CRC (Other exams) case studies
CRC · Put your knowledge to work in context.
The Certified Risk Adjustment Coder (CRC) credential, offered by AAPC, validates a professional's expertise in risk adjustment coding: the discipline of applying ICD-10-CM diagnosis codes to capture a patient's complete health status in value-based care. AAPC describes the credential as demonstrating proficiency in coding chronic and complex conditions accurately, complying with risk adjustment guidelines, and supporting proper reimbursement under Medicare Advantage, ACA marketplace plans, and other risk-adjusted payment systems. The CRC case studies are 5 cases and about 1,802 words.
1Risk Score Impact of a Diabetic Neuropathy Query
A Medicare Advantage plan is reviewing a 72-year-old female member (community, non-dual) whose demographic score is 0.400. The chart supports CHF (HCC 85, coefficient 0.350) and type 2 diabetes without complications (HCC 38, coefficient 0.105).
409 words, about 2 min2Diabetic Kidney Disease Without a Documented CKD Stage
A 68-year-old male with type 2 diabetes has an eGFR of 27 mL/min/1.73 m2 and urine albumin-to-creatinine ratio of 420 mg/g. The nephrology note states 'diabetic kidney disease' and 'CKD,' but does not assign a stage.
332 words, about 2 min3Recapturing COPD From a Problem List and PRN Inhaler
An 81-year-old female member has a problem list entry of 'history of COPD.' At this year's annual wellness visit, the nurse practitioner writes: 'COPD - no exacerbations since last year. Continue albuterol inhaler PRN.
359 words, about 2 min4Probable Diagnoses, Missing Date, and a Post-Audit Addendum
A RADV audit selects a 77-year-old male member. The submitted diagnoses include Parkinson's disease (G20) and multiple sclerosis (G35).
340 words, about 2 min5Hypertension, CKD, and Heart Failure: One Combination Code or Three?
A 70-year-old female has long-standing hypertension, CKD stage 3b (eGFR 38), and heart failure with reduced ejection fraction (EF 30%). The cardiology note documents 'hypertensive heart disease with heart failure' and 'CKD stage 3b.' The primary care note says 'hypertension, CKD, HFrEF.' The coder sees I10, I50.20, and N18.3 in the problem list.
362 words, about 2 min