CRC Risk Adjustment Coding case studies
CRC Risk Adjustment Coding · Put your knowledge to work in context.
The Certified Risk Adjustment Coder (CRC) credential, offered by AAPC, validates expertise in risk adjustment coding - specifically, applying ICD-10-CM diagnosis codes to capture the complete health status of patients in value-based care models. It is designed for new entrants to medical coding who want to start in risk adjustment and value-based care, experienced but uncertified coders seeking to validate their skills, certified coders expanding into risk adjustment and HCC coding, and healthcare professionals working with payers, provider groups, or organizations involved in value-based care. The CRC Risk Adjustment Coding case studies are 5 cases and about 4,730 words.
1One Visit, Four Diabetes Codes: What Can Actually Be Submitted
An established 67-year-old Medicare Advantage member is seen by her primary care physician on August 14, 2025. The assessment lists type 2 diabetes with diabetic chronic kidney disease, stage 3b (E11.22, N18.32), long-term insulin use, and a BMI of 38.4.
888 words, about 4 min2Six Conditions, One Word: Does "Continue" Meet MEAT?
An internal review pulls the September 3, 2025 annual wellness visit note of a 72-year-old female member from a 14-provider group practice. The note is template-generated.
920 words, about 5 min3Sixty Charts, Twenty Findings: Sizing the Problem Before RADV Arrives
A plan audits a 60-member random sample drawn from a Medicare Advantage contract's 2024 payment-year population of 4,800; the contract submits diagnoses from calendar year 2023 for that payment year. Auditors flag 20 charts.
912 words, about 5 min4Suspected COPD, Prediabetes, and a Consultant Who Says "Capture Everything"
A 58-year-old man is seen October 21, 2025 for his first visit at a new practice. History of MI 2019, two stents, no chest pain; continue aspirin 81, metoprolol, atorvastatin.
939 words, about 5 min5Seven Records, One Data Year: Sorting the 2026 Submission Batch
A coding team is asked to determine which records in its review batch can support risk-adjusting diagnoses for a Medicare Advantage contract's 2026 payment year . The batch contains: (A) a telehealth visit on December 18, 2025 by the member's nurse practitioner documenting newly diagnosed COPD with spirometry results and a treatment plan; (B) an urgent care visit on January 3, 2026 for a CHF exacerbation treated with IV diuretics and a referral to cardiology; (C) a cardiology letter dated November 2025 summarizing a March 2025 face-to-face visit, with the original March encounter note also in the record; (D) an inpatient discharge summary from a December 2025 admission listing sepsis and acute kidney injury; (E) a member-completed health risk assessment from February 2026 stating "my doctor told me I have rheumatoid arthritis"; (F) an ophthalmology note from July 2025 documenting proliferative diabetic retinopathy; (G) an April 2025 note documenting malnutrition signed only by a registered dietitian, with no physician statement anywhere in the record.
1,071 words, about 5 min