AAPC-CRC Certified Risk Adjustment Coder - Set 4 - Part 1

Correct Answer: A compilation of diagnoses relevant to the patient's health status

A problem list is a compilation of diagnoses, past or current, that are relevant to the patient's health status. It should reflect clinically significant conditions and be maintained according to organizational policies and procedures. Option a is incorrect because that is the meaning of "unable to determine", a provider's answer to a query when data are insufficient, not a record of diagnoses. Option b is incorrect because that is ambiguous documentation, which may require clarification, whereas a problem list gathers diagnoses relevant to the patient's health status. Option c is incorrect because that describes clinical indicators, which include provider assessments, diagnostic findings, treatments and medications, rather than a compilation of past or current diagnoses.

Correct Answer: Query professionals may not add emphasis formatting to indicators

It is not appropriate for the query professional to add formatting to emphasize a clinical indicator. Emphasis could be construed as leading. Only emphasis already present in the provider's own documentation may be preserved. Option b is incorrect because information from a relevant prior visit may support a query when clinically pertinent to the present encounter, so this is not a flaw. Option c is incorrect because guidance says clinical indicators should include a citation of where they were found, so the policy's citation requirement is appropriate rather than faulty. Option d is incorrect because reporting values as documented is the compliant approach; a heart rate of 120 is communicated as such, not labeled tachycardia.

Correct Answer: Designated responsibility for template oversight

Under creation and approval of templates, organizations should designate responsibility for template oversight, including approval authority and version control, alongside a defined creation process and input from providers and other disciplines. Option a is incorrect because review and maintenance covers updating templates on a regular schedule and retiring outdated ones, not assigning who holds approval authority or controls versions. Option b is incorrect because instructions for use give guidance on when and how templates are applied and stress that they do not replace clinical judgment. Option d is incorrect because modality requires that formatting, elements, and response options meet compliance standards whether a query is manual, automated, or technology-assisted; it assigns no oversight role.

Correct Answer: eu- : abnormal

The prefix eu- means normal or good, as in eupnea. The meaning abnormal belongs to dys-, which is also listed as painful, difficult or laboured, so this pairing is the incorrect one. Option a is incorrect because brady- is listed with the meaning slow, as shown in bradycardia, so this pairing matches the standard list. Option b is incorrect because the prefix a-, like an-, is listed as meaning no, not, without, and it negates the meaning, as in atypical. Option c is incorrect because ante- is given the meaning before, and its example of use in a medical term is antepartum.

Correct Answer: Homeostasis

Homeostasis is the state of relative constancy of the body's internal environment. Survival depends on the body maintaining or restoring it, and Cannon named it for the relatively constant states the body maintains. Option a is incorrect because it concerns detecting changes in the internal or external environments, which is one body activity, not the constant state itself. Option c is incorrect because it describes the division of labor among components at all levels of the body, not a constant internal environment. Option d is incorrect because it is the broad term for all chemical reactions in the body, including catabolism, rather than the state of relative constancy.

Correct Answer: Keloid

A keloid forms when scar tissue is overproduced because collagen formation continues after the wound has healed. Fibroblasts generate this collagen, so the result is a raised excess of fibrous scar tissue. Option a is incorrect because it is the scar left by acne and chickenpox, and it has a sunken appearance instead of excess tissue. Option b is incorrect because it appears when melanocytes accumulate irregularly in the skin, so it reflects pigment cells and has no link to collagen or wound repair. Option d is incorrect because it is a bedsore caused by constant, long-term, unrelieved pressure on bony body parts, not by overproduced scar tissue.

Correct Answer: rule of nines

Burns are sometimes measured by the size of the total surface area affected. This is the rule of nines, which links specific anatomical areas to a percentage that is a factor of nine. Option b is incorrect because it names the quantity being measured when burn size is assessed, while the method that assigns percentages to body regions is something else. Option c is incorrect because it is the separate way burns are classified by how serious they are, not a method for measuring size by body area. Option d is incorrect because it is a treatment given to offset dehydration in burn patients and does not measure how much of the body is burned.

Correct Answer: demyelination

Demyelination refers to the loss or destruction of the myelin sheath. In multiple sclerosis, this process forms scar tissue and lesions in the CNS and impairs the transmission of nerve impulses. Option a is incorrect because names a loss of speech and language tied to Broca's and Wernicke's areas, not damage to the myelin sheath. Option b is incorrect because is a later consequence of new lesions and neuronal injury in MS, not the name for the myelin loss itself. Option c is incorrect because describes the body's early attempt to restore myelin, which can lessen clinical symptoms, rather than the loss or destruction of the sheath.

Correct Answer: Sheared olfactory tract axons

When the frontal lobe moves relative to the ethmoid bone, the olfactory tract axons may be sheared apart. This loss of the olfactory nerve causes anosmia, the loss of the sense of smell. Option b is incorrect because meningitis is an infectious inflammatory process of the protective membranes covering the brain and spinal cord, not a result of the frontal lobe shifting against bone. Option c is incorrect because the corpus callosum is white matter deep in the cerebrum that carries communication between the two hemispheres, so it does not serve smell. Option d is incorrect because age-related anosmia develops gradually as olfactory neurons replace themselves less well, which does not fit sudden onset after facial trauma.

Correct Answer: Hypoglycemia

Hypoglycemia is grouped with hyperglycemia as an acute complication of DM. Kidney failure, neuropathy and peripheral vascular disease result from long-term blood vessel and nerve damage caused by elevated blood sugar. Option a is incorrect because circulatory problems in the lower extremities, leading to foot ulcerations and possible amputation, belong with the long-term complications rather than the acute ones. Option b is incorrect because it is a listed long-term complication; DM is a leading cause of diabetic nephropathy, which over time can progress to kidney failure. Option c is incorrect because nerve damage often affecting the legs and feet, with pain, tingling and paresthesia, is among the long-term complications of DM.

Correct Answer: Arrhythmogenic cardiomyopathy

Arrhythmogenic cardiomyopathy is the type described as inherited and resulting in irregular heart rhythms. The other types are defined by an enlarged muscle, an enlarged ventricle, or a scarred and stiffened myocardium. Option a is incorrect because has an unknown cause and is seen in people of any age, with one ventricle larger than normal. Option b is incorrect because is a complication of other conditions that scar or stiffen the myocardium, not an inherited rhythm disorder. Option d is incorrect because is an abnormally enlarged heart muscle of unknown cause, often undiagnosed, and can cause sudden death in otherwise healthy young people.

Correct Answer: Anemia

Anemia is a reduction in red blood cells, hemoglobin, or hematocrit, and it is not listed among the common causes of heart failure. Severe anemia can produce angina or myocardial infarction as symptoms, but it is not itself named a cause of HF. Option a is incorrect because hypertension is listed as a common cause of HF because it creates vascular resistance that the heart must overcome to pump blood. Option b is incorrect because cardiomyopathy appears in the list of common HF causes alongside CAD, myocardial infarction, hypertension and valve disorders. Option c is incorrect because an MI can kill muscle tissue, and when the infarct affects the left ventricle the heart's ability to pump is severely affected.

Correct Answer: Helper T cells

HIV is a cause of secondary immunodeficiency and leads to AIDS. It specifically impacts the helper T cells, which weakens the immune response, unlike SCID, which is an inherited genetic defect affecting both B and T cell arms. Option a is incorrect because memory B cells form during a primary B cell response and drive stronger secondary responses; they are not the cells HIV specifically impacts. Option b is incorrect because phagocytes are one of several cell types whose failure can cause immunodeficiency generally, but HIV is not described as acting specifically on them. Option d is incorrect because plasma cells are antibody-secreting cells produced during B cell responses, and HIV is not described as targeting them specifically.

Correct Answer: Second-hand smoke

Second-hand smoke, a combination of sidestream smoke and exhaled mainstream smoke, is considered carcinogenic and can cause lung cancer in individuals who are not tobacco users, such as nonsmokers living with a smoker. Option a is incorrect because radon gas is a listed risk factor, but the documentation describes exposure to a smoker's smoke at home, not radon. Option b is incorrect because mainstream smoke is the smoke inhaled directly by the smoker, so it describes the smoker's own exposure and not that of a nonsmoker. Option c is incorrect because metastasis is spread of cancer from other parts of the body and is not an environmental exposure arising from a household member's smoking.

Correct Answer: Education on alcohol abstinence

Clients with chronic pancreatitis require pain management, a low-fat diet, and education on alcohol abstinence, and possibly exogenous pancreatic enzymes. ERCP and cholecystectomy are tied to gallstone-caused acute pancreatitis. Option a is incorrect because it may be performed when acute pancreatitis is caused by gallstones, so it belongs to the acute gallstone-related presentation rather than chronic disease management. Option b is incorrect because it is described as a possibility in severe cases of acute pancreatitis, not as a measure every client with chronic disease requires. Option d is incorrect because this procedure is listed with cholecystectomy as an option for gallstone-induced acute pancreatitis, not as a requirement for chronic pancreatitis.

Correct Answer: End-stage renal disease

In the standard list of urinary system abbreviations, ESRD stands for end-stage renal disease. The similar abbreviations ARF, CKD and ESWL expand to different terms, so the letters must be matched exactly. Option a is incorrect because this is the expansion of CKD, a separate entry in the urinary abbreviation list with its own letters. Option b is incorrect because this expansion belongs to the abbreviation ARF, which names a sudden loss of kidney function rather than the end-stage condition. Option c is incorrect because this expansion is ESWL, a procedure for stones, not a disease state, even though its first letters resemble ESRD.

Correct Answer: Papanicolaou test

The Papanicolaou test (Pap smear) looks for precancers, which are cell changes on the cervix. It can find cervical cancer early, when treatment is most effective, and it screens only for cervical cancer. Option a is incorrect because these genes appear as breast cancer risk factors, so they belong to breast cancer rather than to cervical screening. Option c is incorrect because it is a diagnostic procedure the guidance lists for endometriosis, not a screen for cervical cell changes. Option d is incorrect because the guidance pairs this sampling with endometriosis diagnosis, and it examines the uterine lining rather than looking for precancers on the cervix.

Correct Answer: Grading

Grading is how pathologists measure how different a cancer cell is from a normal one. It reflects the severity of cancer, and a lower grade generally represents a more favourable prognosis. Option a is incorrect because it means cancer cells have spread to other organs, which is the M of TNM, not a measure of cell difference. Option b is incorrect because it describes size and spread of cancer determined from a pathology report, so it addresses extent of disease rather than cell appearance. Option c is incorrect because it refers to the size and spread of cancer as determined by diagnostic techniques, not to how abnormal the cells look.

Correct Answer: Renal arteries

Atherosclerosis affecting the renal arteries can cause decreased urine output and result in chronic kidney disease (CKD). This shows how a vascular disease leads to a chronic renal condition. Option a is incorrect because when these are affected, the findings are transient ischemic attacks or stroke symptoms such as weakness, speech difficulties, and confusion, which are neurological rather than kidney-related. Option b is incorrect because plaque in these vessels is tied to chest pain (angina) from coronary artery disease, a cardiovascular finding, so it does not explain reduced urine output. Option d is incorrect because atherosclerosis there produces vision loss, an ophthalmic finding, and is not the route to decreased urine output or chronic kidney disease.

Correct Answer: Appropriate and accurate payments

CMS uses risk adjustment to make appropriate and accurate payments for enrollees with differences in expected costs. Payments reflect each beneficiary's health status and demographic characteristics rather than an average amount. Option a is incorrect because sicker enrollees generally receive higher risk scores, which produce higher per member per month payments, so the effect runs the opposite direction. Option c is incorrect because risk adjustment replaces a single average Medicare amount with payment that reflects the risk of the beneficiaries each plan actually enrolls. Option d is incorrect because bids are risk adjusted so that standardized bids can serve as base payments; the goal is not identical bids from every plan.