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Free CRC Practice Questions

10 free, exam-style Certified Risk Adjustment Coder (CRC) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CRC practice test to study every exam domain.

Question 1

A 72-year-old Medicare Advantage patient is seen for a routine office visit. The provider documents: 'Essential hypertension, well controlled. CKD stage 3b - unrelated to hypertension.' The provider prescribes lisinopril and orders a comprehensive metabolic panel. Which ICD-10-CM code assignment is correct for risk adjustment purposes?

  1. I10, N18.32 - coded separately because the provider states the conditions are unrelated
  2. I12.9, N18.32 - hypertensive CKD is assumed per ICD-10-CM guideline I.C.9, regardless of provider statement
  3. N18.32, I10 - CKD sequenced first as the reason for the metabolic panel
  4. I10 only - CKD stage 3b cannot be captured without nephrology documentation
Show answer & explanation

Correct answer: B - I12.9, N18.32 - hypertensive CKD is assumed per ICD-10-CM guideline I.C.9, regardless of provider statement

Question 2

During an outpatient visit, a provider documents: 'Patient presents with progressive fatigue, unintentional weight loss of 15 lbs over 3 months, and night sweats. Probable lymphoma - referring to oncology for biopsy.' For this outpatient encounter, how should the coder assign the diagnosis?

  1. Code the probable lymphoma using the appropriate C81-C85 neoplasm code, as the provider has documented a clinical impression
  2. Code the signs and symptoms only: R53.83 (fatigue), R63.4 (weight loss), R61 (night sweats) - uncertain diagnoses are not coded in outpatient settings
  3. Code Z85.79 (personal history of lymphoma) until the biopsy confirms the diagnosis
  4. Do not assign any codes until the oncology consultation and biopsy results are available
Show answer & explanation

Correct answer: B - Code the signs and symptoms only: R53.83 (fatigue), R63.4 (weight loss), R61 (night sweats) - uncertain diagnoses are not coded in outpatient settings

Question 3

A 58-year-old female completed lumpectomy and radiation therapy for right breast cancer two years ago. She is currently taking tamoxifen daily as prescribed by her oncologist. The provider documents: 'Breast cancer - continuing adjuvant hormonal therapy, no evidence of recurrence.' Which code assignment is appropriate?

  1. Z85.3 (personal history of malignant neoplasm of breast) - active treatment ended with completion of radiation
  2. C50.911 (malignant neoplasm of right breast) - tamoxifen is active antineoplastic treatment, maintaining the active cancer code
  3. Z79.818 (long-term use of other agents affecting estrogen receptors) as the only code - the cancer is in remission
  4. C50.911, Z79.818, Z85.3 - report all three to capture the complete clinical picture
Show answer & explanation

Correct answer: B - C50.911 (malignant neoplasm of right breast) - tamoxifen is active antineoplastic treatment, maintaining the active cancer code

Question 4

A health plan actuary asks a risk adjustment coder about the CMS-HCC model version blending for Payment Year 2025. Which statement accurately describes the V24-to-V28 transition for PY 2025?

  1. PY 2025 uses 100% V28, as the transition was completed in Payment Year 2024
  2. PY 2025 uses a blend of 67% V28 and 33% V24 for RAF score calculation
  3. PY 2025 uses a blend of 33% V28 and 67% V24, with full V28 delayed until PY 2027
  4. PY 2025 uses a blend of 50% V28 and 50% V24 as the midpoint of the three-year transition
Show answer & explanation

Correct answer: B - PY 2025 uses a blend of 67% V28 and 33% V24 for RAF score calculation

Question 5

When calculating a Medicare Advantage beneficiary's RAF score, which component is applied as a statutory reduction mandated by the Affordable Care Act to account for differences in diagnosis coding patterns between Medicare Advantage and Fee-for-Service?

  1. The Normalization Factor of 1.045, which deflates raw scores to budget neutrality
  2. The Coding Intensity Adjustment of 5.9%, applied as a minimum reduction to MA risk scores
  3. The Frailty Adjuster, which reduces scores for community-dwelling beneficiaries relative to institutional
  4. The Fee-for-Service Adjuster, which reconciles MA encounter data against FFS claims benchmarks
Show answer & explanation

Correct answer: B - The Coding Intensity Adjustment of 5.9%, applied as a minimum reduction to MA risk scores

Question 6

During a CMS RADV audit, a medical record submitted for an HCC-mapped diagnosis shows a detailed encounter note with full MEAT documentation supporting the diagnosis, but the provider's signature is illegible and the credential cannot be determined. What is the appropriate remedy?

  1. The record is automatically invalid - no remedy exists for illegible signatures under RADV
  2. The provider may submit a re-signed copy of the original encounter note with a legible signature
  3. A CMS-generated attestation form may be completed to authenticate the signature, but it does not validate the diagnosis itself
  4. The compliance officer may submit a letter confirming the provider's identity, which substitutes for the signature requirement
Show answer & explanation

Correct answer: C - A CMS-generated attestation form may be completed to authenticate the signature, but it does not validate the diagnosis itself

Question 7

A risk adjustment coder reviews an office visit note for a Medicare Advantage patient. The provider's assessment/plan addresses hypertension and diabetes in detail. However, the patient's EMR problem list also includes 'COPD' and 'major depressive disorder,' neither of which are mentioned anywhere in the encounter note narrative - not in the HPI, exam, or assessment/plan. What is the appropriate coding action for the COPD and depression?

  1. Code all four conditions - the problem list is part of the medical record and serves as documentation
  2. Do not code COPD or depression for this encounter - a diagnosis must be addressed in the encounter note with MEAT to be reported for risk adjustment
  3. Code COPD and depression only if the patient's active medication list includes drugs for those conditions
  4. Query the provider to confirm the COPD and depression are still active before coding them from the problem list
Show answer & explanation

Correct answer: B - Do not code COPD or depression for this encounter - a diagnosis must be addressed in the encounter note with MEAT to be reported for risk adjustment

Question 8

A Medicare Advantage patient has the following validated diagnoses for the current payment year: Type 2 diabetes with diabetic chronic kidney disease (HCC 18), Type 2 diabetes without complications (HCC 19), and chronic obstructive pulmonary disease (HCC 111). After applying CMS-HCC V24 hierarchies, which HCC(s) contribute to the patient's RAF score?

  1. HCC 18, HCC 19, and HCC 111 - all validated diagnoses contribute individually to the RAF
  2. HCC 18 and HCC 111 - HCC 19 is trumped by HCC 18 within the diabetes hierarchy, while HCC 111 is from a different disease family and remains additive
  3. HCC 19 and HCC 111 - the least severe diabetes HCC is used because the more specific code has a lower coefficient
  4. HCC 18 only - hierarchies eliminate all lower-ranked HCCs across all disease families
Show answer & explanation

Correct answer: B - HCC 18 and HCC 111 - HCC 19 is trumped by HCC 18 within the diabetes hierarchy, while HCC 111 is from a different disease family and remains additive

Question 9

CASE: A 68-year-old male presents for a routine follow-up. Provider documentation states: 'Hypertension, stable on amlodipine. End-stage renal disease on hemodialysis three times weekly. Type 2 diabetes with diabetic nephropathy, on insulin glargine. Dialysis access site examined - AV fistula functioning well.' Select the correct code assignment:

  1. I12.0, N18.6, Z99.2, E11.22, Z79.4 - hypertensive CKD with ESRD, ESRD, dialysis dependence, DM2 with nephropathy, long-term insulin
  2. I13.10, N18.6, Z99.2, E11.22, Z79.4 - hypertensive heart and CKD with ESRD (combination code), with DM2 nephropathy and insulin
  3. I10, N18.6, Z99.2, E11.9, Z79.4 - essential HTN coded separately, ESRD, dialysis, DM2 without complications, insulin
  4. I12.0, N18.6, E11.22, Z79.4 - hypertensive CKD with ESRD, DM2 nephropathy, and insulin; dialysis status is implied by ESRD
Show answer & explanation

Correct answer: A - I12.0, N18.6, Z99.2, E11.22, Z79.4 - hypertensive CKD with ESRD, ESRD, dialysis dependence, DM2 with nephropathy, long-term insulin

Question 10

A risk adjustment coder must understand the pathophysiological distinction between diabetes types to assign correct ICD-10-CM codes. Which statement accurately describes the primary mechanism of Type 2 diabetes mellitus, supporting its classification under E11?

  1. Autoimmune destruction of the pancreatic beta cells in the islets of Langerhans, resulting in absolute insulin deficiency
  2. Progressive insulin resistance at the cellular level combined with relative insulin deficiency due to beta cell dysfunction
  3. Destruction of the adrenal cortex leading to impaired glucose metabolism and secondary hyperglycemia
  4. Overproduction of glucagon by the alpha cells of the pancreas, suppressing all insulin secretion
Show answer & explanation

Correct answer: B - Progressive insulin resistance at the cellular level combined with relative insulin deficiency due to beta cell dysfunction

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