CRC - Certified Risk Adjustment Coder Clinical Documentation Improvement Questions and Answers

Question 1

A risk adjustment coder is reviewing a medical record for a patient with diabetes. The physician's note states, 'Diabetes - stable.' Which of the following CDI actions is most appropriate?

Accepted Answer

Query the provider to clarify the type of diabetes and any associated manifestations or complications.

Answer

Code for unspecified diabetes without complications as the documentation is sufficient.

Answer

Assume Type 2 diabetes as it is the most common form.

Answer

Do not code for diabetes as 'stable' does not meet medical necessity.

Question 2

Which of the following phrases in a physician's documentation best supports a reportable diagnosis for risk adjustment purposes by satisfying the 'MEAT' criteria?

Accepted Answer

Continue lisinopril for management of hypertension.

Answer

Patient has a history of myocardial infarction.

Answer

Discussed patient's ongoing struggle with morbid obesity.

Answer

Hypertension is listed on the problem list.

Question 3

A CDI specialist notices that a physician consistently documents 'CKD' for patients with chronic kidney disease without specifying the stage. Why is this a significant issue for risk adjustment?

Accepted Answer

It prevents the assignment of a more specific HCC that reflects a higher disease burden and risk score.

Answer

It is not an issue, as 'CKD' maps to a valid HCC.

Answer

It violates HIPAA regulations regarding patient privacy.

Answer

It only matters for inpatient coding, not ambulatory encounters.

Question 4

A 72-year-old male patient's record includes a diagnosis of congestive heart failure (CHF). The documentation for the visit states: 'Patient presents for follow-up of CHF. Lungs are clear, no edema noted. Will continue current medications. Return in 3 months.' Which element of MEAT criteria is met in this documentation?

Accepted Answer

All of the above

Answer

Evaluation

Answer

Assessment

Answer

Monitoring

Question 5

What is the primary goal of a compliant physician query in the context of clinical documentation improvement for risk adjustment?

Accepted Answer

To obtain additional clarification or specificity for a documented condition that is not clearly supported.

Answer

To suggest diagnoses that will lead to a higher RAF score.

Answer

To educate the physician on how to code more effectively.

Answer

To correct billing errors found on previous claims.

Question 6

When reviewing a patient's chart for an annual wellness visit, a CRC finds a diagnosis of major depression documented in the problem list but not addressed in the encounter note. Which of the following actions should the coder take?

Accepted Answer

Query the provider to determine if the condition was monitored, evaluated, assessed, or treated during the visit.

Answer

Capture the HCC for major depression since it is on the problem list.

Answer

Delete the diagnosis from the problem list as it is no longer active.

Answer

Assume the condition is stable and code it without a query.