100+ Free CRHC Practice Questions

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Granulomatosis with polyangiitis (GPA, formerly Wegener's) is reported with which ICD-10-CM code?

M31.30

M30.0

M31.7

M30.3

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2026 Statistics

Key Facts: CRHC Exam

150

Total Items

AAPC

5h 40m

Exam Time

AAPC

$299

AAPC Member Fee

AAPC

Required Since 7/2023

Zero-waste single-use vial

The AAPC CRHC consists of 150 MCQ items over 5h40m with 70% passing. Fee $299 AAPC member. Master joint injection codes (20600-20611 by size with/without US guidance), biologic infusion admin codes (96365 initial up to 1 hr; 96366 each addt'l hr), HCPCS J-codes for biologics, and JW/JZ wastage modifiers.

Sample CRHC Practice Questions

Try these sample questions to test your CRHC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which structure forms the synovial lining that becomes the primary site of inflammation in rheumatoid arthritis?

A.Articular cartilage

B.Synovium (synovial membrane)

C.Subchondral bone

D.Joint capsule outer layer

Explanation: The synovium is the inner lining of the joint capsule. In rheumatoid arthritis, autoimmune-driven inflammation causes synovial hyperplasia (pannus), which then erodes cartilage and bone. Coders must recognize that RA is primarily a synovial disease to assign correct M05/M06 codes.

2A patient with seropositive rheumatoid arthritis presents with rheumatoid factor and anti-CCP antibodies. Which ICD-10-CM category is appropriate?

A.M06.0- (Rheumatoid arthritis without rheumatoid factor)

B.M05.- (Rheumatoid arthritis with rheumatoid factor)

C.M08.- (Juvenile arthritis)

D.M12.- (Other and unspecified arthropathy)

Explanation: ICD-10-CM category M05 is reserved for seropositive RA (rheumatoid factor positive). Anti-CCP positivity supports seropositivity. Specific subcategories require site and laterality, e.g., M05.711 for RA without organ involvement of right shoulder.

3A rheumatologist performs an injection of the right knee joint without imaging guidance for osteoarthritis. Which CPT code is reported?

A.20605

B.20610

C.20611

D.20600

Explanation: CPT 20610 reports arthrocentesis, aspiration, and/or injection of a major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa) WITHOUT ultrasound guidance. The knee is a major joint.

4Which J-code reports infliximab (Remicade), reference product, per 10 mg?

A.J3262

B.J1745

C.Q5103

D.J0129

Explanation: J1745 is HCPCS Level II for injection, infliximab, excludes biosimilar, 10 mg. Each 100 mg vial reports as 10 units of J1745.

5An established patient is seen for a planned IV infusion of tocilizumab. The rheumatologist also performs a separately identifiable problem-focused E/M for new joint swelling. Which modifier appends the E/M code?

A.Modifier 24

B.Modifier 25

C.Modifier 57

D.Modifier 59

Explanation: Modifier 25 is appended to a significant, separately identifiable E/M service performed by the same provider on the same day as a procedure or other service (such as joint injection or infusion). Documentation must support the E/M as separate from the procedure work.

6Per the JZ modifier requirement effective July 1, 2023, when is JZ appended to a single-use drug HCPCS code?

A.When any amount is wasted from a single-use vial

B.When zero drug amount is discarded from a single-use vial

C.Only when waste exceeds 10%

D.When the drug is multi-dose

Explanation: Modifier JZ attests that ZERO drug amount was discarded/not administered from a single-dose container. CMS requires JZ on Part B claims for separately payable Part B drugs from single-dose containers when there is no waste.

7Which code reports the first hour of an IV infusion of a therapeutic drug (non-chemotherapy biologic)?

A.96360

B.96365

C.96374

D.96413

Explanation: CPT 96365 reports intravenous infusion, for therapy/prophylaxis/diagnosis (excluding chemotherapy or biologic anti-neoplastic), initial up to 1 hour. Used for biologic infusions like infliximab, tocilizumab, belimumab, abatacept.

8A patient with SLE is diagnosed with lupus nephritis. Which ICD-10-CM code captures this organ involvement?

A.M32.10

B.M32.13

C.M32.9

D.N05.9

Explanation: M32.13 is systemic lupus erythematosus with renal involvement (lupus nephritis). When SLE involves a specific organ system, use the appropriate M32.1x subcategory rather than the unspecified code.

9Adalimumab (Humira) is most commonly self-administered by the patient. Which billing approach is correct for office encounters where the patient self-injects at home?

A.Bill J0135 plus 96372 in office

B.Do not bill the J-code or admin code; the drug is dispensed via specialty pharmacy

C.Bill 96365 for IV infusion

D.Bill 20610 for joint injection

Explanation: Adalimumab (J0135) is a SubQ self-administered biologic typically dispensed through specialty pharmacy under the patient's pharmacy benefit (Medicare Part D). The clinic does not bill the drug or administration when the patient injects at home.

10Which ICD-10-CM code reports polymyalgia rheumatica?

A.M35.3

B.M31.5

C.M79.7

D.M53.1

Explanation: M35.3 is the ICD-10-CM code for polymyalgia rheumatica (PMR), an inflammatory condition causing shoulder/hip girdle pain and stiffness in older adults. PMR frequently coexists with giant cell arteritis (M31.5/M31.6).

About the CRHC Exam

AAPC specialty credential for rheumatology coders. Validates expertise in joint injection/aspiration CPT (20600-20611 by joint size with/without US guidance), biologic infusion administration (96365-96368 + 96372), HCPCS J-codes for biologics and DMARDs (infliximab J1745, biosimilars Q5103/Q5104, tocilizumab J3262, abatacept J0129, rituximab J9312), ICD-10-CM rheumatology (M-codes for RA, SLE, gout, OA), and biologic compliance (REMS, step therapy, biosimilar substitution).

Questions

150 scored questions

Time Limit

5 hours 40 minutes

Passing Score

70%

Exam Fee

$299 AAPC member (AAPC)

CRHC Exam Content Outline

15%

Rheumatology Anatomy, Pathophysiology and Disease Spectrum

RA, SLE, AS, PsA, gout, OA, vasculitis, fibromyalgia, PMR

20%

E/M for Rheumatology

Office (2021), inpatient/observation (2023), consults; chronic disease management

20%

CPT Rheumatology Procedures

Joint injection 20600-20611 by size + with/without US guidance, trigger point 20552-20553

15%

HCPCS J-Codes for Biologics and DMARDs

Infliximab J1745, biosimilars Q5103/Q5104/Q5121, tocilizumab J3262, abatacept J0129, rituximab J9312

15%

ICD-10-CM Rheumatologic Diagnoses

M05/M06 RA, M32 SLE, M10 gout, M15-M19 OA, M30-M31 vasculitis, M79.7 fibromyalgia

15%

Modifiers, Bundling and Compliance

25 (E/M with procedure), 50/59 multiple/separate joints, JW/JZ wastage, REMS, step therapy

How to Pass the CRHC Exam

What You Need to Know

Passing score: 70%
Exam length: 150 questions
Time limit: 5 hours 40 minutes
Exam fee: $299 AAPC member

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CRHC Study Tips from Top Performers

1Master joint injection codes by size + guidance: small (fingers/toes), intermediate (wrist/elbow/ankle/TMJ), major (shoulder/hip/knee). With US guidance is the higher-numbered code (20604/20606/20611)

2Know aspiration + injection same joint = ONE code (cannot bill both). Different joints = modifier 50 or 59

3Memorize biologic admin: 96365 IV initial up to 1 hr; 96366 each addt'l hr; 96372 SubQ therapeutic; pair with HCPCS J/Q-code for the drug

4Understand JW/JZ since 7/2023: required reporting on Medicare single-use vial biologics — JW with waste, JZ when zero waste

Frequently Asked Questions

How are joint injection codes selected?

Joint injections (20600-20611) are coded by joint SIZE + with/without US guidance: 20600 small joint (fingers/toes) without guidance; 20604 small with US; 20605 intermediate (wrist/elbow/ankle/TMJ) without; 20606 intermediate with US; 20610 major (shoulder/hip/knee/subacromial bursa) without; 20611 major with US. Cannot bill aspiration AND injection of SAME joint as separate codes (one code covers both). Different joints use modifier 50 (bilateral) or 59 (distinct).

How are biologic infusions coded?

Two-part billing: HCPCS J-code for the drug + CPT admin code. Admin: 96365 (IV infusion initial up to 1 hr); 96366 (each addt'l hr); 96367 (each addt'l SEQUENTIAL different drug 1st hr); 96368 (concurrent infusion). SubQ injection of biologic (e.g., golimumab Simponi Aria IV vs SubQ self-admin) = 96372 therapeutic injection. Self-administered SubQ biologics (etanercept, adalimumab, certolizumab pegol SubQ) are typically dispensed via specialty pharmacy and NOT admin-coded by physician office.

What is the JW/JZ rule for biologics?

JW (drug or biological wasted from single-use vial — Medicare requires reporting wasted units along with administered units) and JZ (zero waste from single-use vial — required since July 2023). One must appear on every Medicare claim line for single-use vial biologics. Multi-dose vials don't require JW/JZ. Biosimilars have their own Q-codes (e.g., Q5103 infliximab-dyyb Inflectra; Q5104 infliximab-abda Renflexis).