CRC Exam Flashcards

Q: What is the CRC exam format?

The AAPC CRC exam has 100 multiple-choice questions in a 4-hour window. Local metadata lists 70% as the passing score.

Q: What reference book is central to CRC prep?

The CRC exam centers on diagnosis coding, so efficient ICD-10-CM code book navigation is essential.

Q: What topics are highest yield?

Focus on chronic condition capture, HCC hierarchies, annual recapture, code specificity, outpatient diagnosis rules, MEAT documentation, provider queries, and RADV audit risk.

Question 1

CRC exam core skill

Accepted Answer

The CRC tests whether you can abstract supported diagnoses, assign accurate ICD-10-CM codes, understand HCC risk models, and recognize compliance risk.

Question 2

CRC passing score

Accepted Answer

Local metadata lists 70%, or 70 of 100 questions, as the passing score for the AAPC CRC exam.

Question 3

ICD-10-CM code book

Accepted Answer

CRC candidates must navigate ICD-10-CM quickly. Tabular instructions, chapter guidelines, Excludes notes, and code specificity drive correct answers.

Question 4

Risk adjustment

Accepted Answer

Risk adjustment predicts expected healthcare cost or resource use based on demographics and documented health status, so plans are paid more fairly for sicker populations.

Question 5

CMS-HCC model

Accepted Answer

The CMS-HCC model maps selected ICD-10-CM diagnoses to hierarchical condition categories for Medicare Advantage payment adjustment.

Question 6

RAF score

Accepted Answer

A Risk Adjustment Factor score estimates expected cost relative to an average beneficiary. A RAF above 1.0 predicts above-average cost.

Question 7

Capitation

Accepted Answer

Capitation pays a fixed amount per member for a period. Risk adjustment modifies that payment based on the member's documented risk.

Question 8

HCC hierarchy

Accepted Answer

A hierarchy ranks related conditions so only the most severe category in that disease group counts for payment, preventing double counting.

Question 9

Annual recapture

Accepted Answer

Chronic HCC conditions generally must be documented and reported each calendar year. A condition captured last year does not automatically count this year.

Question 10

CMS-HCC vs HHS-HCC

Accepted Answer

CMS-HCC is used for Medicare Advantage populations. HHS-HCC is used for Affordable Care Act commercial marketplace risk adjustment.

Question 11

CDPS model

Accepted Answer

CDPS is a risk adjustment model often associated with Medicaid populations. CRC candidates should recognize that different payers use different models.

Question 12

Demographic factors

Accepted Answer

Risk models may include age, sex, Medicaid status, disability status, institutional status, and other demographic variables in addition to diagnosis codes.

Question 13

MEAT

Accepted Answer

MEAT stands for Monitor, Evaluate, Assess or Address, and Treat. At least one supported element can help validate a diagnosis for risk adjustment.

Question 14

Monitor

Accepted Answer

Monitor documentation shows the provider tracked a condition, such as reviewing labs, symptoms, disease status, or treatment response.

Question 15

Evaluate

Accepted Answer

Evaluate documentation shows the provider assessed test results, disease progression, exam findings, or clinical significance of a condition.

Question 16

Assess or Address

Accepted Answer

Assess or address documentation shows the provider considered the condition in the assessment, impression, status, or decision-making.

Question 17

Treat

Accepted Answer

Treat documentation shows medication, referral, procedure, counseling, monitoring plan, or other management for the condition.

Question 18

Provider query

Accepted Answer

A query asks the provider to clarify incomplete, inconsistent, vague, or conflicting documentation. It must be nonleading and clinically supported.

Question 19

Prospective review

Accepted Answer

Prospective review happens before or at the visit to identify suspected chronic conditions and gaps that the provider may need to evaluate and document.

Question 20

Concurrent review

Accepted Answer

Concurrent review occurs during the encounter or care episode, allowing documentation clarification while the provider can still address the patient record promptly.

Question 21

Retrospective review

Accepted Answer

Retrospective review examines completed records after the encounter to find supported diagnoses, missed HCCs, or unsupported submitted codes.

Question 22

Suspect logic

Accepted Answer

Suspect logic uses clues such as medications, labs, claims, or history to flag possible conditions. The coder still needs provider documentation before coding.

Question 23

Highest specificity

Accepted Answer

Risk adjustment coding requires the most specific ICD-10-CM code supported by documentation. Unspecified codes may fail to map or may understate severity.

Question 24

Outpatient uncertain diagnoses

Accepted Answer

Do not code probable, suspected, questionable, rule-out, or differential diagnoses as confirmed in outpatient risk adjustment. Code known signs, symptoms, or confirmed conditions.

Question 25

History vs active cancer

Accepted Answer

Use active cancer codes when disease is present or under active treatment. Use personal history codes when treatment is complete and there is no evidence of current disease.

Question 26

Diabetes without documented complication

Accepted Answer

If Type 2 diabetes is documented without complications, code uncomplicated diabetes. Do not infer complications from medication alone; query when clinical indicators support more specificity.

Question 27

Diabetes with CKD

Accepted Answer

ICD-10-CM presumes a causal relationship between diabetes and CKD unless documentation says otherwise. Use a diabetes-with-CKD code plus the CKD stage code.

Question 28

Hypertensive CKD

Accepted Answer

When hypertension and CKD are documented, ICD-10-CM presumes a relationship unless another cause is stated. Use the hypertensive CKD combination code and CKD stage.

Question 29

Heart failure specificity

Accepted Answer

Documented type and acuity matter: systolic, diastolic, acute, chronic, and acute on chronic codes can map differently than unspecified heart failure.

Question 30

COPD exacerbation

Accepted Answer

COPD with acute exacerbation is more specific than unspecified COPD. Code only what the provider documents and supports.

Question 31

CKD stage and ESRD

Accepted Answer

Code the documented CKD stage. A dialysis-dependent patient is commonly coded as ESRD with dialysis status when documentation supports it.

Question 32

CVA sequelae

Accepted Answer

Residual deficits from an old stroke are coded with sequelae codes, not acute stroke codes. Current hemiplegia or other deficits may risk-adjust.

Question 33

Metastatic cancer coding

Accepted Answer

When supported, code the primary malignancy, metastatic site, and related conditions such as cachexia. Complete capture reflects disease burden.

Question 34

Amputation status

Accepted Answer

A completed amputation is coded with an acquired absence status code when relevant. Status codes can carry risk adjustment value and need annual recapture when current.

Question 35

Tracheostomy status

Accepted Answer

A current tracheostomy can be reported with a status code when it is relevant to the encounter and supported by documentation.

Question 36

Excludes1 note

Accepted Answer

Excludes1 means the two conditions generally cannot be coded together because they are mutually exclusive for the same encounter.

Question 37

Excludes2 note

Accepted Answer

Excludes2 means the condition is not included under that code, but both conditions may be coded together if the patient has both.

Question 38

Code First note

Accepted Answer

A Code First note tells the coder to sequence the underlying condition before the manifestation or associated condition.

Question 39

Use Additional Code note

Accepted Answer

A Use Additional Code note tells the coder to add another code for a fuller clinical picture, such as a manifestation, exposure, or status.

Question 40

Laterality

Accepted Answer

Laterality identifies right, left, or bilateral involvement. Use laterality when the code set and documentation support it.

Question 41

Seventh character

Accepted Answer

Some ICD-10-CM categories require a seventh character for encounter type or healing status. Missing required characters make codes invalid.

Question 42

MCC-style specificity trap

Accepted Answer

A coder may not choose a more severe code just because it has higher risk value. Severity must be explicitly documented and clinically supported.

Question 43

Upcoding

Accepted Answer

Upcoding reports a diagnosis or severity level not supported by the record. In risk adjustment, it creates payment and audit risk.

Question 44

Undercoding

Accepted Answer

Undercoding omits supported conditions or uses nonspecific codes when specificity is documented. It understates patient risk and can distort quality data.

Question 45

False Claims Act

Accepted Answer

The False Claims Act prohibits knowingly submitting false claims to federal programs. Unsupported HCC submissions can create FCA exposure.

Question 46

RADV audit

Accepted Answer

Risk Adjustment Data Validation audits verify that submitted diagnoses are supported in medical records. Unsupported HCCs can be deleted and payments recouped.

Question 47

Acceptable provider documentation

Accepted Answer

Risk adjustment diagnoses must come from an acceptable provider type and a valid encounter. Coders cannot use unsupported problem-list or nonprovider clues alone.

Question 48

Chart cloning

Accepted Answer

Copied-forward diagnoses can create unsupported coding if the condition was not addressed during the current encounter. MEAT helps identify current support.

Question 49

Overpayment rule

Accepted Answer

When unsupported risk adjustment payments are identified, organizations must investigate, correct, and return overpayments according to applicable rules.

Question 50

Balanced coding

Accepted Answer

A strong CRC captures all supported conditions without adding unsupported ones. Accuracy, specificity, and compliance matter more than maximizing RAF.

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