AAPC Certified Risk Adjustment Coder (CRC)
certification exam new version 2026 update with over 500 actual questions and answers
Your answers
BMI ≥ is considered obese. Give this one a try later!
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A patient's multiple hospitalizations are being analyzed for payment adjustments. Which model is best suited?
A patient with multiple ER visits is flagged for care coordination. What process is this?
A patient presents with type 2 diabetes and hypertension. Which coding system is used?
A patient stops taking medication early, causing a disease flare-up. What term describes this phenomenon?
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3 of 546 Term
A patient is assigned a RAF of 1.2. What does this mean for the plan's payment?
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Code acute CVAand sequelae if documented.
Code final confirmed diagnosis, not initial symptom
Code ulcer first, then secondary infection per guideline
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Plan payment is adjusted 20% higher than baseline
Term
A patient develops pneumonia lasting 3 days. Is this acute or chronic?
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Acute
Do not code resolved condition unless sequelae exist
HCC model
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Term
DefinitionRight-sided heart failure due to lung disease.
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Practical case application HCC diagnoses
Complete and precise
Cor pulmonale
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Dementia
Term
Accurate coding increases plan revenue. What mechanism is responsible?
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Enhanced provider network management
Increased administrative efficiency
Term
Correct HCC assignment and RAF calculation
Improved patient satisfaction surveys
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DefinitionSet of rules directing proper ICD-10-CM code assignment.
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Core documentation HCC hierarchical structure
Quality improvement Coding guidelines
Term
DefinitionThe sum of HCC weights for a patient adjusted by demographics.
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Double counting RAF calculation
More severe HCC is counted due to hierarchy Only the higher-weighted condition
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Definition
Financial impact of coding
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Coding additional secondary conditions raises RAF by 0.3. What does this mean financially?
Accurate coding across multiple chronic conditions leads to higher annual revenue. What is responsible?
DefinitionThe link between patient documentation, coding, and monetary compensation.
Patient with multiple HCCs is coded properly. How does this affect CMS payment?
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Term
DefinitionA standardized system to evaluate health plan performance and patient outcomes.
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Severity Process measures
Operational metrics Quality metrics
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Definition
Bundle branch block
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Cardiac conduction disorders may include arrhythmias, heart block, and _.
Proper provider signatures ensure and accountability in the medical record.
Definition
Epilepsy
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Convulsions can occur with or without _.
Using combination codes ensures coding of both and manifestation.
Drugs that increase the strength of heart contraction are called _.
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DefinitionMood disorder characterized by persistent sadness and loss of interest.
Septicemia is systemic infection with
Cardiomyopathy can be dilated, hypertrophic, or _.
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Term
Coding for pregnancy requires the use of codes for trimester.
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Pulmonary hypertension
Body Mass Index (BMI)
Insufficient documentation
Obstetric complication
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Definition
Diabetes with chronic complication HCC
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Patient with positive blood cultures and fever. Code?
Patient with diabetic neuropathy and CKD. Which HCC applies?
Patient reports tingling and numbness in feet due to diabetes. Condition?
Patient diagnosed with malignant colon tumor. Code?
Term
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ICD-10-CM guidelines require coding of conditions that affect current care.
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Stable angina
Chronic comorbid
Hospitalizations
Diagnosis coding
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Definition
Chronic CHF with acute exacerbation code
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Patient has COPD exacerbation. Documentation lists chronic COPD. How should coding reflect this?
A patient presents with chest pain, later diagnosed as angina. What coding guideline applies?
Term
Patient has acute exacerbation of CHF on chronic CHF.
Coding?
Physician documents "rule out MI."
How should this be coded?
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DefinitionLegal attestation by a provider confirming entries in the medical record.
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RAF calculation
Financial impact of coding
Differential diagnosis
Signature
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Definition
Ischemic heart disease first, then CHF.
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Patient has sudden jerking movements without loss of
Patient has CHF with preserved EF secondary to
consciousness. Coding? ischemic heart disease. Coding?
DefinitionCondition where the heart cannot meet the body's circulatory demands.
Patient has persistently high blood pressure readings. What condition is coded?
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Definition
Insufficient documentation
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Aprovider documents "diabetes," but type and complications are not noted. What is the issue?
DefinitionBarrier that occurs when documentation does not contain enough detail to assign ICD codes correctly.
DefinitionDocumentation that does not meet CMS standards for supporting HCCs.
DefinitionDocumentation that does not contain enough detail to support coded diagnoses.
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Definition
DVT as complication; include underlying cause if documented.
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Patient has diabetes with neuropathy and CKD. What should the coder do first?
A patient develops liver toxicity from acetaminophen overdose. This is an example of?
Patient develops DVT postoperatively. Coding?
Patient weighs 95 kg and is 1.65 m tall. What condition is assessed?
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Term
A health plan monitors HbA1c testing rates for diabetics. This reflects?
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Quality of care measurement
Risk adjustment scores
Star ratings
Missing or undocumented conditions
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Term
DefinitionTool to evaluate and compare Medicare Advantage plan performance.
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Cloud ratings Polar ratings Circle ratings Star ratings
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Term
Clear documentation of chronicity helps distinguish between ________ and acute conditions. Give this one a try later!
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Term
Neuropathy refers to nerve damage.
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Peripheral 1 to 5
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Term
What is predictive modeling in healthcare?
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Using data to diagnose current conditions accurately. Applying statistical algorithms to manage patient records.
Analyzing data to improve hospital logistics.
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Using data and statistical algorithms to forecast future outcomes or costs.
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Term
Patient with chest pain at rest. How is angina classified?
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Encounter, cost Unstable angina
Pneumonia (underlying infection) Cor pulmonale
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Definition
Disallowed diagnoses
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Hybrid models combine and approaches to predict risk.
DefinitionThe systematic use of algorithms to anticipate patient risk.
Term
Missing or unclear signatures can result in during audits.
Coding requires identification of comorbidities that affect _.
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A patient has dilated cardiomyopathy. How should it be coded?
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Maximum appropriate RAF, increased payment
COPD HCC and CHF HCC
Specific cardiomyopathy typedilated
To guide care management and risk adjustment
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Term
Patient has acute COPD exacerbation on chronic COPD. How is it coded?
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CKD stage 4 and dialysis dependence
Vertebral fracture, lumbar region
Chronic COPD with acute exacerbation
Missing or undocumented conditions
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Term
Coding errors can lead to or underpayment.
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Hepatitis C Overpayment
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Definition
HCC assignment expertise
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DefinitionLogic that identifies potential gaps in diagnosis coding for follow-up.
DefinitionSurgical creation of an opening in the body for elimination or feeding.
DefinitionPractical skill of choosing the correct HCC based on documentation.
DefinitionErrors caused by assigning a more severe code than supported by documentation.
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Definition
Congestive heart failure (CHF)
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DefinitionCondition where the heart cannot meet the body's circulatory demands.
DefinitionA note directing coder to use additional codes to fully describe the condition.
DefinitionModels that include both statistical predictions and clinical judgment.
DefinitionDocumentation that does not contain enough detail to support coded diagnoses.
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Suspect logic supports accurate submission for risk adjustment.
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ICD coding
Treatment planning
Patient scheduling
Billing procedures
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Definition
Case-based coding exercise
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DefinitionAbnormal tissue growth that can be benign or malignant.
DefinitionSurgical connection between artery and vein for dialysis.
DefinitionNumeric value assigned to patients to estimate risk and adjust payments.
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DefinitionUsing patient scenarios to practice correct code assignment.
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Definition
Depression
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DefinitionA documented verification of medical record entries by a licensed provider.
DefinitionSurgical creation of an opening in the body for elimination or feeding.
DefinitionA condition that often coexists with other diseases and
DefinitionMood disorder characterized by persistent
affects risk adjustment. sadness and loss of interest.
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Definition
Secondary diabetes
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Patient has COPD and heart failure exacerbation. Which HCCs are relevant?
Hybrid models often combine -based and -based approaches.
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Patient develops diabetes after pancreatic surgery. What type of diabetes?
Using combination codes ensures coding of both and manifestation.
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Term
A patient with multiple comorbidities is analyzed for Medicare payment. Which feature of HCC prevents double counting?
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Disease prevalence Diagnosis codes
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Definition
Secondary / complication
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Patient with diabetic neuropathy and CKD. Which HCC applies?
Coders must differentiate between acute, chronic, and ________ conditions.
Diabetes with neuropathy is considered a diagnosis.
DefinitionThe systematic use of algorithms to anticipate patient risk.
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Term
A patient experiences dizziness when taking a new antihypertensive. This is an example of a _.
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Definition
Cor pulmonale
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Patient with stage 5 CKD on dialysis. Which codes apply?
A patient has CHF, but the coder misses it in documentation. What type of error occurred?
Patient with COPD develops right ventricular enlargement. What condition is this?
Documentation should clearly distinguish between and resolved conditions.
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Term
DefinitionA systematic summary of a patient's past and present conditions.
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Symptom (R codes)
Suspect logic
Term
Population health management
Patient history
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The ________ effect occurs when the body adapts to a drug, reducing its effect over time.
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Dependence Tolerance
Withdrawal Addiction
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Definition
Pneumonia (underlying infection)
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Patient has sepsis due to pneumonia. Which code is sequenced first?
Patient chart is missing signed progress notes. What issue does this create?
A patient's chart lacks provider signature.What is the likely consequence?
Patient with chest pain undergoes ECG and labs to rule out MI. What coding principle applies?
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Term
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Definition
Seven
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Secondary conditions affecting treatment or risk adjustment must be _.
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In HCC coding, conditions are grouped based on their and cost impact.
Codes in ICD-10-CM can be up to characters long.
RADV audits review a of patient charts for validation.
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Term
CDPS was developed at for Medicaid populations.
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University of California, San Diego (UCSD)
Johns Hopkins University
Harvard Medical School
Stanford University
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Term
RAF scores translate patient complexity into _.
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Clinical outcomes
Administrative efficiency
Operational improvements
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Financial adjustments
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Definition
CKD stage 3 plus anemia if documented as caused by CKD.
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Patient has stage 3 CKD with anemia. Coding?
Patient has leg swelling and confirmed DVT. What condition must be coded?
Patient has diabetes with neuropathy and CKD. What should the coder do first?
Patient with ST-elevation MI confirmed by ECG and troponin. Coding?
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Term
Provider documents "possible pneumonia," coder assigns confirmed pneumonia code. What barrier is this?
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Legal validity
Ischemic heart disease first, then CHF.
Term
Insufficient documentation / unsupported diagnosis
Both conditions per coding guidelines.
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CMS identifies unverified diagnoses in a Medicare Advantage plan. What process is this?
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Cor pulmonale
Laterality
CMS quality
Definition
CDC/NCHS
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ICD-10-CM coding guidelines are established by the _.
AMedicare Advantage plan is audited and multiple HCCs are unsupported. Which process identified this?
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Patient presents with rash, etiology unknown. Which code type applies?
A plan improves flu vaccination rates, impacting overall star rating. What is being measured?
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Patient has CHF secondary to hypertension. Which diagnosis is coded first?
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Verifies authenticity and accountability of the record
CKD stage 3 plus anemia if documented as caused by CKD.
Term
CKD stage 5 and dialysis dependence
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Hypertension (underlying cause) first, then CHF.
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The CMS calculates plan payments based on aggregated from individual RAF scores.
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Individual health records
Average risk score
Provider satisfaction ratings
Total patient volume
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Term
DefinitionAnalytical approach that integrates claims, clinical data, and predictive algorithms to improve outcomes.
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Under-coding
Quality improvement
Hybrid predictive modeling
Risk Adjustment Factor
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Definition
MI as principal diagnosis, cardiomyopathy as secondary if documented.
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Patient diagnosed with HIV infection. What must be coded?
Patient presents with acute MI and heart failure. Which condition is coded first?
A patient's chronic kidney disease is not coded. What happens to RAF?
Patient with myocardial infarction and cardiomyopathy. Coding?
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Term
A patient's EHR shows a lab value indicating diabetes but no diagnosis code. Suspect logic flags this. What is this an example of?
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Coding opportunity identification
Risk adjustment
Disease prevalence
Predictive modeling
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Term
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Coding guidelines Complete and precise
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Definition
Physician or qualified healthcare provider
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Code assignment should be based on documentation in the record.
Drugs that suppress the immune system are called?
Patient has sepsis due to pneumonia. Which code is sequenced first?
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Patient has acute COPD exacerbation on chronic COPD. How is it coded?
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Term
A reduces inflammation without causing immunosuppression.
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Steroidal anti-inflammatory drug
Nonsteroidal antiinflammatory drug (NSAID)
Antihistamine
Immunosuppressant medication
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Term
DefinitionAn unintended condition resulting from medical care.
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Suspect logic
Complications of care
HCC hierarchical structure
AVfistula
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Definition
Assessment
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DefinitionSection of medical record detailing provider's interpretation and assessment of patient's condition.
Physician writes "patient feels sick." How does this impact coding?
DefinitionSection of medical record containing orders, procedures, and care plan.
diagnoses must be clearly differentiated from suspected or rule-out conditions.
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A patient's multiple hospitalizations are being analyzed for payment adjustments. Which model is best suited?
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Risk adjustment model HCC model Hybrid model Risk score methodology
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A patient's CHF, COPD, and diabetes are coded accurately. What is the expected effect?
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Minimum appropriate RAF, lower payment
Maximum appropriate RAF, increased payment
Reduced RAF, decreased payment
Stable RAF, unchanged payment
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Term
DefinitionA model that prevents double counting of overlapping chronic conditions.
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HCC hierarchical structure Risk score methodology
Hybrid model Risk adjustment model
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Definition
Artificial opening
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Patient chart is missing signed progress notes. What issue does this create?
DefinitionSurgical connection between artery and vein for dialysis.
DefinitionSurgical creation of an opening in the body for elimination or feeding.
DefinitionThe barrier created when a provider does not sign or date medical record entries.
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Term
A patient's missed lab follow-up triggers a coding review via automated system. What is applied?
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Quality improvement
Coding opportunity identification
Suspect logic
Historical claims
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Definition
Practical coding methodology
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DefinitionA framework to ensure patient care meets clinical standards and desired outcomes.
DefinitionDocumentation that does not contain enough detail to support coded diagnoses.
DefinitionA note that explains whether a secondary condition can be coded with the primary condition.
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DefinitionA systematic approach to assigning ICD-10CM codes based on documentation.
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Term
What is the main purpose of HCC risk adjustment?
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To improve patient satisfaction and enhance services
To streamline administrative processes and reduce paperwork
To evaluate provider performance and allocate resources
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To predict future healthcare costs and adjust payments accordingly
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Term
The RAF score predicts a patient's for payment purposes.
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Medication adherence Insurance coverage eligibility
Hospital discharge rate
Definition
History and physical exam
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Expected healthcare cost
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Accurate diagnosis coding depends on documentation.
What is the term for the study of drug movement through the body?
Term
Acomplete medical record must include , assessment, and plan.
Predictive modeling improves ______ management and resource allocation.
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Use of unspecified codes should be minimized and only when ________ are unavailable.
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Underlying disease
LD50 (lethal dose 50)
Future healthcare costs
Detailed documentation
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Term
RAF scores are used primarily in populations.
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Definition
Acute exacerbation of COPD
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Patient with COPD has sudden worsening shortness of breath. How is this coded?
Patient has CHF secondary to hypertension. Which diagnosis is coded first?
Patient with CKD stage 4 starts dialysis. What must be coded?
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Patient with chest pain undergoes ECG and labs to rule out MI. What coding principle applies?
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Definition
Confirmed
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Missing diagnosis codes can lead to financial impact. of medical record elements reduces risk of coding errors.
DefinitionA documented verification of medical record entries by a licensed provider.
Definition
Together if appropriate
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HCC models are primarily used to predict in Medicare populations.
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diagnoses must be clearly differentiated from suspected or rule-out conditions.
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Cor pulmonale results from ________ causing right heart failure.
DefinitionA measure of body fat based on weight and height.
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"Excludes2" notes indicate conditions that may be coded ________.
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Financial impact from risk adjustment depends on both coding accuracy and _.
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Administrative cost reduction
Patient population risk
Service utilization rates
Provider performance metrics
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Term
Coders must document code rationale for purposes.
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HCC model
Obstetric complication
Audit and compliance
Risk adjustment scores
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Definition
Reimbursement
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Combination codes are used when both etiology and are known.
Accurate coding across multiple chronic conditions leads to higher annual revenue. What is responsible?
Term
Accurate coding directly impacts for providers and plans.
DefinitionCoding errors caused by assigning codes not supported by the record.
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A patient takes a new drug that induces liver enzymes, reducing the effect of their other medication. This is an example of?
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Enzyme inhibition
Metabolism
Term
Enzyme induction Biotransformation
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Predictive modeling helps identify patients for proactive care.
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Stable Routine-checkup
High-risk
Low-risk
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Term
DefinitionThe monetary effect of documented conditions on plan or provider payments.
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Financial impact of coding
Increased payment to the plan/provider
Higher aggregate RAF, increased plan payments
Only the higher-weighted condition
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Term
Patient has chronic obstructive pulmonary disease with acute exacerbation. What guideline is applied?
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Code the correct anatomic site and laterality Plan payment is adjusted 20% higher than baseline
Term
Use combination code capturing both condition and exacerbation Chronic Illness and Disability Payment System
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Accurate coding ensures correct and avoids underpayment.
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Failure to follow official diagnosis coding guidelines can result in
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Population health management
Coding inaccuracy
Congestive heart failure (CHF) Claim denial or recoupment
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Definition
Deep vein thrombosis; a blood clot in a deep vein, usually in the leg.
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What does RAF stand for in risk adjustment coding?
Hepatitis B is a liver infection.
What is DVT?
Drugs that increase heart rate are classified as?
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Term drugs block sodium channels to prevent nerve signal transmission.
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Beta blockers Anticonvulsants
Muscle relaxants Local anesthetics
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Definition
CKD stage 5 and dialysis dependence
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Patient with stage 5 CKD on dialysis. Which codes apply?
Patient intubated for respiratory failure. What must be coded?
Patient diagnosed with HIV infection. What must be coded?
Patient with swelling and leg discomfort due to varicose veins. Code?
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HCC risk adjustment is used primarily for payments.
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Term
A coder ignores official coding guideline sequencing rules. What could happen?
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Congestive heart failure (CHF)
Audit findings and potential recoupment
Active conditions Payment increases proportionally
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Term
DefinitionMethod for Medicaid to predict cost based on chronic illness.
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Term
DefinitionDisease of the heart muscle affecting contraction or relaxation.
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Cardiomyopathy
Risk score
Medical record
Anticoagulants
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Term
A patient presents with chest pain, later diagnosed as angina. What coding guideline applies?
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Locate the correct code by condition or disease
Code final confirmed diagnosis, not initial symptom
Code all diagnoses; sequence per guidelines
Code all relevant chronic conditions to calculate RAF
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Term
DefinitionA system designed to ensure fair payments based on predicted healthcare costs.
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Collection Outcome adjustment
Hierarchy Risk adjustment
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Term
HCC coding directly affects a patient's _.
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Term
DefinitionLogic system that identifies possible gaps in care or coding for validation.
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Risk
Historical claims
Suspect logic
Hierarchy
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Term
Patient has a colostomy after surgery. What should be coded?
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Specific cardiomyopathy typedilated
Presence of artificial opening
Both conditions should be coded as comorbidities.
RAF decreases, leading to underpayment
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Term
Physician writes "patient feels sick." How does this impact coding?
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Insufficient documentation
Identify all chronic conditions and complications for HCC assignment.
Non-specific documentation; cannot assign a precise ICD10-CM code
Multiple risk factors and comorbidities are coded
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Term
Hypercholesterolemia increases risk for disease.
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Cardiovascular Acute-on-chronic
Cor pulmonale Diagnosis codes
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Term
A patient with multiple ER visits is flagged for care coordination.
What process is this?
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Data exploration
Predictive modeling
Graphical analysis
Data mining
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Definition
Code underlying infection first (Klebsiella), then pneumonia if required.
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Chronic hypertension is documented with heart disease. How should coding reflect risk?
Patient has sepsis due to pneumonia. Which code is sequenced first?
Patient has pneumonia secondary to Klebsiella. How is this coded?
A patient is assigned a RAF of 1.2. What does this mean for the plan's payment?
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A
health plan tracks readmission rates and preventive screenings to improve ratings. Which system is applied?
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Official diagnosis coding guidelines prevent ________ and maintain coding consistency.
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Misinterpretation
"Use additional code"
Term
Payment and reimbursement
Historical claims
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Cachexia is severe associated with chronic illness.
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Wasting / malnutrition
History and physical exam
CVA with residual hemiplegia
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Purpose (e.g., colostomy, ileostomy)
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Term
Patient presents with rash, etiology unknown. Which code type applies?
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Symptom code (R code)
Code all comorbid conditions to capture risk
Always code right, left, or bilateral when specified
Code underlying condition first
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Term
Patient with right heart failure due to high pulmonary artery pressure.
Diagnosis?
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COPD HCC and CHF HCC
Pulmonary hypertension
Dilated cardiomyopathy
Klebsiella pneumoniae infection
Term
Coding comorbidities accurately affects the patient's score.
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TRUE Cachexia Documentation support RAF
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Term
DefinitionBarrier that occurs when documentation does not contain enough detail to assign ICD codes correctly.
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HCC model Insufficient documentation
Type (stable/unstable) and severity Complications of care
Term
Multiple conditions are documented without clarity on which is active. What coding guideline applies?
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Code symptoms only (R codes)
Chronic bronchitis and emphysema if specified
Code only active and current conditions
Core elements of the medical record
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Term
For RADV validation, each diagnosis must be clearly supported by
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Definition
Do not code resolved condition unless sequelae exist
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A patient has COPD with acute exacerbation, but no documentation supports acute status. What is the impact?
A A patient develops a cough after starting an ACE inhibitor. What type of reaction is this?
A patient's pneumonia has resolved, but the note says "history of pneumonia." What is the correct coding action?
A patient stops taking medication early, causing a disease flare-up. What term describes this phenomenon?
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Term
Drugs that mimic the action of a natural substance in the body are called?
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Antagonists
Antipyretics
Agonists
Diuretics
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Term
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Combination codes are used when both etiology and are known.
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Application skills
Coding inaccuracy
Manifestation
RAF calculation
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Term drugs increase urine output.
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Term
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Drugs that increase the strength of heart contraction are called
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Definition
Code chronic COPD with acute exacerbation.
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Patient with multiple HCCs is coded properly. How does this affect CMS payment?
Patient has chronic obstructive pulmonarydisease with acute exacerbation. What guideline is applied?
Patient has COPD exacerbation. Documentation lists chronic COPD. How should coding reflect this?
Patient presents with CVAand residual hemiplegia. How should coding reflect this?
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Term
DefinitionMissing or incomplete information in the medical record that prevents accurate coding.
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Insufficient documentation
Hepatitis and cirrhosis
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Term
Each HCC carries a weight that contributes to the patient's ________ score.
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QUALITY
UTILIZATION
RAF COMPLIANCE
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Term
What does ICD-10-CM stand for?
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Verifies authenticity and accountability of the record
Indicates conditions that cannot be coded together
Accurately translate medical documentation into ICD-10-CM codes for risk adjustment and billing.
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International Classification of Diseases, 10th Revision, Clinical Modification
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Term
DefinitionDocumentation that does not contain enough detail to support coded diagnoses.
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Coding guidelines
Insufficient documentation
Insufficient documentation / lack of specificity Dose-dependent adverse effect
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Term
DVT can lead to if the clot travels to the lungs.
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Pulmonary embolism
Double counting
Another disease Encounter, cost
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Term
Patient has right bundle branch block on ECG. How is this coded?
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Hepatitis C Cor pulmonale
Coding guidelines and principal diagnosis
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Cardiac conduction disorderbundle branch block
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Term
DefinitionRules that flag potential diagnoses from patient data for review.
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Reimbursement and public perception
Suspect logic
Claims Clinical
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Term
HCCs are organized in a to prevent double counting.
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Matrix
Hierarchy Category Classification
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Term
DefinitionCodes representing complications or residual effects following acute illness or injury.
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Late effects (sequelae)
Medical record
Cardiac conduction disorders
Patient history
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Definition
Risk accurately
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Underreporting chronic conditions can lead to for the provider or plan.
Predictive modeling improves ______ management and resource allocation.
Coders should identify acuteon-chronic conditions to capture _.
Coders must always validate ________ in patient charts before coding.
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Vertebral fractures involve the _.
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Financial incentives
Hypoglycemic agents
Secondary diabetes Spine / vertebrae
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Definition
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Condition primarily responsible for admission, usually pneumonia.
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A patient's multiple conditions are coded incorrectly, triggering an audit. What risk arises?
Patient intubated for respiratory failure. What must be coded?
Patient with COPD and pneumonia requiring hospitalization. Principal diagnosis?
Patient with diabetic neuropathy and CKD. Which HCC applies?
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Term
DefinitionThe process of distinguishing between two or more conditions with similar symptoms.
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Drug-drug interaction
Predictive modeling
Term
Congestive heart failure (CHF)
Differential diagnosis
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The amount of drug needed to produce a therapeutic effect is the ______.
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Maintenance
Therapeutic
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Definition
Code all relevant chronic conditions to calculate RAF
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Chronic hypertension is documented with heart disease. How should coding reflect risk?
Cardiac conduction disorders affect the heart's _.
A Medicare Advantage patient has controlled diabetes. How does HCC adjust risk?
Patient has pneumonia secondary to Klebsiella. How is this coded?
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Definition 5
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What does HCC stand for in risk adjustment coding?
CDPS assigns weights to conditions based on and expected cost.
CKD stages range from 1 to
Patient has leg swelling and confirmed DVT. What condition
must be coded?
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Term
DefinitionSudden interruption of blood flow to the brain causing neurological deficits.
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Upcoding
Stroke
Definition
Under-coding or over-coding
Severity
Core elements of the medical record
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Give this one a try later! of medical record elements reduces risk of coding errors.
A patient has CHF, but the coder misses it in documentation. What type of error occurred?
Patient with stage 3 pressure ulcer on sacrum. Coding?
Don't know?
Accurate documentation review helps prevent _.
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Term
HCC models are updated annually by _.
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FDA(Food and Drug Administration)
CDC (Centers for Disease Control)
AMA(American Medical Association)
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CMS (Centers for Medicare & Medicaid Services)
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Term
Major depressive disorder is a type of _.
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Dementia Depression
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Definition
Application skills
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Practicalcoding exercises strengthen forCRC exam success.
Septicemia is systemic infection with ________.
Patient diagnosed with HIV infection. What must be coded?
HCC riskadjustment is used primarily for payments.
Don't know?
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Definition
Objective
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CMS identifies unverified diagnoses in a Medicare Advantage plan. What process is this?
Documentation must clearly link diagnoses to to support risk adjustment coding.
Documentation should include findings, lab results, and diagnostic tests.
DefinitionPredictive metric that reflects patient disease burden and guides reimbursement.
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Term
CDPS stands for _. Give this one a try later!
Chronic Illness and Disability Planning System
Chronic Illness and Development Payment System
Chronic Illness and Disability Payment System Chronic Disease Prevention System
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Term
Patient has COPD and heart failure exacerbation. Which HCCs are relevant?
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Both conditions per coding guidelines. Convulsions
Mechanical ventilation COPD HCC and CHF HCC
Term
Don't know?
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The rate at which a drug leaves the body is called?
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Absorption Toxicity Clearance Metabolism
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Definition
Core elements of the medical record
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DefinitionA record of all elements of a patient's care used for coding and billing.
Physician documents "rule out MI." How should this be coded?
Term
DefinitionDocumentation that includes patient history, examination, and assessment.
Physician writes "patient feels sick." How does this impact coding?
Don't know?
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What is the study of how drugs interact with the body called?
Give this one a try later! Pharmacokinetics
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Term
Coding and documentation directly affect adjustment factors.
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Cardiomyopathy Risk
High-risk Chronic
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Term
DefinitionA record section that describes physical findings observed by the provider.
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Term
Patient with stroke develops hemiplegia months later. Which guideline applies?
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Confirmed diagnosisangina; do not code initial symptom only.
Code all relevant chronic conditions to calculate RAF
Code underlying infection first (Klebsiella), then pneumonia if required.
Definition
Risk adjustment factor (RAF)
Don't know?
Code late effect of stroke plus residual condition
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of medical record elements reduces risk of coding errors.
Coding requires identification of comorbidities that affect _.
DefinitionPractical skill of choosing the correct HCC based on documentation.
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Accurate documentation of comorbidities affects ________ scores.
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Term
Patient diagnosed with malignant colon tumor. Code?
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Complete and precise
Payment adjustment and risk score
Colon cancer (malignant neoplasm)
Claim may be denied or flagged in RADV audit
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Definition
Use only when more specific information is not available
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What is the ICD-10-CM rule for unspecified codes?
A patient has type 1 diabetes with nephropathy. How should this be coded?
Patient has pneumonia secondary to Klebsiella. How is this coded?
A patient is assigned a RAF of 1.2. What does this mean for the plan's payment?
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Term
Suspect logic improves documentation and supports _______ adjustment accuracy. Give this one a try later!
Clinical Financial
Operational Risk
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Definition
Both conditions should be coded as comorbidities.
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Patient reports low mood, fatigue, and hopelessness for 2 months.
Coding?
A patient has hypertension and diabetes. How should coding reflect this?
Patient has dyspnea and edema due to CHF. Which HCC category applies?
Patient has COPD exacerbation, but no provider signature exists. How does this affect coding?
Don't know?
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Definition
Omission error
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documentation is a common barrier to accurate risk adjustment coding.
DefinitionCoding errors caused by assigning codes not supported by the record.
occurs when multiple conditions are documented but not coded.
Accurate coding directly impacts for providers and plans.
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Excludes1/Excludes2 note
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DefinitionA code that represents the external cause, place of occurrence, or activity at time of injury.
DefinitionA note directing coder to use additional codes to fully describe the condition.
Term
DefinitionA note that explains whether a secondary condition can be coded with the primary condition.
What is the purpose of the "Excludes1" note in ICD-10-CM?
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One common documentation barrier is missing for chronic conditions.
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Clinical evidence
Therapeutic dose
Symptom codes
Patient history
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Term
Complications of care are adverse outcomes caused by _.
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Medical intervention or treatment
Financial incentives
Financial impact of coding
Cardiac conduction disorderbundle branch block
Don't know?
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Definition
Code the correct anatomic site and laterality
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A patient has dilated cardiomyopathy. How should it be coded?
A patient's chart lacks provider signature.What is the likely consequence?
Patient has left wrist fracture. Which guideline is relevant?
Patient presents with rash, etiology unknown. Which code type applies?
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Term
Drugs that interfere with bacterial growth are called?
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Antibodies
Nsaids
Diuretics
Antibiotics
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Term
A patient stops taking medication early, causing a disease flare-up.
What term describes this phenomenon?
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Metabolism
Nonadherence
Polypharmacy Excretion
Term
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Patient with diabetes and foot ulcer. How should coding reflect this?
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Cachexia
Verifies authenticity and accountability of the record
Under-coding due to insufficient documentation
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Use combination codediabetes with foot ulcer complication.
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Term
A provider improves patient outcomes and reduces readmissions. This reflects improvement in?
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Quality of life
Quality of care
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Term
Patient has COPD exacerbation, but no provider signature exists.
How does this affect coding?
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Vertebral fracture, lumbar region
Acute exacerbation of COPD
Diagnosis may not be validated in RADV audit
CKD stage 3 plus anemia if documented as caused by CKD.
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Term
DefinitionSystem grouping ICD-coded diagnoses into categories that predict cost.
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Risk Adjustment Factor
Hierarchy
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Term
DefinitionModels that include both statistical predictions and clinical judgment.
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HCC model
Hierarchy
Hybrid risk adjustment models Risk score methodology
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Term
DefinitionA 5-star system measuring health plan performance, including quality and patient satisfaction.
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Term
DefinitionA condition that often coexists with other diseases and affects risk adjustment.
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Financial impact of coding
Comorbidity
Toxicity Medical record
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Term
What does RAF stand for in risk adjustment coding?
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Quality Improvement
Patient Population Risk
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Term
HCC categories are mapped from codes.
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Term
DefinitionAdjustment factor applied to plan payment to reflect patient risk.
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Term
Patient has sudden jerking movements without loss of consciousness. Coding?
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Hybrid model
Under-coding
Secondary diabetes Convulsions
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Term
A patient presents with stable chest pain during exercise. What condition is this?
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Stable angina
Definition
Diagnosis coding
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ICD-10-CM codes are updated by the CDC/NCHS.
Hepatotoxicity
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COPD exacerbations are considered conditions.
Hybrid models combine and approaches to predict risk.
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ICD-10-CM codes are primarily used for in the U.S.
Term
Drugs that block receptor sites and prevent a response are called
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Agonists
Synergists
Inhibitors Antagonists
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Definition
Identify all chronic conditions and complications for HCC assignment. Give this one a try later!
Patient has persistently high blood pressure readings. What condition is coded?
Patient has CHF secondary to hypertension. Which diagnosis is coded first?
Patient has CHF with preserved EF secondary to ischemic heart disease. Coding?
Definition
Missing signature
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Apatient develops kidney failure due to aminoglycoside antibiotics. This is an example of?
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Patient has diabetes with neuropathy and CKD. What should the coder do first?
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DefinitionCoding errors caused by assigning codes not supported by the record.
A chart contains typed notes but no electronic signature. What is the primary barrier?
A provider improves patient outcomes and reduces readmissions.This reflects improvement in?
Don't know?
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Patient Survey
Laboratory
Radiology Claims
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Term
Differential diagnosis helps distinguish angina from _.
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Myocardial infarction Artificial opening
Medicare Advantage Disallowed diagnoses
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Term
Drugs that suppress the immune system are called?
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Corticosteroids Positive Chronotropic Agents
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Term
Patient presents with uncontrolled hypertension. What ICD-10-CM guideline applies?
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Code hypertension with documented type first
Assign combination code for diabetes with multiple complications.
Confirmed diagnosisangina; do not code initial symptom only.
Code chronic COPD with acute exacerbation.
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178 of 546 Definition
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DefinitionSurgical connection between artery and vein for dialysis.
DefinitionBarrier that occurs when documentation does not contain enough detail to assign ICD codes correctly.
DefinitionPublished rules outlining how diagnoses should be reported for payment and risk adjustment.
DefinitionSurgical creation of an opening in the body for elimination or feeding.
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Term
DefinitionA temporary chest pain due to myocardial ischemia.
Give this one a try later! Claims
Don't know?
DefinitionRisk adjustment system combining multiple data sources for precise predictions.
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DefinitionStandardized system for classifying and coding diagnoses and conditions.
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Hybrid models may incorporate ________ data for more precise predictions.
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Pharmacy
Lifestyle
Demographic
Genetic
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Term
Artificial openings must be documented with type.
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Purpose (e.g., colostomy, ileostomy)
Proton pump inhibitors
Behavior (benign/malignant)
Subjective findings
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184 of 546
Term
A provider documents "diabetes," but type and complications are not noted. What is the issue?
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Assigns highest-weighted HCC, hierarchy applies
Insufficient documentation
Insufficient specificity for coding
Nonadherence
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Term
A coder assigns ICD-10-CM codes that contradict official guidelines. What is the risk?
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Reduced RAF and lost payment opportunity
Audit findings or payment recoupment
Audit findings and potential recoupment
Non-compliance with signature requirement
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Term
RADV audits review a of patient charts for validation.
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Recoupments Sample
Wasting / malnutrition Symptom codes
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Term
RAF is recalculated based on annual CMS updates.
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Yearly Daily Quarterly Monthly
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DefinitionFinancial metric used by CMS to determine plan payments based on patient risk.
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Poa indicators HCCs RAF score HCC model
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Definition
Paired
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Drugs that mimic the action of a natural substance in the body are called?
Coders must be familiar with chronic disease for proper risk adjustment.
Patient has persistently high blood pressure readings. What condition is coded?
Don't know?
Laterality must be specified for conditions affecting _______ limbs or organs.
Definition
Indicates conditions that cannot be coded together
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Patient has acute COPD exacerbation on chronic COPD. How is it coded?
What is the main goal of practical diagnosis coding?
A patient's undiagnosed hypertension is flagged by suspect logic. What action should the provider take?
Don't know?
What is the purpose of the "Excludes1" note in ICD-10CM?
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Term
Coding requires identification of comorbidities that affect _.
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Risk adjustment
Physician notes
Clinical evidence
Chart documentation
Definition
Confirmed diagnosisangina; do not code initial symptom only.
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Patient presents with chest pain, later diagnosed with angina. Which code is assigned?
Patient admitted with CHF exacerbation and COPD. Both are documented. How should coding be applied?
Patient has acute kidney failure secondary to sepsis. What ICD-10CM principle applies?
Patient presents with CVAand residual hemiplegia. How should coding reflect this?
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Term
CDPS can assign patients to multiple based on their conditions.
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194 of 546
Term
Patient with stage 3 pressure ulcer on sacrum. Coding?
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Chart documentation
Stage 3 sacral ulcer
Mechanical ventilation Body Mass Index (BMI)
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195 of 546
Term elements include history, exam, labs, and provider assessment.
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Cardiomyopathy
After acute phase
Don't know? 196
Definition
Manifestation
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DefinitionAssigning codes that do not match the documented diagnosis.
DefinitionTool to evaluate and compare MedicareAdvantage plan performance.
Combination codes capture both etiology and when applicable.
DefinitionA condition that often coexists with other diseases and affects risk adjustment.
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Definition
Cerebrovascular accident
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One barrier to accurate coding is inconsistent or incomplete _.
What does RAF stand for in risk adjustment coding?
HCC models are primarily used to predict in Medicare populations. CVA stands for _.
Don't know?
Patient with positive blood cultures and fever. Code?
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Predictive modeling
Septicemia / sepsis
Acute exacerbation of COPD
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Financial adjustments
Don't know?
Term
DefinitionAnalytical process that identifies patients likely to benefit from interventions.
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Graphical analysis
Statistical modeling
Data modeling Predictive modeling
Don't know?
Term
The CDPS model is specifically used for which population?
200 of 546
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Don't know?
Tricare Champva
Term
Patient with cancer presents with weight loss and muscle wasting.
Diagnosis?
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Cachexia
Compliance
Chronic COPD with acute exacerbation
Cardiomyopathy
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Term
A A patient develops a cough after starting an ACE inhibitor. What type of reaction is this?
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Allergic reaction
Acute drug reaction
Adverse drug reaction (ADR)
Idiosyncratic reaction
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Term
Lack of a valid can lead to non-compliance in coding audits.
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Signature
RAF score
Risk accurately
Disease
Don't know?
204 of 546
Definition
Assign codes per official laterality rules
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A patient's past surgery is documented but not relevant to current care. Should it be coded?
Chronic conditions are documented but lack lab or exam support. What is the issue?
Patient chart is missing signed progress notes. What issue does this create?
Don't know?
Provider documentation is vague about laterality of fracture. What guideline applies?
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Definition
Use most specific code per ICD-10-CM guidelines
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Patient admitted for heart failure due to hypertension. What guideline is followed?
Coding additional secondary conditions raises RAF by 0.3. What does this mean financially?
A patient with diabetes has neuropathy documented but not coded. What element of documentation is missing?
A provider documents "hypertension" without specifying type. Which guideline is relevant?
Don't know?
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Term
DefinitionA progressive loss of cognitive function affecting memory and reasoning.
Give this one a try later! Dementia Signature
Neoplasm RAF score
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Term
A patient has multiple chronic conditions. Which model would group their conditions for risk adjustment?
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HCC model
Hybrid risk adjustment models
CDPS Hybrid model
Don't know?
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Definition
Manifestations
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Coders must be familiar with chronic disease for proper risk adjustment.
Coders must review lab results, imaging, and for code validation.
Coders must always apply to each case for proper HCC assignment.
One common documentation barrier is missing for chronic conditions.
Don't know?
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A provider documents all chronic conditions for coding. What is the expected outcome on finances?
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Optimized reimbursement due to accurate RAF
Reduced reimbursement due to overcoding
Delayed payments due to coding Errors
Lowered revenue from inaccurate RAF
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Respirator/ventilator status must be documented for coding.
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Term
DefinitionHierarchical coding system that assigns risk weights to diagnoses.
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More severe HCC is counted due to hierarchy
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A patient has COPD with acute exacerbation, but no documentation supports acute status. What is the impact?
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Document confirmed diagnosis only
Cannot assign correct severity code; incomplete documentation
Diagnosis may be disallowed in RADVaudit
Cardiac conduction disorderbundle branch block
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Definition
Practical coding workflow
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DefinitionThe process of using predictive models to allocate resources efficiently.
DefinitionMissing or incomplete information in the medical record that prevents accurate coding.
Documentation of additional comorbidities increases RAF from 0.9 to 1.1. What is the financial effect?
DefinitionStep-by-step process of reviewing the chart, identifying diagnoses, and assigning codes.
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Term
Patient with elevated LDL cholesterol. Condition?
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Cor pulmonale
Biotransformation
Coronary artery
Hypercholesterolemia
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Term
CMS uses HCC RAF scores to adjust plan payments for risk.
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Administrative
Definition
Inaccurate
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Failure to note laterality can lead to coding errors.
DefinitionTool to evaluate and compare MedicareAdvantage plan performance.
Artificial openings include , ostomies, and catheters.
The CDPS model is specifically used for which population?
Don't know?
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Term
DefinitionA record of all elements of a patient's care used for coding and billing.
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Don't know?
218 of 546
Definition
Code the underlying condition before the manifestation
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Physician documents "rule out MI." How should this be coded?
What is the guideline for "code first" in ICD-10-CM?
CDPS stands for ________.
Cardiac conduction disorders affect the heart's _.
Don't know?
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Definition
Myocardial infarction
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A patient is flagged for early intervention due to predicted Patient intubated for respiratory failure. What must be coded?
hospitalization. What process was used?
Missing or unclear signatures can result in during audits.
Don't know?
Patient with ST-elevation MI confirmed by ECG and troponin. Coding?
220 of 546
Term
What does "quality of care" measure?
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Cost efficiency, administrative processes, facility maintenance.
Patient satisfaction, insurance coverage, billing accuracy.
Effectiveness, safety, timeliness, and patient experience of healthcare delivery.
Compliance, documentation, staff training of healthcare delivery.
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Term
GERD stands for _.
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Medical intervention or treatment
Hierarchical Condition Categories
Gastroesophageal reflux disease
Risk adjustment factor (RAF)
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Term
Cor pulmonale results from causing right heart failure.
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Population health management
Subjective findings
Pulmonary hypertension
Physician notes
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Term
The is the lowest dose that produces a noticeable effect.
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Term
________ occurs when a code is assigned to a condition not documented by the provider.
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Term
DefinitionA model used to fairly distribute Medicaid payments among plans.
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Term
A patient's chart lacks provider signature. What is the likely consequence?
226 of 546
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More severe HCC is counted due to hierarchy Assign codes per official laterality rules
Claim may be denied or flagged in RADV audit
To guide care management and risk adjustment
Definition
227 of 546
Supporting clinical evidence
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"Use additional code" notes indicate that should be added if applicable.
Documentation barriers can lead to reduced for health plans.
Patient reports tingling and numbness in feet due to diabetes. Condition?
Don't know?
Documentation should include that justify all coded diagnoses.
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Term
A Medicare Advantage patient has controlled diabetes. How does HCC adjust risk?
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Reduces risk score based on health improvement
Increases risk score based on age and demographics
Assigns standard risk score regardless of condition
Term
What is diagnosis coding?
Don't know?
Assigns risk score based on severity and hierarchy
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Multiple risk factors and comorbidities are coded
Risk Adjustment Data Validation
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The process of translating documented medical diagnoses into standardized codes. Pharmacodynamics
Don't know?
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Two conditions map to the same HCC hierarchy. Which contributes to RAF?
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Reduced payment and lower RAF score Financial recoupment or penalties
Higher RAF score due to complication coding
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Only the higher-weighted condition
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Term
A patient develops kidney failure due to aminoglycoside antibiotics. This is an example of?
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Don't know?
232 of 546
Quality of care metrics are often tied to and reimbursement.
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Don't know?
233 of 546 Term
DefinitionA formal audit process to ensure submitted risk-adjusted diagnoses are supported by medical records.
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234 of 546
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Peripheral Kidney
Seven Immune
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Definition May lead to under-coding or rejected RADVdiagnosis
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A provider fails to document complications of diabetes. What coding consequence occurs?
A chart lacks severity details for heart failure. What is the effect on HCC assignment?
Patient has CHF with preserved EF secondary to ischemic heart disease. Coding?
Patient presents with acute MI and heart failure. Which condition is coded first?
Don't know?
A patient with pressure ulcer on sacrum and cellulitis. How should coding be approached?
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Code all diagnoses; sequence per guidelines
Code hypertension with documented type first
Code ulcer first, then secondary infection per guideline
Higher aggregate RAF, increased plan payments
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Term
What is the ICD-10-CM guideline for laterality?
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Always code right, left, or bilateral when specified
Code chronic COPD with acute exacerbation.
Code underlying condition first
Using data and statistical algorithms to forecast future outcomes or costs.
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Term
CHF is characterized by the heart's inability to blood effectively.
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Term
CMS updates HCC models to reflect trends. Give this one a try later!
Dementia
Don't know?
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Term
A patient develops liver toxicity from acetaminophen overdose. This is an example of?
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Neurotoxicity
Cardiotoxicity
Hepatotoxicity
Ototoxicity
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Term
Automated alerts suggest coding chronic kidney disease not documented. What logic is applied?
241 of 546
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Suspect logic
Under-coding
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Term
Coders must review lab results, imaging, and for code validation.
242 of 546
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Pharmacokinetics
Physician notes
RAF calculation
Critical care
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Term
DefinitionA framework to ensure patient care meets clinical standards and desired outcomes.
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Give this one a try later! Quality
Quality
Don't know?
Term
Hybrid models often combine -based and -based approaches.
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Encounter, cost
Service, revenue
Outcome, quality
Performance, value
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Term
Official coding guidelines provide rules for code and sequencing.
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Patient
Don't know?
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Term
DefinitionPredictive metric that reflects patient disease burden and guides reimbursement.
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HCC model Poa indicators
ICD-10-CM RAF score
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Term
Secondary diabetes is caused by or medications.
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Manifestations
Risk adjustment
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Term
Patient presents with jaundice, fatigue, and confirmed hepatitis C. Code?
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Overpayment
Term
Hepatitis C
Hybrid model
HIV infection
Don't know?
249 of 546
A plan improves flu vaccination rates, impacting overall star rating. What is being measured?
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Preventive care quality
Definition
Chart documentation
Risk adjustment scores
Don't know?
250 of 546
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CDPS can assign patients to multiple based on their conditions.
Predictive modeling uses both _______ and real-time clinical data.
Practical coding involves assigning ICD-10-CM codes based on _.
Accurate documentation of comorbidities affects scores.
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Term
Coding errors due to using only ________ can lead to inaccurate risk adjustment.
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Risk adjustment HCC model
Unsupported coding Symptom codes
Term
Don't know?
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Ulcers and wounds require documentation of site, depth, and _.
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Severity Errors Stage Agonists
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Term
Drugs that block histamine H1 receptors are called?
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Anticoagulants
Antihistamines
Anticholinergics
Antitussives
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254 of 546
Term
Drugs that prevent blood clot formation are called?
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Anticoagulants
Antihypertensives
Antidepressants
Antihistamines
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Resolved or sequelae
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DefinitionThe systematic use of algorithms to anticipate patient risk.
The measure of drug safety comparing therapeutic dose to toxic dose is called?
Coders must differentiate between acute, chronic, and conditions.
Patient has COPD and heart failure exacerbation. Which HCCs are relevant?
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256 of 546 Term
Missing diagnosis codes can lead to financial impact.
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257 of 546
Term
DefinitionThe systematic use of algorithms to anticipate patient risk.
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Data modeling
Statistical modeling
Predictive modeling
Data mining
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258 of 546
Term
Drugs that relax bronchial muscles are called?
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Term
A patient's chronic kidney disease is not coded. What happens to RAF?
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RAF is unaffected by coding changes
RAF increases, leading to overpayment
RAF remains stable with no impact
RAF decreases, leading to underpayment
Don't know?
260 of 546
Term
DefinitionChronic obstructive pulmonary disease causing airflow limitation.
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Term
Don't know? 261 of 546
A patient develops tremors after taking a high dose of a stimulant. This is an example of?
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Rebound effect Acute drug reaction
Competitive antagonism
Dose-dependentadverse effect
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262 of 546
Term
Documentation shows diabetes with nephropathy. Which HCC rule applies?
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Multiple HCCs are ignored due to redundancy
More severe HCC is counted due to hierarchy
Definition
Less severe HCC is counted due to priority
Only primary diagnosis is considered
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Dialysis dependence and AV fistula
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Patient has diabetes with neuropathy and CKD. What should the coder do first?
A provider documents all chronic conditions for coding. What is the expected outcome on finances?
Patient has chest discomfort during exertion, diagnosed as angina. What is the key documentation for coding?
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A patient receives hemodialysis via AV fistula. What condition should be documented?
Term
Varicose veins are abnormally dilated _.
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Term
265 of 546
A provider documents "infection" without specifying site. What is the coding error?
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Lack of specificity
Clinical evidence
Predictive modeling
Late effects (sequelae)
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Veins GERD
Kidney ICD
Term
A provider improves coding practices across the patient panel. What is the overall impact?
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Reduced individual RAF, lower plan costs
Stable aggregate RAF, unchanged plan payments
Loweraggregate RAF, decreased plan payments
Higher aggregate RAF, increased plan payments
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Definition
Include stage and type to allow accurate ICD-10-CM code assignment
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Patient has chronic kidney disease stage 3. How should this be documented for coding?
Patient has CHF, but no severity or manifestation is documented. What coding issue arises?
Patient with chest pain undergoes ECG and labs to rule out MI. What coding principle applies?
Patient has leg swelling and confirmed DVT. What condition must be coded?
Definition
130/80
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Hypertension is defined as blood pressure ≥ ________ mmHg.
Hepatitis B is a liver infection.
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Documentation barriers can impact a plan's total revenue.
Differential diagnosis helps distinguish angina from _.
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Term
What does HCC stand for in risk adjustment coding?
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Hospital-acquired Conditions
Definition
Circumstances
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Predictive modeling uses both _______ and real-time clinical data.
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Hierarchical Condition Categories
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Accurate coding directly impacts for providers and plans.
External cause codes describe of injury or poisoning.
Clear documentation reduces the risk of audits and _.
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Term
HCC RAF score is critical for accuracy in Medicare Advantage.
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Compliance Administrative
Operational Efficiency Payment
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Term
A "manifestation" code identifies the of a disease.
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Complication or effect Audit and compliance Quality metrics Upcoding
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Term
Type 2 diabetes with chronic kidney disease stage 3. How is coding handled?
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RADV stands for _.
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Risk Adjustment Data Validation
required
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275 of 546 Term
A patient is assigned a high-risk score due to multiple chronic conditions. What is the purpose?
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To guide care management and risk adjustment
Term
DefinitionA numeric method to compare patient risk across populations.
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Risk score methodology
Definition
Code UTI as underlying cause, then sepsis.
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Patient has sepsis secondary to UTI. How is coding applied?
Term
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Drugs that inhibit enzymes to decrease drug activity are called?
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279 of 546
Definition
Hypertension
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Patient has persistently high blood pressure readings. What condition is coded?
Definition
Heart attack
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Myocardial infarction is commonly called a _.
Term
Drugs metabolized in the liver undergo _.
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Biotransformation
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Definition Insufficient
281 of 546
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documentation is a common barrier to accurate risk adjustment coding.
Term
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ICD-10-CM has specific guidelines for _______ when coding multiple conditions.
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Sequencing
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Incomplete coding of complications
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A patient's diagnosis is "type 2 diabetes with neuropathy." Only diabetes is coded. What is the error?
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Term
Hepatitis B is a liver infection.
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Term
Patient with multiple HCCs is coded properly. How does this affect CMS payment?
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Definition
Financial impact based on coding accuracy and patient risk
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A panel with higher overall RAF scores generates more revenue. What explains this?
Term
288 of 546
Frequent coding errors include misinterpretation, omission, and ________.
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Over-coding
Term
DefinitionAssigning codes that do not match the documented diagnosis.
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Coding inaccuracy
Definition
Explicit link between diagnosis and condition
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A patient with diabetes has neuropathy documented but not coded. What element of documentation is missing?
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A plan needs to adjust payments for high-risk patients using diagnosis and cost. Which model is appropriate?
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Hybrid model
Term
Signs and symptoms should be coded only when _.
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Diagnosis is not established
Term
The measure of drug safety comparing therapeutic dose to toxic dose is called?
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Therapeutic index
Term
A patient's kidney function decreases drug clearance. This affects which pharmacokinetic phase?
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Definition
Use combination code for diabetes with complication
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A patient with diabetes and neuropathy. Which coding guideline applies?
Term
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A patient's high blood pressure is controlled, but documentation does not indicate chronicity. What is the coding error?
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Under-coding due to missing chronicity
Definition
Blood clot
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Pulmonary embolism is caused by in the pulmonary arteries.
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Definition
Documentation
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Multiple coding guidelines emphasize accurate to support quality metrics and reimbursement.
Term
A patient is flagged for early intervention due to predicted hospitalization. What process was used?
299 of 546
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Predictive modeling
300 of 546 Term
A patient's drug level remains high despite dosage adjustment. Which pharmacokinetic phase might be altered?
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Excretion
Term
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A patient experiences sudden drop in blood pressure after rapid IV administration. This is an example of?
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Acute drug reaction
Term
Predictive modeling uses historical claims and data.
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Clinical
Definition
Sequencing guideline
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DefinitionA coding note indicating the correct order for multiple codes.
Term
DefinitionPublished rules outlining how diagnoses should be reported for payment and risk adjustment.
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Official diagnosis coding guidelines
Term
What is the difference between acute and chronic conditions?
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Acute conditions are sudden onset and short-term; chronic conditions are long-lasting or recurring.
Term
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A patient's past surgery is documented but not relevant to current care. Should it be coded?
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No, only active or relevant conditions are coded
Term
Suspect logic reduces ________ by identifying potential missing diagnoses.
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Under-coding
Term
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A patient newly diagnosed with CHF is assigned an HCC. What does this affect?
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Payment adjustment and risk score
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Term
DefinitionNotes made by provider describing patient's reported symptoms.
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Subjective findings
Term
DefinitionThe process of using predictive models to allocate resources efficiently.
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Population health management
Definition
Signature
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A missing in a chart can result in a diagnosis being invalid during RADV review.
Term
DefinitionA measure of body fat based on weight and height.
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Definition
Locate the correct code by condition or disease
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DefinitionAlphabetic Index in ICD-10-CM is used to a code.
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Term
DefinitionA tool to prevent underpayment for sicker patients.
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Risk adjustment
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Term
Cardiomyopathy affects the of the heart.
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Myocardial muscle
Definition
Multiple risk factors and comorbidities are coded
316 of 546
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Patient has obesity, hypertension, and diabetes. How does this affect coding? 317 of 546
Definition RADV
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A Medicare Advantage plan is audited and multiple HCCs are unsupported. Which process identified this?
Patient with diabetes, neuropathy, CKD, and hypertension. Coding?
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Code all conditions per documentation and HCC rules.
Term
Physician documents "rule out MI." How should this be coded?
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Code only symptoms or findings, not MI
Definition
Code underlying condition first
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Term
Patient admitted for acute kidney failure secondary to urinary tract infection. Which guideline applies?
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DefinitionA documented verification of medical record entries by a licensed provider.
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Signature
Term
Angina can be or unstable.
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Stable
Definition
Dementia
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Patient forgets appointments and repeats questions. Diagnosis?
Term
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RADV audits ensure that risk-adjusted payments are and supported.
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Valid
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Term
The ________ route delivers medication directly into the bloodstream.
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Intravenous
Term
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The effect occurs when a drug binds to unintended receptors.
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Off-target effect
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Accurate
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Proper documentation must support coding for reimbursement.
Term
Coding neoplasms requires specifying site and _.
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Behavior (benign/malignant)
Term
Alzheimer's disease is the most common cause of _.
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Term
Suspect logic is often used to identify for coding validation.
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Dementia
Term
Patient intubated for respiratory failure. What must be coded?
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Mechanical ventilation
Term
332 of 546
Patient has chest discomfort during exertion, diagnosed as angina. What is the key documentation for coding?
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Type (stable/unstable) and severity
Term
Underreporting chronic conditions can lead to for the provider or plan.
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Lost revenue
Definition
Insufficient documentation / lack of specificity
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Diabetes is documented without specifying type. Which barrier does this represent?
Definition
Medical record
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Accurate coding requires thorough review of the _.
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Term
Risk adjustment relies on accurate from the medical record.
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Documentation
Term
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Proper provider signatures ensure and accountability in the medical record.
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Legal validity
Term
DefinitionA model that uses claims data to estimate expected healthcare costs.
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Risk adjustment model
Term
A patient's blood pressure rises after missing a dose. This is an example of?
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Term
DefinitionSection of medical record containing orders, procedures, and care plan.
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Plan of care 341 of 546 Definition
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Patient has leg swelling and confirmed DVT. What condition must be coded?
Definition
ICD-10-CM etiology/anatomic site coding
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Term
DefinitionCodes that describe the body part, site, or laterality of a condition.
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Predictive modeling identifies a patient likely to develop COPD exacerbation. How does this benefit care?
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Allows proactive management and reduces costs
Definition
Feeding tubes
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Artificial openings include , ostomies, and catheters.
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Term
Patient reports low mood, fatigue, and hopelessness for 2 months.
Coding?
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Depression
Definition
Code specific fracture type, site, and laterality
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Patient has open fracture of left tibia. Which guideline applies?
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Term
Predictive modeling improves ______ management and resource allocation.
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Population health
Definition
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Principal diagnosiscondition primarily responsible for admission (e.g., pneumonia).
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Patient with acute COPD exacerbation and pneumonia. Which is principal diagnosis?
Term
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Hybrid models increase prediction accuracy by combining ________ and clinical insights.
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Statistical methods
Term
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Coders must always validate in patient charts before coding.
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Documentation
Term
Coding teams review automated suspect logic alerts weekly. What is the purpose?
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Ensure accurate and complete coding for risk adjustment 352 of 546
Term
Patient has permanent gastrostomy tube. What condition is coded?
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Artificial opening for feeding
Term
353 of 546
The ________ effect occurs when combined drugs produce a greater effect than each alone.
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Synergistic
Definition
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Both conditions per coding guidelines.
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Patient has chronic kidney disease stage 4 and acute kidney injury. How is this coded?
Term
DefinitionA combination code reports both the and manifestation of a condition.
355 of 546
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Underlying disease
Term
The _______ is the period when drug levels are therapeutic but below toxic levels.
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Therapeutic window 357 of 546
Term
Predictive modeling can help reduce _______ by anticipating high-risk events.
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358 of 546
Term
ICD-10-CM codes are updated by the CDC/NCHS.
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Annually
Term
359 of 546
Two patients have the same diagnosis, but one is more severe. How does RAF account for this?
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Higher RAF assigned for greater severity
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Term
Patient with swelling and leg discomfort due to varicose veins.
Code?
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Varicose veins of lower extremities
Term
361 of 546
DefinitionChronic liver inflammation leading to scarring and liver dysfunction.
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Hepatitis and cirrhosis
Term
362 of 546
BMI is calculated as weight (kg) divided by height (m) squared. True or False?
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Definition
Practical case application
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DefinitionUsing real-life examples to ensure coding aligns with documentation.
Term
Coders must always verify the of diagnoses in the chart.
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Documentation support
Term
DefinitionLogic that identifies potential gaps in diagnosis coding for follow-up.
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Suspect logic
Term
366 of 546
Two drugs compete for the same receptor, reducing each other's effect.This is an example of?
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367 of 546
Term
Drugs that block stomach acid secretion are called?
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pump inhibitors
Term
368 of 546
A patient's past pharmacy use is analyzed along with diagnoses. Which model type is this?
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Proton
Correct answer
Hybrid model
Definition
HCC assignment and RAF calculation
369 of 546
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Accurate coding across multiple chronic conditions leads to higher annual revenue. What is responsible?
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Term
Star ratings can range from stars.
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1 to 5
Term
DefinitionA code that represents the external cause, place of occurrence, or activity at time of injury.
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External cause code
Definition
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Compliance
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Official coding guidelines must be followed to prevent errors.
Term
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The process by which a drug is transformed into a different chemical form in the body is called?
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Metabolism
Term
CDPS uses data to predict future Medicaid costs.
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Diagnosis and pharmacy
Term
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Acute-on-chronic conditions require documentation of both ________ and chronic state.
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Term
A patient develops a rash after taking penicillin. This is an example of a ?
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Adverse drug reaction
Definition
Guidelines
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Coders must follow official ICD-10-CM _.
Definition
RADVaudit
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CMS selects a sample of patient charts for review. Which process is being applied?
Definition
Payment and reimbursement
379 of 546
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Accurate diagnosis coding directly impacts and risk adjustment.
Term
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The ________ approach incorporates both historical cost and diagnostic information.
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Hybrid model
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Term
Star ratings influence both plan and member enrollment.
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Reputation
Term
A patient has both HIV and diabetes. How does HCC handle overlapping conditions?
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Assigns highest-weighted HCC, hierarchy applies
Term
Risk factors for heart disease include hypertension, diabetes, smoking, and _.
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Term
DefinitionComprehensive record of patient's encounter including history, exam, assessment, and plan.
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Definition
Immune
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HIV attacks the system.
Term
386 of 546
DefinitionRecurrent seizures caused by abnormal brain electrical activity.
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Epilepsy
Term
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Drugs used to treat depression by increasing serotonin levels are called?
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SSRIs (Selective Serotonin Reuptake Inhibitors)
Definition
Pneumonia
388 of 546
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Patient has fever, cough, and infiltrates on chest X-ray. Code?
Term
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A Medicaid patient with multiple chronic conditions is assessed for payment. Which model accounts for both pharmacy and diagnosis data?
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Term
CDPS categories are assigned based on and prescription use.
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Diagnosis codes
Definition
Underlying disease
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Using combination codes ensures coding of both and manifestation.
Patient presents with acute MI and heart failure. Which condition is coded first?
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Underlying cause or principal diagnosis first per guidelines.
Definition
Cardiac conduction disorder
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Patient has atrial fibrillation on ECG. Which category does this belong to?
Definition
Double counting
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HCC coding hierarchy prevents from inflating RAF.
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Term
Higher star ratings often lead to for health plans.
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Term
Patient has chest pain, but no definitive diagnosis. Which guideline applies?
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Code symptoms only (R codes)
Term
A patient with diabetes and CHF is being evaluated for risk adjustment. Which model is most likely used?
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HCC model
Definition
Clinical judgment
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Term
Coders must always apply to each case for proper HCC assignment.
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A patient with congestive heart failure and diabetes would have multiple ________ impacting RAF.
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400
A patient has two chronic conditions, but only one is coded for risk adjustment. What is the impact?
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Underestimation of patient risk and payment
DefinitionProcess used by CMS to audit and validate submitted HCC diagnoses.
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Term
What does "code also" indicate in ICD-10-CM?
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Additional code may be required for related condition
Term
Predictive modeling identifies high-risk patients to prevent avoidable hospital admissions. What is the impact?
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Cost reduction and improved care
Term
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Documentation barriers can lead to reduced for health plans.
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Term
Hypothyroidism results in decreased hormone production.
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Thyroid
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Term
DefinitionCoding errors caused by assigning codes not supported by the record.
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Unsupported coding
Term
A drug that prevents platelet aggregation is called?
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Antiplatelet agent
Term
Patient admitted for heart failure due to hypertension. What guideline is followed?
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Code underlying hypertension first, then heart failure
Term
High-quality care can improve star ratings and _.
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Risk adjustment scores
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Term
Patient with diabetes, CKD, and hypertension. How should coding be handled?
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Code all comorbid conditions to capture risk
Term
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Star ratings are part of the program to evaluate Medicare Advantage and Part D plans.
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Definition
Document confirmed diagnosis only
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Patient with chest pain undergoes ECG and labs to rule out MI. What coding principle applies?
Term
DefinitionErrors caused by assigning a more severe code than supported by documentation.
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Definition
Electrical system
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Cardiac conduction disorders affect the heart's _.
Term
Patient with angina, hypertension, and diabetes. Coding?
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Code all diagnoses; sequence per guidelines
Term
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A patient with cancer and CHF is analyzed. Which HCC concept determines which condition contributes most to risk score?
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Hierarchy
Term
Drugs with a high potential for abuse are classified as?
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Controlled substances (Schedule I-V)
Term
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In HCC coding, conditions are grouped based on their and cost impact.
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Severity
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Predictive modeling uses both and real-time clinical data.
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Historical claims
Term
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Hybrid models are often used in ________ populations where both cost and clinical severity matter.
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Medicare Advantage
Term
Secondary conditions affecting treatment or risk adjustment must be
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Coded
Term
Documentation should clearly distinguish between and resolved conditions.
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Term
Angina is a symptom of ischemic heart disease.
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Coronary artery
Term
A medication designed to release slowly over time is called?
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Extended-release formulation
Term
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Patient has dyspnea and edema due to CHF. Which HCC category applies?
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CHF HCC
Definition
Unspecified code from ICD-10-CM
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Diagnosis documented as "unspecified pneumonia." Which code type is used?
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Term
The term for drugs absorbed through the skin is?
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Transdermal
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Term
Star ratings evaluate health plans on ______, clinical outcomes, and member satisfaction.
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Process measures
Definition
Multi-diagnosis coding
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DefinitionCorrectly coding multiple conditions from one patient encounter.
Term
One barrier to accurate coding is inconsistent or incomplete _.
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Provider documentation
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Term Klebsiella pneumoniae commonly causes _.
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Term
Patient reports fatigue, weight gain, and low T4. Diagnosis?
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Hypothyroidism
Term
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Coding additional secondary conditions raises RAF by 0.3. What does this mean financially?
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Plan receives proportionally higher reimbursement
Term
Accurate coding improves and reduces risk of audit recoupment.
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Term
Bilateral cataracts documented. How should laterality be coded?
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Use bilateral code or two separate codes if required
Term
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Chronic conditions are documented but lack lab or exam support.
What is the issue?
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Insufficient documentation
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Term
A patient is taking two medications that increase the risk of bleeding. This interaction is called?
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Drug-drug interaction
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Term
Predictive modeling often uses variables such as demographics, comorbidities, and prior utilization.
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Risk factors
Term
A patient experiences severe hypoglycemia due to insulin overdose. What term describes this?
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Toxicity
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Term
The study of how the body absorbs, distributes, metabolizes, and excretes drugs is called ___?
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Definition
Coding based on uncertain diagnosis
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A note states "possible UTI" and the coder assigns confirmed UTI code. What error occurred?
Definition
Errors
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Coding exercises help identify common in documentation.
Definition
Risk-adjusted
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Documentation barriers can impact a plan's total revenue.
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Term
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A healthcare plan wants to predict risk for elderly patients with multiple comorbidities. Which model is ideal?
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HCC model
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Term Following ________ ensures coding accuracy and compliance with CMS standards.
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Official diagnosis coding guidelines
Definition
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CVA with residual hemiplegia
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Patient presents with left-sided weakness after ischemic stroke. Which code applies?
Term
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DefinitionNumeric representation of a patient's disease burden.
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RAF score
Term
DefinitionA scoring system that combines outcomes, patient experience, and utilization measures.
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Star ratings
Term
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DefinitionGuidelines published by CMS and coding authorities to ensure correct diagnosis assignment.
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Definition
Vertebral fracture, lumbar region
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Patient falls and sustains compression fracture of L2. What is coded?
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Term
Septicemia is systemic infection with _.
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Bacteria in blood
Term
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A patient's data triggers an alert for potential heart failure. Which logic is applied?
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Suspect logic
Definition
Code final confirmed diagnosis, not initial symptoms
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A patient presents with cough and fever, later diagnosed with pneumonia. How should coding be handled?
Definition
Chief complaint
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DefinitionA common documentation element detailing current illness, duration, and severity.
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Term
Patient with CKD stage 4 starts dialysis. What must be coded?
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CKD stage 4 and dialysis dependence
Definition
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Cannot assign correct severity code; incomplete documentation
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A patient with asthma exacerbation is seen, but severity is not documented. What is the coding implication?
Definition
Physician notes
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Term
Patient has CHF, but no severity or manifestation is documented. What coding issue arises?
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Term
DefinitionThe barrier created when a provider does not sign or date medical record entries.
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Signature deficiency
Definition
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Code both conditions per documentation; ensure correct sequence
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Patient admitted with CHF exacerbation and COPD. Both are documented. How should coding be applied?
Term
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A patient with multiple chronic conditions is assigned a higher RAF. What is the financial implication?
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Increased payment to the plan/provider
Definition
Code gestational diabetes with trimester-specific code
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Pregnant patient has gestational diabetes. How is it coded?
Term
The ________ is the dose at which a drug is toxic to 50% of the population.
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LD50 (lethal dose 50)
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Term
Patient admitted with fever, cough, and positive sputum culture for Klebsiella. Coding?
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Klebsiella pneumoniae infection
Term
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DefinitionThe application of coding rules to real patient cases for reimbursement and risk adjustment.
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Practical diagnosis coding
Term
Hybrid models combine and approaches to predict risk.
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Diagnosis, demographic
Term
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Two coders assign different codes for the same diagnosis due to vague documentation. This highlights the importance of?
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Definition
Clinical findings
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Term
Documentation must clearly link diagnoses to to support risk adjustment coding.
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Quality of care includes safety, effectiveness, timeliness, efficiency, and _.
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Patient-centeredness
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Term
ICD-10-CM codes require specificity in site, type, severity, and _.
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Laterality
Term
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DefinitionA model that assigns patients to categories based on ICDcoded diagnoses.
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HCC model
Term
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A patient's high-risk score triggers enrollment in a chronic care management program. What process is applied?
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Predictive modeling
Definition
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Cardiomyopathy can be dilated, hypertrophic, or _.
Term
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DefinitionThe numeric value representing predicted healthcare costs for a patient.
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Risk score
Term
A plan improves preventive care metrics and moves from 3 to 4 stars. This impacts?
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Reimbursement and public perception
Term
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Late effects codes are used for conditions that appear after an injury or disease.
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Term
CDPS assigns weights to conditions based on ________ and expected cost.
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Severity
Term
DefinitionAbnormalities in the heart's rhythm or electrical conduction.
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Cardiac conduction disorders
Term
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"Use additional code" notes indicate that ________ should be added if applicable.
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Secondary conditions or manifestations
Term
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A provider fails to document complications of diabetes. What coding consequence occurs?
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Lower RAF due to incomplete HCC assignment
Term
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A patient's diabetes is documented with complications. How does this impact RAF?
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Higher RAF score due to complication coding
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Term
A patient has type 1 diabetes with nephropathy. How should this be coded?
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Code diabetes with complication using combination code
Definition
Code all comorbidities.
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Patient has hypertension and hyperlipidemia. Both affect risk adjustment. How should coding proceed?
Term
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Patient admitted for stroke; history shows priorTIA. How is this coded?
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Code acute CVA; document prior TIA separately if relevant.
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Term
CDPS uses both inpatient and claims data.
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Term
A provider underdocuments chronic conditions. What is the likely consequence?
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Reduced payment and lower RAF score
Term
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Documented symptoms without confirmed diagnosis may require codes.
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Symptom (R codes)
Term
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A patient's lab confirms diabetes, but the note lacks specification.
What is the coding step?
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Query provider for type and complications
Term
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ICD-10-CM contains _______ tables for combination and manifestation codes.
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Tabular
Definition
HIV infection
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Patient diagnosed with HIV infection. What must be coded?
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491 of 546 Term
Documentation of additional comorbidities increases RAF from 0.9 to 1.1. What is the financial effect?
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Payment increases proportionally
Term
Patient develops postoperative infection. How should this be coded?
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Complication of carepostoperative infection
Term
The ______ of a drug is the highest concentration it reaches in the bloodstream.
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Peak plasma level
Term
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HCC risk scores adjust payments to account for patients' ________ burden.
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Term
Patient presents with CVA and residual hemiplegia. How should coding reflect this?
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Code acute CVAand sequelae if documented.
Term
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DefinitionA model designed to reflect patient disease burden in payment systems.
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Risk adjustment model
Term
HCC categories are organized in a ________, meaning higher-risk conditions trump lower-risk.
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Hierarchy
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Term conditions often require ongoing management and monitoring.
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Chronic
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Term
Sequencing of codes is determined by _.
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Coding guidelines and principal diagnosis
Definition
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Patient weighs 95 kg and is 1.65 m tall. What condition is assessed?
Definition
Diabetic neuropathy
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Patient reports tingling and numbness in feet due to diabetes. Condition?
Dilated cardiomyopathy
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Patient presents with fatigue and enlarged heart. Which type of cardiomyopathy is likely?
Term
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_______ is the concentration of a drug needed to produce 50% of its maximum effect.
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EC50 (effective concentration 50)
Term
Drugs that increase heart rate are classified as?
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Positive chronotropic agents
Definition
Coding guidelines
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To prevent errors, coders should use and physician queries for clarification.
Term
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A Medicaid patient with severe asthma is being evaluated. Which model is used to adjust payment?
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CDPS
Term
RADV audits are primarily used to verify for Medicare Advantage plans.
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HCC diagnoses
Term
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DefinitionAbnormal tissue growth that can be benign or malignant.
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Neoplasm
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Term
What does HCC stand for?
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Hierarchical Condition Categories 510
Term
AV fistula is commonly used for _.
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Hemodialysis access
Financial impact of coding errors can lead to either overpayment or
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Definition
RAF
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Definition
Omission
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One common coding error is of chronic conditions.
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Term
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A provider fails to document a chronic condition for one patient.
What happens?
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Reduced RAF and lost payment opportunity
Definition
Verifies authenticity and accountability of the record
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What is the purpose of a provider's signature in medical documentation?
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Definition "Use additional code"
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DefinitionA note directing coder to use additional codes to fully describe the condition.
Definition
Acute-on-chronic
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COPD exacerbations are considered conditions.
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Term
Patient reports heartburn and acid regurgitation. What condition is coded?
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GERD
Term
CMS uses to incentivize high-performing health plans.
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Star ratings
Documentation lists "chronic kidney disease" without stage. What guideline applies?
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Assign most specific ICD-10-CM code per official coding rules
Definition
Non-compliance with signature requirement
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Term
Pneumonia is an infection of the _.
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Lungs
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Term
What is the term for the study of drug movement through the body?
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Absorption, Distribution, Metabolism, Excretion (ADME)
Definition
Heart failure
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Cor pulmonale is a type of right-sided _.
Term
DefinitionA model that hierarchically organizes conditions by severity and cost impact.
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HCC model
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Term
A patient's multiple conditions are coded incorrectly, triggering an audit. What risk arises?
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Financial recoupment or penalties
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Term
546
Patient has type 2 diabetes with nephropathy and retinopathy. How is coding handled?
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Assign combination code for diabetes with multiple complications.
Definition
Recoupments
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Clear documentation reduces the risk of audits and _.
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Term
Accurate HCC coding minimizes risk of audits.
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Compliance or recoupment
Term
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Patient has acute kidney failure secondary to sepsis. What ICD-10CM principle applies?
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Definition
Code osteoporosis first if causal relationship, then fracture
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Patient has fracture due to osteoporosis. How should coding be approached?
Term
HCC models are primarily used to predict ________ in Medicare populations.
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Future healthcare costs
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Term
Pulmonary hypertension increases pressure in the circulation.
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Term
A patient has CHF, but the coder misses it in documentation. What type of error occurred?
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Under-coding
Definition
Pulmonary embolism
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Patient develops sudden dyspnea and chest pain; CT confirms PE. Coding?
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Term
COPD includes and chronic bronchitis.
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Emphysema
Term
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A patient's undiagnosed hypertension is flagged by suspect logic. What action should the provider take?
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Validate and document the condition for coding
Term
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DefinitionA standardized system for categorizing chronic conditions in Medicaid.
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CDPS
Definition
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Accurately translate medical documentation into ICD-10-CM codes for risk adjustment and billing.
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Term
Each HCC has an assigned weight that contributes to total RAF.
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Numerical
Term
RADV audits help detect errors in risk-adjusted _.
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Coding submissions
Term
DefinitionThe practice of analyzing data to improve clinical outcomes and reduce variation in care.
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Quality improvement
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Term of medical record elements reduces risk of coding errors.
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Completeness and clarity
Definition
Chronic bronchitis and emphysema if specified
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Patient has chronic cough and wheezing with COPD diagnosis. How is it coded?
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Drugs that lower blood glucose levels are called?
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Hypoglycemic agents
Term
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DefinitionNumeric value assigned to patients to estimate risk and adjust payments.
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RAF score
