AAPC - CRC TEST 1

Which of the following medications are prescribed to cancer patients to eradicate the cancer or for prophylaxis?

I. Tamoxifen

II. Anastrozole

III. Januvia

IV. Crestor

A. I and II

B. I and III

C. II and III

D. I, II, III and IV

A. I and II

The definition of a best medical record for a RADV audit is:

A. Documentation validates the CMS requested HCCs, contains all the necessary documentation elements and has an additional HCC not requested by CMS

B. Documentation that validates all the requested HCCs

C. Documentation that validates the requested HCC, but there is no provider signature

D. Documentation that validates the requested HCC plus validates an additional HCC, contains all the necessary documentation elements, but is missing the provider signature, for which a signed CMS attestation was provided but not signed by the provider

A. Documentation validates the CMS requested HCCs, contains all the necessary documentation elements and has an additional HCC not requested by CMS

Which of the following are reported by a provider for beneficiaries in a Medicare Advantage Plan?

I. Nature of the presenting problem

II. Resolved conditions that have been treated in the past

III. Family history for all conditions

IV. All chronic conditions

C. I and IV

Which of the following records would be a good source for a retrospective chart audit?

A. DME documentation

B. Cardiologist records

C. Dietician notes

D. RN notes

B. Cardiologist records

Retrospective audits should include the following attributes:

I. Provider signatures

II. Supporting documentation of the patient's diagnoses

III. DOS

D. I, II and III

Which type of audit evaluates appropriate risk scores of patients?

A. ZPIC

B. RADV

C. RAC

D. CERT

B. RADV

What information is required when submitting documentation to support a diagnosis for a RADV/IVA?

A. All patient records for the calendar year resulting in care for a chronic condition

B. All inpatient hospital records where a readmission occurred

C. A single DOS for outpatient records and the full inpatient set for hospital records

D. All professional provider documentation for the previous year

C. A single DOS for outpatient records and the full inpatient set for hospital records

What is TRUE regarding the code assignment requirement for chronic kidney disease requiring dialysis (N18.6)?

A. The diagnosis should only be reported when the patient is admitted to the hospital.

B. The diagnosis should only be reported when the patient is diagnosed with CKD and is actively being treated by a specialist.

C. The patient should be diagnosed with CKD and is on chronic dialysis or receiving kidney transplants are associated with this diagnosis.

D. The diagnosis should only be reported when the patient is diagnosed with chronic renal insufficiency.

C. The patient should be diagnosed with CKD and is on chronic dialysis or receiving kidney transplants are associated with this diagnosis.

Joey is prescribed Oxycodone for a back injury by his orthopedic surgeon two years ago. The surgeon documents he would like to try another medication to dull the pain. Joey attempts to change to the newer medication but there is breakthrough pain and he goes back to the Oxycodone. Would code from category F11.2 be appropriate?

A. Yes, Joey has been on the Oxycodone for two years

B. Yes, Joey's pain could not be controlled by the second medication

C. No, a person must be on a medication a minimal of 3 years before "dependency" can be implied

D. No, the surgeon did not document that Joey was dependent on the Oxycodone

D. No, the surgeon did not document that Joey was dependent on the Oxycodone

Diagnoses must be based on face-to face encounters between members and an MD, PA, or NP and status conditions like a below knee amputation, must be assessed and documented in order for payment adjustments to be received. How often should a provider see and assess a patient in a calendar year to validate amputation status?

A. Twice a year

B. Once a year

C. Four times a year

D. Every two years

B. Once a year

A PEG Tube is:

I. Percutaneous Endoscopic Gastrostomy

II. G tube

III. Gastrostomy

IV. Colostomy

A. I

B. I and III

C. I, II, and III

D. IV

C. I, II, and III

Patient is here for follow up. She was seen in the ER two weeks ago where she had an MRI of the brain which showed significant cerebral arteriosclerosis. She was diagnosed with a TIA. She has been experiencing slight memory loss. Select the correct code(s).

A. I67.2, Z86.73

B. G45.9

C. Z86.73, R41.3

D. G45.9, I67.2, R41.3

A. I67.2, Z86.73

Patient is here for follow up after her dialysis yesterday. What is the ICD-10-CM code for presence of an AV fistula for dialysis?

A. T82.818D

B. I77.0

C. Z49.31

D. Z99.2

D. Z99.2

A patient presents for a routine checkup for his hypertensive heart failure. He is to continue with his current medication and diet. Select the diagnosis code(s).

A. I50.40, I10

B. I11.0, I50.9

C. I50.9, I10

D. I50.9

B. I11.0, I50.9

Today a 54-year-old man presents for his routine follow up after renal transplant two years ago. The patient has CKD stage 2 and reports no other complaints. Assign the correct ICD-10-CM code(s).

A. N18.2, Z94.0

B. T86.10, Z94.0

C. T86.10

D. Z94.0, N18.2

A. N18.2, Z94.0

A Type 2 diabetic presents with an insulin pump malfunction. What are the correct codes?

A. T85.694A, E11.9

B. T85.694A, E11.620

C. T82.598A, E11.9

D. T82.598A, E11.620

A. T85.694A, E11.9

What is the correct ICD-10-CM code for a patient with COPD exacerbation?

A. J44.1

B. J44.9

C. J45.909

D. J44.9

A. J44.1

The patient had hip replacement surgery three days ago. The provider documents the patient has had a "iatrogenic cerebrovascular infarction due to recent hip replacement surgery during her current hospital stay." Assign the appropriate ICD-10-CM code for the cardiovascular event.

A. I63.50

B. G45.9

C. I97.821

D. I63.9

C. I97.821

What is/are the correct code(s) for a nursing home patient with severe dementia often caught wandering off from the floor?

A. F03.91, Z91.83

B. F02.81, Z91.83

C. F03.90, Z91.83

D. Z91.83

A. F03.91, Z91.83

Patient presents to OB for routine obstetric care. The nurse takes the patient's blood pressure and it reads 140/80. The physician sees the patient and documents the following in the assessment and plan: "A/P: Hypertension, Transient, Check BP at home daily and return to clinic in two days for nurse BP check ". Assign the correct ICD-10-CM code(s).

A. I10

B. R03.0

C. O10.919, Z3A.00

D. O13.9, Z3A.00

D. O13.9, Z3A.00

Which of the following is NOT true?

A. Conditions listed on the problem list for a diabetic patient are coded as complications of the diabetes.

B. If documentation does not state the type of diabetes but indicates the patient uses insulin report Type 2 diabetes code (E11.-).

C. Documentation that indicates a cause and effect relationship includes "due to," "caused by," "with" and "secondary to."

D. A causal relationship is assumed between diabetes and a complication when the term "with" links the two together in the Alphabetic Index.

A. Conditions listed on the problem list for a diabetic patient are coded as complications of the diabetes.

What is the correct ICD-10-CM code for an uncertain gastrointestinal stromal tumor?

A. C49.4

B. C26.9

C. D48.1

D. D37.8

C. D48.1

A 66 year-old male patient with AIDS presents with new onset of shortness of breath. Tests confirm the patient has pneumocystis carinii pneumonia. Select the appropriate diagnosis code(s).

A. B59

B. B59, B20, R06.02

C. B20, B59

D. B20

C. B20, B59

S. Patient returns for follow up of her osteoporosis on anabolic therapy. She continues on TERIPARATIDE shots daily and will complete her two years of that in August of this year. She remains on VITAMIN D reduced to once a week 50,000 units. O: Vital signs are recorded. Despite the above, she seems to be in good spirits today. Moderate kyphotic posture of the thoracic spine noted. Lungs clear, cardiac exam regular rate and rhythm. Vitamin D level was over 40 last time, having been undetectable in March. A: Postmenopausal osteoporosis exacerbated by Vitamin D deficiency and suspected calcium malabsorption. Seems to be stable at this point in that regard. P: 1. CBC, comprehensive metabolic panel. May be able to back off further on her VITAMIN D. 2. When she returns next time in September will obtain DXA to compare with the one she had a year ago. 3. She will complete her two years of TERIPARATIDE injections in August. Select the diagnosis code(s).

A. M81.0

B. M81.0, E55.9

C. M81.0, E55.9, K90.89

D. M81.8, K90.89

B. M81.0, E55.9

Sex: Female. Age: 69 years-old. Nurse Note: Patient presents today with wanting to get back on track. Also wants to go back on synthroid, also wants to lose weight, otherwise no other complaints.

Subjective CC: Stopped meds, feels tired, gained 20 pounds in a year.

HPI: above

ROS: Constitution: Reports weight change, but denies chills, fatigue and fever, tired. Eyes: Denies visual disturbance. Cardiovascular: Denies chest pain and palpitations. Respiratory: Denies cough, dyspnea and wheezing. Gastrointestinal: Denies constipation, diarrhea, dyspepsia, dysphagia, hematochezia, melena, nausea and vomiting. Genitourinary: Denies dysuria, frequency, hematuria, incontinence, nocturia and urgency. Musculoskeletal: Denies arthralgia and myalgia. Skin: Denies rashes, no pain or bleed. Neuro: Denies neurologic symptoms. Psych: Denies symptoms other than stated above. Stress caring for others. Current Meds: None. Allergies: NKDA

PMH: Mammogram: (5/2008). Pelvic/Pap Exam: (5/2008). Blood Test: (5/2007). Bone Density Test: never within 10 years. Dental: (4/2008). Eye Exam: (2/2007) Reviewed and updated. Family History: Father: Hypertension; MI. Mother: Hypertension. Reviewed and updated.

Social History: Highest level of education completed is 12th grade. Marital status: Married. Lives with spouse and grandson. Household pets include fish. Personal Habits: Cigarette Use: None. Alcohol: Rare. Daily Caffeine: Consumes on average three cups of coffee per day. Reviewed and updated.

Objective BP: 142/84 P: 68 T: 98.5 RR: 16 HT: 65" 5'5" WT: 2241b BMI: 37.3 LMP: HYSTERECTOMY Exam: Constitution: Appears overweight. No signs of apparent distress present. Neck: Palpation reveals no lymphadenopathy. No masses appreciated. Thyroid exhibits no thyromegaly. No JVD. Respiratory: Respiration rate is normal. No wheezing. Auscultate good airflow. Lungs are clear bilaterally. Cardiovascular: Rate is regular. Rhythm is regular. No heart murmur appreciated. Extremities: No clubbing, cyanosis or edema. Abdomen: Bowel sounds are normoactive. Palpation of the abdomen reveals no CVA tenderness. Muscle guarding, rebound tenderness or tenderness. No abdominal masses. No palpable hepatosplenomegaly. Skin: Skin is warm and dry.

Assessment #1: Hypothyroidism Plan for #1: Lab: Comp Metabolic Panel I/P TSH (Ultra-Sensitive) Urinalysis Routine T4

Assessment #2: Obesity Plan for #2: Follow-up: Fasting labs then return one month to review and do annual GYN then. At that visit, will arrange biopsy face/temple lesion, order mammogram and she's considering screen c scope.

A. E03.9, E66.9

B. E03.9, E66.01, Z68.37

C. E03.9, E66.9, Z68.37

D. I10, I25.2, E03.9, E66.9

C. E03.9, E66.9, Z68.37

ANESTHESIA: General. PREOPERATIVE DIAGNOSIS: Diabetic ulcer right upper thigh with exposed fat layer. POSTOPERATIVE DIAGNOSIS: Diabetic ulcer right upper thigh with exposed fat layer. PROCEDURE: Debridement of ulcer, right upper thigh. INDICATIONS: This 76 year-old female has developed an ulcer on the upper right thigh. She is here for debridement. The patient has a current history of type 2 diabetes and hypertension. DESCRIPTION OF PROCEDURE: Under general laryngeal mask anesthesia, the patient was placed in left lateral decubitus position and the right lateral thigh and hip was appropriately prepped and draped. Sharp Mayo scissor dissection was used to debride skin, subcutaneous tissue and excise the edges of the wound down to the tensor fascia. Some undermining with fat necrosis was also debrided. It was covered with gauze and a dressing. She tolerated the procedure well. Select the diagnosis code(s).

A. L97.112

B. L97.102, E11.9

C. L97.112, E11.622, I10

D. L97.112, E11.9, I10

C. L97.112, E11.622, I10

Patient Name: JS Male. Physician: HO, MD Report Type: HOSPITAL CONSULTATION REPORT Admit Date: 4/26/XX. Discharge Date: 4/30/XX. DATE OF INPATIENT CONSULTATION: 4/27/XX. CHIEF COMPLAINT: Pulmonary emboli. HISTORY OF PRESENT ILLNESS: I am seeing this patient today in Consultation regarding the recurrent pulmonary emboli. The patient is a 42 year-old gentleman who has a history of recurrent pulmonary emboli. He had his first pulmonary emboli in 05/20XX. The patient was on Coumadin when he was involved in an accident on 10/01/XX. He sustained second-degree burns to more than 50 percent of his body. The patient was hospitalized for several months. He did not have any skin grafts. There was a question of him developing a heparin antibody during that admission. The patient has been on Coumadin for the past three months. Over the last several days, he has developed some pain behind his left knee and some chest discomfort. He brought himself to the emergency department where an ultrasound of his leg revealed a clot in the left thigh, a CT angiogram revealed bilateral pulmonary emboli. He has been given Coumadin 10 milligrams and Arixtra 7.5 milligrams SubQ daily. At this time, he is feeling well. He is not complaining of any leg pain or chest pain. He denies any hemoptysis. REVIEW OF SYSTEMS: Significant for the leg pain and chest discomfort. The further review of systems including the general, eyes, ears and throat, cardiac, respiratory, gastrointestinal, genitourinary, musculoskeletal, neurological, hematological and emotional systems is otherwise negative, except for that stated above. ALLERGIES: The patient has a possible allergy to HEPARIN with a possible heparin antibody. MEDICATIONS: The patient is not on any medications at this time. PAST MEDICAL HISTORY: Significant only for his previous pulmonary emboli and his severe second-degree burn to more than 70 percent of his body. SURGICAL HISTORY: The patient has no prior surgical history. SOCIAL HISTORY: The patient is single, never married. He does not smoke tobacco or drink alcohol. He has his own consulting firm. FAMILY HISTORY: The patient states there is no family history of blood clots. PHYSICAL EXAMINATION: His BP is 133/68, pulse 89, respirations 16, temperature 96.5. The patient is a well-nourished, well-developed white male, in no acute distress, consistent with his stated age of 42. The HEENT examination reveals no oral lesions, no oropharyngeal lesions, no neck masses, no thyromegaly. Heart examination reveals a regular rate and rhythm without murmur or gallop. There are no palpable heaves or thrills. Chest examination is clear to auscultation. There are no wheezes or crackles heard. Abdominal examination reveals positive bowel sounds. The abdomen is soft and non-tender. There is no palpable hepatosplenomegaly, no palpable masses. Lymphatic examination reveals no cervical, axillary, inguinal or epi-trochlear lymph nodes palpable. Skin examination reveals the scars from his burns. There are no nodules or rashes seen. No nodules palpated. Neurologically, his deep tendon reflexes are plus 2/4 in the upper and lower extremities. Motor and sensory are intact. Extremity examination reveals full range of motion in the upper and lower extremities, without cyanosis or edema. The patient is alert and oriented times three and has a normal affect. PERTINENT LABORATORY VALUES: Include hemoglobin of 14.0, WBC of 7.7, platelets of 134,000. Sodium was 139, potassium 4.0, chloride 103, bicarb 29, BUN of 20, creatinine 1.12. The protime is 11.5 seconds and the activated partial thromboplastin time is 30 seconds. CT angiogram reveals bilateral pulmonary emboli. Doppler ultrasound reveals a clot in the left lower extremity. IMPRESSION: 1. Deep venous thrombosis with bilateral pulmonary emboli with a history of a previous pulmonary embolus in 05/2007. 2. Possible heparin antibodies while hospitalized. 3. History of second-degree burns. PLAN: 1 Arixtra 10 milligrams SubQ daily, especially given his possible history of heparin antibody. 2.The patient does require very large doses of Coumadin. He was on 17.5 milligrams alternating with 15 milligrams before he was removed from Coumadin. We will dose him at 17.5 milligrams today. 3. CBC and protime in the morning. 4. The patient will require lifelong anticoagulation as this is his second pulmonary emboli. I appreciate this opportunity to participate in this patient's care. Please do not hesitate to contact me if you have any further question regarding my care of the patient.

Select the diagnosis code(s).

A. I26.99

B. I82.402, T82.818A

C. I26.99, I82.402, Z86.711, Z79.01

D. I26.99, T50.995A, I82.402, Z79.01, T45.525A

C. I26.99, I82.402, Z86.711, Z79.01

01/01/XX SUBJECTIVE: CC: This 43 year-old Caucasian male is here today for a follow-up visit. The patient's past medical history is notable for diabetes, hypertension, and mixed hyperlipidemia. HPI: Patient presents with type 2 diabetes. Specifically, this is type 2, non-insulin requiring diabetes without complications. Compliance with treatment has been good. In regard to the essential hypertension, benign, this was first diagnosed several years ago. He is tolerating the medication well without side effects. Concerning mixed hyperlipidemia, compliance with treatment has been good; he takes his medication as directed, maintains his low cholesterol diet, follows up as directed, and maintains his exercise regimen. ROS: CONSTITUTIONAL: Negative for chills, fatigue, fever and night sweats. CARDIOVASCULAR: Negative for chest pain, claudication, dizziness, palpitations and pedal edema. RESPIRATORY: Negative for dyspnea, hemoptysis and pleuritic chest pain. GASTROINTESTINAL: Negative for abdominal pain, dysphagia, constipation, diarrhea, heartburn, nausea and vomiting. Past Medical, Family, Social History (PFSH): Past Medical History: Coronary Artery Disease Hyperlipidemia Hypertension Surgical History: Appendectomy: at age 27; Tobacco/Alcohol/Supplements: Tobacco: Currently smokes more than three packs per day. An extensive list of the risks of smoking (and reasons to quit) have been reviewed with the patient; these include increased risk of cancer and increased risk of heart attack. Is unwilling to consider quitting tobacco at this time. Alcohol: Patient has a past history of alcoholism. His last drink was over 10 years ago. Substance Abuse History: NEGATIVE Allergies: Nitroglycerin: chest pain Aspirin: Current Medications: Zocor 80mg Tablet 1 tab(s) po hs, Altace 10mg Capsules 1 cap(s) po qd, Insulin, Lispro (Analog rDNA) 100units/1ml Pen System, Disposable 25-30 U Sq AC meals, Norvasc 10mg Tablet 1 tab(s) po qd, Tenormin 100mg Tablet 1 tab(s) po qd, Heal with Steel Health Center. OBJECTIVE: Vitals: BP: 118/78 mm Hg; P: 46 bpm (regularly irregular); R: 12 bpm. Exams: GENERAL: moderately obese; well groomed; anxious; diaphoretic. EYES: lids and lacrimal system are normal in appearance; conjunctiva and cornea are normal. ENT: Oropharynx: normal dentition and gingiva; normal palate; normal oral mucosa. NECK: thyroid is non-palpable; jugular veins are normal. RESPIRATORY: normal respiratory rate and pattern with no distress; normal breath sounds with no rales, rhonchi, wheezes or rubs. CARDIOVASCULAR: normal rate and rhythm without murmurs; normal S1 and S2 heart sounds with no S3, S4, rubs, or clicks; carotids: 2+ amplitude, no bruits; abdominal aorta appears to be of normal size and is without bruits; femoral pulses: 2+ amplitude, no bruits; 2+ pedal pulses; no edema or significant varicosities. GASTROINTESTINAL: no masses or tenderness; no organomegaly. SKIN: no clubbing, cyanosis, ulcerations, or vascular skin lesions. MUSCULOSKELETAL: spine: no scoliosis, kyphosis, or other abnormal spinal curvatures; normal gait; grossly normal tone and muscle strength. NEUROLOGIC/PSYCHIATRIC: mental status: alert and oriented x 3; Mood/Affect: anxious. ASSESSMENT: E11.9 Type 2 diabetes, I10 Essential hypertension, E78.2 Mixed hyperlipidemia. PLAN: Type 2 diabetes LAB ORDERS: hgbA1C, fasting lipid profile, TSH, urinalysis, urine micro-albumin. MEDICATIONS: Over-the-counter medications recommended include aspirin. RECOMMENDATIONS: instructed in use of glucometer (check glucose before each meal), a daily aspirin, adherence to a 2200 calorie ADA diet, HgbA1C level checked quarterly, urine micro albumin test yearly, daily foot self-inspection, yearly dental exams, annual eye exams, need for yearly flu shots, and pneumovax vaccination every five years. FOLLOW-UP: Schedule a follow-up visit in three months. Orders: Collection of venous blood by venipuncture Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory Glycated hemoglobin Urinalysis, automated, without microscopy Dilated Eye Exam Lipid panel (total cholesterol, HDL, triglycerides) Thyroid stimulating hormone (TSH) Urine micro albumin, quantitative Other Orders: Collection of venous blood by venipuncture today Electrolyte panel (Na, K, Cl, CO2) Electrocardiogram, routine with at least 12 leads; with interpretation and report Electronically Signed: M, Jones, M.D.

After review of the record provided, what discrepancy would a coder identify?

A. The provider did not properly sign the documentation

B. The provider does not document an adequate status of the patient's chronic illnesses

C. There is conflicting information regarding whether the patient is being treated with insulin

D. There are no discrepancies in the documentation

C. There is conflicting information regarding whether the patient is being treated with insulin

01/01/XX S: Here to follow up on her atrial fibrillation. No new problems. Feeling well. Medications are reviewed and consistent with the medications that she was discharged home. O: BP: 110/64. Pulse is regular at 72. Neck is supple. Chest is clear. Cardiac normal sinus rhythm. A: Chronic atrial fibrillation, currently stable. P: 1. Prothrombin time. 2. Follow up with myself in 1 month, sooner as needed if has any other problems in the meantime. Will also check a creatinine and potassium today as well. Electronically Signed: M, Jones, M.D. Based on the review of the medical record, what discrepancy would a coder identify?

A. The list of medications was not documented which would affect coding

B. The provider did not document the chief complaint

C. The provider did not properly sign the documentation

D. There are no discrepancies with this documentation

A. The list of medications was not documented which would affect coding

You are reviewing provider documentation for risk adjusted diagnoses so you can provide feedback to the provider. You are looking to validate diabetic neuropathy using the provider's progress note from an office visit earlier in the year. The provider documented "DM with neuropathy controlled, continue current meds" in the body of the progress note. You should inform the provider:

A. The diagnostic statement supports the coding of a type 1 diabetic manifestation

B. The diagnostic statement does identify the causal relationship

C. The provider must indicate the site of the neuropathy for proper coding

D. The provider must indicate the type of diabetes in order for a code to be selected

B. The diagnostic statement does identify the causal relationship

What is an effective way to review documentation deficiencies with a provider?

A. Have the provider read the coding guidelines prior to your training session

B. Provide the provider examples of his/her documentation and suggested improvements

C. Try to catch the provider between patients so the schedule is not interrupted

D. Start with a summary of your credentials to gain the respect of the provider

B. Provide the provider examples of his/her documentation and suggested improvements

What information is usually documented by the provider during the patient history?

I. Patient's response to current treatment

II. The reason for the encounter

III. The provider's observation of the patient's mood

IV. The patient's use of tobacco

A. I and IV

B. I and III

C. I, II, and IV

D. I, II, III and IV

C. I, II, and IV

How are resolved conditions coded?

A. Resolved conditions are reported as current if included on the problem list

B. Resolved conditions are reported as history of when appropriate

C. Resolved conditions are reported as current as a secondary diagnosis, never a first-listed

D. Resolved conditions are reported for one year after onset

B. Resolved conditions are reported as history of when appropriate

Which of the following statements are TRUE regarding the prostate?

I. It is part of the male reproductive system

II. It helps make and store seminal fluid

III. It makes testosterone

IV. It is part of the female urinary system

A. I

B. I and III

C. I and IV

D. I and II

D. I and II

Which organ(s) is/are contained in the thoracic cavity?

I. Heart

II. Stomach

III. Lungs

IV. Hypothalamus

A. I, III, and IV

B. I and III

C. I

D. I, II, and III

B. I and III

Which of the following is FALSE regarding Atherosclerosis?

A. Can affect the coronary (heart) arteries

B. Affects the veins

C. Is promoted by LDL (low density lipoprotein – bad cholesterol) and protected by HDL (high density lipoprotein – good cholesterol)

D. Is a chronic disease that can remain asymptomatic for decades

B. Affects the veins

Predictive models are used to identify people who are at high risk of chronic illnesses having higher medical claims; what can a provider do with this information to decrease the medical costs? I. Develop disease management education programs II. Involve clinical staff to help with coordination of care III. Refer the patients with chronic illnesses to be treated by another provider IV. Determine the return on investment when referring to a specialist for chronic illnesses

A. I and II

B. III and IV

C. I and III

D. I, II, III, and IV

A. I and II

If you were using a predictive model and the results were: • The member had a DME claim for oxygen. • The member had an Rx Claim for a bronchodilator. • The member had a medical claim which included a PFT. Which diagnosis would you predict this member has?

A. Hypertension

B. Emphysema

C. CHF

D. Diabetes

B. Emphysema

Data mining is performed to:

A. Identify data that might be related to patient risk scores

B. Look for opportunities for clinical staff incentives

C. Make sure that low performing providers are penalized for poor outcomes

D. To evaluate the effectiveness of compliance plans

A. Identify data that might be related to patient risk scores

Which code set is used for HCC coding?

I. CPT

II. HCPCS Level II

III. ICD-10-CM

IV. ICD-10-PCS

A. III

B. III and IV

C. I and III

D. I, II, III and IV

A. III

Which statement is TRUE regarding hierarchies?

A. Used exclusively by CMS for Medicare Advantage plans

B. Mandated to be used for all Medicaid payment models

C. Utilized by some private payers

D. All of the above

C. Utilized by some private payers

What does CMS' Star Ratings program monitor?

A. Performance of Medicare Advantage plans

B. Fraud and abuse

C. Adherence to state scope of practice

D. Performance of Medicare providers

A. Performance of Medicare Advantage plans

Which risk adjustment model is used by Medicaid programs?

A. HCC

B. CDPS

C. ZIPC

D. MIPS

B. CDPS

Using the information provided below, which statement is TRUE:

A. When a patient is diagnosed with hepatorenal syndrome and biliary cirrhosis, HCC28 is used

B. When a patient is diagnosed with chronic hepatitis and hepatopulmonary syndrome, HCC27 is used

C. When a patient is diagnosed with alcohol liver damage and biliary cirrhosis, HCC29 is used

D. When a patient is diagnosed with autoimmune hepatitis and cirrhosis of the liver, HCC29 is used

B. When a patient is diagnosed with chronic hepatitis and hepatopulmonary syndrome, HCC27 is used

CC: Patient is here to discuss catapress Rx and also patient has a nonproductive cough, nasal drainage and sinus congestion/pressure. Symptoms for a few days. SubjectiveHPI: She is back on her Catapress patch and doing wellEarwax, used Debrox Cough, wheezing and nasal congestion for a few daysROS:Constitutional: Denies symptoms other than stated above.ENMT: Denies ENMT symptoms other than stated above.Cardiovascular: Denies chest pain, edema and palpitations.Respiratory: Denies symptoms other than stated above.Gastrointestinal: Denies gastrointestinal symptoms.Genitourinary: Denies urinary symptoms.Psych: Stable w/o acute changes.Current Meds: Lancets, Onetouch Test Strips, Citalopram Hydrobromide 40 mg, Simvastatin 40 mg, Glipizide 10 mg, Metformin HCL 1000 mg, Benztropine Mesylate 1 mg, One Touch Glucose Monitor, Catapres-TTS- 1 0.1 mg/24hrAllergies: NKDASocial History: Marital status: Single. Lives in an assisted living facility. Personal Habits: Cigarette Use: None. Alcohol: Denies alcohol use. Drug Use: Denies Drug Use. Daily Caffeine: Consumes on average 4 sodas per day. Reviewed, no changes.ObjectiveBP: 124/72. Pulse: 88. T: 97.7. RR: 20. HT: 63" 5'3", WT: 2091b Constitutional: No signs of apparent distress present.ENMT: Tympanic membranes: not visible due to impacted cerumen. Congestion of the nasal mucosae. Posterior pharynx is normal.Neck: Palpation reveals no lymphadenopathy. Thyroid exhibits no thyromegaly. No JVD.Respiratory: Respiration rate is normal. Auscultate good airflow. Mild expiratory wheezes appreciated over the lungs bilaterally.CV: Rate is regular. Rhythm is regular. No heart murmur appreciated.Extremities: No clubbing, cyanosis or edema.Abdomen: Abdomen Is Benign.Musculoskeletal: Walks with a normal gait.Skin: Skin is warm and dry.Psych: Patient's attitude is cooperative. No apparent anxiety, depression, or agitation. Patient shows good eye contact.Patient had increased cough response with attempted irrigation which subsided immediately.

Assessment #1: J06.9 URI Upper Respiratory Infections Acute Unspecified Sites

Plan for #1: Med Current: Zithromax Z-Pak 250 mg as directed Proventil HFA108 mcg/act 2 puff q 4h pm

Assessment #2: E11.9 Diabetes Mellitus W/O Complication Type II or Unspecified ControlledPlan for #2: Med Current: Glipizide 10 mg 1 po bid Metformin HCL 1000 mg 1 po bidLab: Diabetic PanelFollow-up: after lab work

Assessment #3: H61.23 Impacted CerumenPlan for #3: Referral: ENT referral

After the coder reviews the documentation, which codes are recommended to be reported that will affect the HCC risk adjustment value?

I. J06.9II. E11.9III. H61.23

A. I, II and III

B. I, III

C. II

D. II and III

C. II

Which of the following general statements is NOT TRUE regarding Risk Adjustment practices and Quality?

A. Health Care Plans with Four Star Quality Ratings can still improve their score because the highest rating is a Five

B. From a data discovery perspective, they are essentially inseparable

C. Data Collection for HEDIS and Star Ratings Programs can be achieved during their prospective member evaluations

D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical record information that is collected in support of risk adjustment

D. Quality Measures like Star Ratings and HEDIS have no correlation with the medical record information that is collected in support of risk adjustment

Which statement is coded as a history of condition?

A. Patient presents with a history of colon cancer. He is currently getting chemotherapy administered by his oncologist.

B. Patient has a history of osteoarthritis currently taking celebrex.

C. Patient presents with CHF complaining of shortness of breath.

D. Patient presents for a follow up of hypertension. She has a history of breast cancer.

D. Patient presents for a follow up of hypertension. She has a history of breast cancer

Which medical record(s) can be submitted for HCC validation?I. Physician office progress noteII. Outpatient HospitalIII. Critical Access HospitalIV. Laboratory test resultsV. Diagnostic X-rays

A. I, II, and III

B. IV

C. I, II, III, and IV

D. I, II, III, IV, and V

A. I, II, and III

Which of the following elements would NOT be taken into consideration for risk adjustment?

A. The number of years a patient has been covered under Medicare Advantage

B. Gender

C. Procedure codes

D. Place of service

A. The number of years a patient has been covered under Medicare Advantage

Which provider is NOT an approved provider for diagnosis code capture under the HCC model?

A. LCSW

B. CRNA

C. Podiatrist

D. Registered nurse

D. Registered nurse