CM code for this condition? I12.9, N18.30 - CORRECT ANSWERS ✔✔Patient is seen in his physician's office and diagnosed with benign hypertension and Stage 3 chronic kidney disease. Select the diagnosis codes. E11.52, Z79.4 remember that DM & Gangrene is a combo code and the z code is for the insulin use. - CORRECT ANSWERS ✔✔A 65 year-old male presents to the office with history of ongoing diabetes which has been controlled with insulin for follow-up exam with his family practice physician, during this encounter the physician notes a chronic diabetic wound of his right greater toe and determines gangrene has set in. After examination and testing the family practice physician recommends the gentleman to be seen by a general surgeon for treatment of his gangrene of his right great toe. What are the correct diagnoses to report for this encounter? T87.40, L03.039 - CORRECT ANSWERS ✔✔A 65 year-old male patient was admitted with ascending cellulitis and infection of a 2nd, 3rd, and 4th toes amputation site. What are the appropriate diagnosis codes for this? A/P: Mild CKD - CORRECT ANSWERS ✔✔Which one of the following physician's assessment supports the correct coding for CKD stage 2, code N18.2?
- Disease interactions. 3.Patient age - CORRECT ANSWERS ✔✔Which of the following can effect RAF score? Risk Adjustment Processing System - CORRECT ANSWERS ✔✔What does the abbreviation RAPS indicate? 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 - CORRECT ANSWERS ✔✔What is a disease Hierarchy? CDPS - CORRECT ANSWERS ✔✔Which risk adjustment model incorporates high, medium, and low risk in the numeric value? Eases the transition from one year's model to the next because of potential lost values - CORRECT ANSWERS ✔✔Which statement is TRUE regarding the HCC blended model? Exam - CORRECT ANSWERS ✔✔Which element of the documentation includes the provider's objective findings? Risk adjustment factor - CORRECT ANSWERS ✔✔What is the purpose of collecting diagnoses in risk adjustment coding? Monitor, Evaluate, Assess, Treat - CORRECT ANSWERS ✔✔What does the acronym MEAT stand for?
January to December - CORRECT ANSWERS ✔✔What is the reporting period for risk adjustment coding? 60 days - CORRECT ANSWERS ✔✔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. N63.20, Z85.3 - CORRECT ANSWERS ✔✔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? Electronic signature/authentication, Accepted by - Acknowledged by - Approved by- Authenticated by - - CORRECT ANSWERS ✔✔Which one of the following is an acceptable signature for risk adjustment? Assign when a diagnosis has not been established by the provider
- CORRECT ANSWERS ✔✔According to the ICD-10-CM guidelines, when are coding signs and symptoms acceptable? CMS requires the provider to sign the on a timely basis. - CORRECT ANSWERS ✔✔When does Medicare require the provider to sign the medical record
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. - CORRECT ANSWERS ✔✔Code Right eyebrow laceration, subsequent encounter Represents "other specified", when a specific code is not available for a conditon, alpha index directs you to "other specified" - CORRECT ANSWERS ✔✔NEC (not elsewhere classified) "Not otherwise specified" equivalent to unspecified. - CORRECT ANSWERS ✔✔NOS single code used to classify two dx or dx with associated secondary process or complication. - CORRECT ANSWERS ✔✔combination code "Not coded here", code exluded should never be used at the same time as the code above, whe two conditons cannot occur together. - CORRECT ANSWERS ✔✔Excludes 1 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. - CORRECT ANSWERS ✔✔Excludes 2
interpreted to mean either "and" or "or" when it appears - CORRECT ANSWERS ✔✔And means associated with or due to, in alpha index presumes a causal relationship between the two conditons. Can be used even if provides doesn't indicate - CORRECT ANSWERS ✔✔with indicates another term should be referenced. - CORRECT ANSWERS ✔✔See Two codes may be required to fully describe the condition but the sequencing of the two codes is discretionary - CORRECT ANSWERS ✔✔Code also no time limit on when it can be coded, generally requires two codes sequenced in the following order, conditon or nature of sequla then sequla is sequnced next. - CORRECT ANSWERS ✔✔Sequela If documented as "borderline" at the time of discharge the dx is coded as confirmed- unless the classification provides a specific entry ( e.g. borderline diabetes.) - CORRECT ANSWERS ✔✔borderline dx ccan be used if there is no dx for patient - CORRECT ANSWERS ✔✔use of signs and symptoms
centers, psyicatric hospitals, rutal health clinic(free standing and provider based) - CORRECT ANSWERS ✔✔acceptable outpatient facilities
