Castleport Test Prep

AAPC CRC Exam Prep: Free Study Guide and 30 Practice Questions

Start your AAPC CRC exam prep with the chart question below, then use the priority map, 29 more original questions, and a six-week plan.

These are original, unofficial practice questions, not AAPC exam questions.

Start here: which diagnoses does this note support?

CRC-01 · Cases

Office visit, February 12, 2026, for fatigue. The signed assessment reads: "Fatigue; possible hypothyroidism. TSH ordered, results pending. Hypertension, stable; continue lisinopril." The note also says last year's pneumonia resolved and plays no part in today's care. Which diagnoses does this visit support?

  • A. Fatigue and hypertension
  • B. Hypothyroidism and hypertension
  • C. Fatigue only
  • D. Fatigue, hypertension and pneumonia
Show answerHide answer for CRC-01

Answer: A. In an outpatient record, a "possible" diagnosis isn't coded. You code what's certain, which here is the symptom (fatigue). Hypertension is a chronic condition the provider is actively managing, so it's reported too.

  • Why not B: Treats "possible hypothyroidism" as confirmed. Outpatient coding doesn't allow that.
  • Why not C: Leaves out hypertension, which the provider assessed and treated at this visit.
  • Why not D: Adds pneumonia, a resolved condition that doesn't affect today's care.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. IV.H-IV.J, p. 114

That one question gives you a useful habit: decide what the record actually supports before you think about codes or payment models.

Where the CRC's 100 questions come from

AAPC publishes how the 100 questions split up (AAPC, "Taking the CRC exam"). The middle column is AAPC's count; the last two are our study notes and the matching practice on this page.

Where the CRC's 100 questions come from
AAPC content area Questions What you need to be able to do Practice here
Diagnosis coding 30 Apply ICD-10-CM guidelines and Coding Clinic to scenarios; spot common risk adjustment coding errors; know which conditions risk adjust CRC-02 to CRC-09
Compliance 15 Explain prospective, retrospective and RADV audits; recognize common RADV coding errors CRC-13 to CRC-17
Risk adjustment models 15 Apply ACA (HHS-HCC), CDPS, CMS-HCC and private payer models; name the elements of a risk score CRC-22 to CRC-24
Documentation improvement 12 Find documentation gaps and conflicts; communicate them to providers the right way CRC-18 to CRC-21
Purpose and use of risk adjustment models 10 Explain data mining and predictive modeling; apply hierarchies ("trumping") CRC-25 to CRC-27
Pathophysiology/medical terminology/anatomy 5 Read acronyms, terms and anatomy in a chart CRC-29 to CRC-30
Quality of care 3 Explain HEDIS and Star Ratings and how they line up with risk adjustment CRC-28
Cases 10 Read a medical record, code the supported diagnoses, and report the ones that risk adjust CRC-01, CRC-10 to CRC-12
Total 100

The 10 cases come at the end of the exam (AAPC).

Here's the part to plan for: diagnosis coding plus the cases is 40 questions. The other 60 are about models, compliance, documentation, quality, and pathophysiology/medical terminology/anatomy — knowledge that daily ICD-10-CM work doesn't automatically build.

If you've seen "150 questions" or "5 hours 40 minutes" elsewhere, that's an older AAPC format. AAPC's older proctor instructions list it (older AAPC instructions); its current pages say 100 questions in four hours (AAPC Help Center).

Pick your first review task

Already worked CRC-01? Use what happened to choose where to start.

Pick your first review task
What went wrong Start with What to produce
You picked a diagnosis the note didn't establish CRC-01, CRC-03, CRC-17 and the chart walkthrough For each condition, the exact words that support or rule it out
You knew the condition but not the code rule CRC-02 to CRC-09 The Index entry, the Tabular check, and the guideline section that decided it
Model questions felt like guesswork How a risk score is built, CRC-22 to CRC-27 One line per model: who it covers, prospective or concurrent, what goes in
Audit or quality questions blurred together CRC-13 to CRC-16, CRC-28 What the audit or measure checks, in one sentence

How to work a CRC coding question

When a CRC question gives you a medical record, keep these three decisions separate.

  1. What does the record support? Use the provider's diagnostic statement and ICD-10-CM's specific documentation rules. "Probable" and "rule out" don't count in outpatient records. A lab value or a drug on a med list isn't a diagnosis (FY 2026 guidelines, Sec. I.A.19, I.B.14 and IV.H).
  2. Which code describes it? Find the term in the Alphabetic Index, confirm it in the Tabular List, and follow every note (Sec. I.B.1).
  3. What does the model do with it? Only now ask whether it maps to a category, which hierarchy applies, and which model the question names.

A quick work line for your practice notes: setting → documented condition → controlling guideline → verified code → model, if asked.

You'll see "MEAT" — Monitored, Evaluated, Assessed/Addressed, Treated — all over risk adjustment training. AAPC teaches the mnemonic as a documentation reminder (AAPC Knowledge Center). Use it alongside the official coding guidelines, not as a substitute for them.

CRC practice questions

These 29 questions continue the set that started with CRC-01, for 30 in all. They include practice in every AAPC content area, with more questions on diagnosis coding and compliance.

Your score here is feedback on these 30 items only. It isn't a scaled score and it doesn't predict passing. With one to eight questions per area, a domain result points you to a topic to review, not a measurement of your ability.

The diagnosis-coding vignettes are fictional February 2026 outpatient encounters unless another date or setting is stated. They follow the FY 2026 ICD-10-CM guidelines and official FY 2026 Tabular List and Index. The compliance and model questions identify their own sources; their policy dates are separate from the fictional encounter dates.

Diagnosis coding

CRC-02 · Diagnosis coding

In the ICD-10-CM Alphabetic Index you find: Diabetes, type 2, with, chronic kidney disease, E11.22. What do you do next?

  • A. Report E11.22. The Index gives the full code.
  • B. Check whether E11.22 maps to a payment category before deciding
  • C. Report category E11, since the Index pointed there
  • D. Look up E11.22 in the Tabular List and follow its instructional notes
Show answerHide answer for CRC-02

Answer: D. The Index only points you to a code. You confirm it in the Tabular List, where the notes live. E11.22 carries a "use additional code" note for the CKD stage, and you'd miss it if you stopped at the Index.

  • Why not A: The Index doesn't always give the full code, and it never shows the Tabular notes.
  • Why not B: Payment impact plays no part in choosing a code.
  • Why not C: A category isn't a reportable code when the category is subdivided.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.B.1-I.B.2, p. 12; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: E11.22 and its additional-code instruction

CRC-03 · Diagnosis coding

Office visit. Assessment: "Chest pain, probable angina. Stress test ordered." Which code is reported for this visit?

  • A. I20.9 Angina pectoris, unspecified
  • B. R07.9 Chest pain, unspecified
  • C. I20.9 and R07.9
  • D. Z03.89 Encounter for observation for other suspected diseases and conditions ruled out
Show answerHide answer for CRC-03

Answer: B. In outpatient coding, "probable" diagnoses aren't coded. You code the documented sign or symptom (chest pain) to the highest degree of certainty for the visit.

  • Why not A: Codes an uncertain diagnosis as if it were confirmed.
  • Why not C: Still includes the uncertain angina.
  • Why not D: Z03.89 is for observation of a suspected condition that was ruled out in a person without relevant signs or symptoms. Here, the patient has chest pain and the workup is pending.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. IV.H, p. 114; Sec. I.B.18, p. 17; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: I20.9, R07.9, Z03 and Z03.89

CRC-04 · Diagnosis coding

Assessment: "Type 2 diabetes, A1c reviewed, continue metformin. CKD stage 3b, stable, recheck BMP in 3 months." The provider doesn't say whether the two are related. Which codes describe the diabetes and the CKD?

  • A. E11.9, N18.32
  • B. E11.22 only
  • C. E11.22, N18.32
  • D. E11.65, N18.32
Show answerHide answer for CRC-04

Answer: C. The Index lists chronic kidney disease under diabetes "with," so ICD-10-CM presumes the link unless the provider says they're unrelated. Use E11.22, then add the CKD stage as its note instructs.

  • Why not A: Ignores the presumed link between diabetes and CKD.
  • Why not B: Leaves out the stage code that E11.22 tells you to add.
  • Why not D: E11.65 means diabetes with hyperglycemia, which isn't documented here.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.A.15, p. 11; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Index: Diabetes, with, chronic kidney disease; Tabular: E11.22, N18.32, E11.65

CRC-05 · Diagnosis coding

"Diabetes mellitus without complications. Continues insulin glargine nightly." No type is documented anywhere in the record. Which codes are correct?

  • A. E10.9, Z79.4
  • B. E11.9 only
  • C. E11.9, Z79.4
  • D. E13.9, Z79.4
Show answerHide answer for CRC-05

Answer: C. When the type isn't documented, the default is type 2, and insulin use doesn't change that. Add Z79.4 for long-term (current) insulin use.

  • Why not A: Assumes type 1 just because the patient uses insulin.
  • Why not B: Leaves out the long-term insulin status code.
  • Why not D: "Other specified" diabetes isn't documented.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.C.4.a.2-I.C.4.a.3, p. 40; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: E10.9, E11.9, E13.9, Z79.4

CRC-06 · Diagnosis coding

"Type 2 diabetes, resolved after bariatric surgery last year. Off all diabetes medications." What should the coder do?

  • A. Assign E11.A, type 2 diabetes without complications in remission
  • B. Query the provider about whether the diabetes is in remission
  • C. Assign E11.9
  • D. Assign Z86.39, personal history of other endocrine disease
Show answerHide answer for CRC-06

Answer: B. E11.A needs the provider to document remission. The FY 2026 guidelines say "resolved" doesn't mean remission. When it's unclear, query the provider.

  • Why not A: Puts the coder's judgment in place of the provider's documentation.
  • Why not C: Ignores the documented change in the condition.
  • Why not D: Treats "resolved" as settled history instead of clarifying the ambiguous diabetes status.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.C.4.a.1(b), p. 40; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: E11.A and Z86.39

CRC-07 · Diagnosis coding

"Follow-up for previously treated right breast cancer. Mastectomy in 2021; chemotherapy and radiation completed in 2022. No evidence of disease. No further cancer-directed treatment." How is the cancer reported?

  • A. C50.911
  • B. C50.911 and Z90.11
  • C. Z80.3
  • D. Z85.3
Show answerHide answer for CRC-07

Answer: D. The cancer was removed and treated, treatment is finished, and there's no evidence of disease. That makes it personal history, so use Z85.3.

  • Why not A: Reports an active cancer that no longer exists.
  • Why not B: Still reports active cancer. Adding the acquired-absence code doesn't fix that.
  • Why not C: This is the code for a family history of breast cancer, not the patient's own history.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.C.2.m, p. 38; Sec. IV.J, p. 114; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: Z85.3, C50.911, Z90.11, Z80.3

CRC-08 · Diagnosis coding

"HIV positive, on antiretroviral therapy, viral load undetectable." No HIV-related illness or AIDS has ever been documented. Which code describes the HIV?

  • A. Z21
  • B. B20
  • C. R75
  • D. Z11.4
Show answerHide answer for CRC-08

Answer: A. When a patient is HIV positive and on antiretrovirals, but no HIV disease, HIV-related illness or AIDS is documented, assign Z21. You may add Z79.899 for the long-term drug therapy.

  • Why not B: B20 needs documented HIV disease, AIDS or an HIV-related illness.
  • Why not C: R75 is for inconclusive HIV test results.
  • Why not D: Z11.4 is for HIV screening.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.C.1.a.2(e), (g), (j), pp. 20-22; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: Z21, B20, R75, Z11.4, Z79.899

CRC-09 · Diagnosis coding

"Dementia due to Parkinson's disease, no behavioral disturbance, severity not specified." Which sequence is correct?

  • A. F02.80, then G20.A1
  • B. G20.A1, then F02.80
  • C. F03.90 only
  • D. G20.A1 only
Show answerHide answer for CRC-09

Answer: B. Under the etiology/manifestation convention, the underlying disease comes first, followed by the "in diseases classified elsewhere" manifestation code. The guidelines use dementia with Parkinson's disease as their example; the Index and Tabular List identify the specific codes.

  • Why not A: Reverses the order. A manifestation code can't be listed first.
  • Why not C: Ignores the documented cause of the dementia.
  • Why not D: Leaves out the dementia.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.A.13, pp. 10-11; Sec. I.C.5.d, p. 45; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Index: Dementia, with, Parkinson's disease; Tabular: G20.A1 and F02.80

Chart cases

CRC-01 at the top of this page is the first case.

CRC-10 · Cases

Office follow-up, 74-year-old. Assessment and plan: "1. Hypertension: BP 138/82 on lisinopril, continue. 2. CKD stage 3a: eGFR 52, stable, recheck in 6 months." Nothing in the note links the two. Which codes are reported (in any order)?

  • A. I10, N18.31
  • B. I12.9, N18.30
  • C. I12.9, N18.31
  • D. I13.10, N18.31
Show answerHide answer for CRC-10

Answer: C. ICD-10-CM presumes hypertension and CKD are related unless the provider documents that they are unrelated, so you use the hypertensive CKD combination code (I12.9 covers CKD stages 1-4 or unspecified CKD) plus the CKD stage. Stage 3a has its own code.

  • Why not A: Misses the presumed link between hypertension and CKD.
  • Why not B: Uses unspecified stage 3 even though stage 3a is documented.
  • Why not D: I13 requires heart disease, which isn't documented.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.C.9.a.2, pp. 50-51; Sec. I.C.14.a.1, p. 62; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: I12.9, N18.31, N18.30, I13.10

CRC-11 · Cases

"Left MCA ischemic stroke in 2024. Residual right-sided hemiparesis; patient is right-handed. Continues home exercise program." Which code reports the stroke-related condition at today's visit?

  • A. I69.351
  • B. I63.512
  • C. Z86.73
  • D. I69.354
Show answerHide answer for CRC-11

Answer: A. A deficit that remains after the acute stroke is a sequela, so it's coded to I69. The weakness is on the right side and the patient is right-handed, so it affects the dominant side.

  • Why not B: I63.512 is the acute infarction, which isn't the current problem.
  • Why not C: Z86.73 is history of stroke without residual deficits, but this patient has one.
  • Why not D: I69.354 is the left, nondominant side.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.C.9.d, p. 53; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: I69.351, I69.354, I63.512, Z86.73; National Library of Medicine, MeSH: Hemiplegia (D006429), Scope Note

CRC-12 · Cases

Office follow-up. "Type 2 diabetes with diabetic chronic kidney disease, now ESRD; hemodialysis Monday/Wednesday/Friday. Hypertension controlled. Right below-knee amputation in 2019 after trauma; uses a prosthesis, and gait/prosthesis needs are reviewed today." Which set is complete and correct (in any order)?

  • A. E11.22, I12.9, N18.6, Z99.2, Z89.511
  • B. E11.9, I10, N18.6, Z99.2, Z89.511
  • C. E11.22, I12.0, N18.6, Z89.511
  • D. E11.22, I12.0, N18.6, Z99.2, Z89.511
Show answerHide answer for CRC-12

Answer: D. The provider documents diabetic CKD. Hypertension with ESRD goes to I12.0. ESRD is reported as N18.6, with no additional N18 stage code. Dialysis dependence (Z99.2) and the acquired absence of the right leg below the knee (Z89.511) are status codes; N18.6 instructs you to add the dialysis status when applicable.

  • Why not A: I12.9 covers CKD stages 1-4 or unspecified CKD, not ESRD.
  • Why not B: Misses the documented diabetic CKD and the presumed hypertension-CKD relationship.
  • Why not C: Leaves out the dialysis status code.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.A.15, p. 11; I.C.9.a.2, pp. 50-51; I.C.14.a.1, p. 62; I.C.21.c.3, p. 93; IV.J, p. 114; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: E11.22, I12.0, I12.9, N18.6, Z99.2, Z89.511

Compliance

CRC-13 · Compliance

What is the main purpose of CMS's Risk Adjustment Data Validation (RADV) audits?

  • A. To score plans for Star Ratings
  • B. To recalibrate CMS-HCC model coefficients
  • C. To confirm that diagnoses Medicare Advantage organizations submitted for payment are supported by medical records
  • D. To audit physicians' E/M levels
Show answerHide answer for CRC-13

Answer: C. RADV checks that submitted diagnoses are supported by the enrollee's medical record. When a diagnosis isn't supported, CMS can recover the overpayment.

  • Why not A: Star Ratings are a separate quality program.
  • Why not B: RADV doesn't set model coefficients.
  • Why not D: E/M levels aren't what RADV reviews.

Source: CMS, Medicare Advantage RADV Program, About the program

CRC-14 · Compliance

A Medicare Advantage organization's internal retrospective review finds several submitted diagnoses with no medical record support. After applicable reconciliation, the organization identifies an overpayment within the six most recent completed payment years. CMS has not directed it to suspend reporting or data corrections for a RADV audit. What does federal regulation require?

  • A. Wait for the next RADV audit
  • B. Report and return the overpayment no later than 60 days after identifying it
  • C. Offset it by submitting other diagnoses found in the same records
  • D. Nothing, unless the amount passes a dollar threshold
Show answerHide answer for CRC-14

Answer: B. Under 42 CFR 422.326, an MA organization must report and return an identified overpayment within 60 days of identifying it, unless CMS directs otherwise for a RADV audit. The question rules out that exception.

  • Why not A: Waiting for the next audit delays an obligation that has already started.
  • Why not C: Submitting other diagnoses does not satisfy the duty to correct and return this identified overpayment.
  • Why not D: The 60-day rule doesn't depend on the overpayment's size.

Source: 42 CFR 422.326, reporting and returning overpayments, Sec. 422.326(a), (d), (f); CMS, Payment Year 2024 RADV Audit Methods and Instructions, Sec. 11, p. 17

CRC-15 · Compliance

In a CMS RADV medical record review, which record can't, on its own, support a risk-adjusting diagnosis?

  • A. A signed physician office note from a face-to-face visit
  • B. A hospital inpatient discharge summary signed by the attending physician
  • C. A signed hospital outpatient record of a face-to-face visit with an appropriately credentialed provider
  • D. A laboratory report with no supporting provider encounter note
Show answerHide answer for CRC-15

Answer: D. A lab-only record is not a valid RADV source. A valid medical record from an acceptable source must support the reported diagnosis.

  • Why not A: This is a standard acceptable source.
  • Why not B: A signed discharge summary is acceptable.
  • Why not C: A signed face-to-face hospital outpatient record is an acceptable source when the other record requirements are met.

Source: CMS, Payment Year 2024 RADV Audit Methods and Instructions, Sec. 6-6.1, pp. 6-7; Appendix A, INV5, p. 18

CRC-16 · Compliance

Under CMS's published payment-year 2024 RADV audit instructions, which physician office record has an authentication defect?

  • A. A note with no provider signature and no valid CMS-generated attestation
  • B. A note with a handwritten provider signature and credentials
  • C. A note electronically signed by the named, credentialed provider
  • D. An EHR entry authenticated and signed by the provider at the point of service
Show answerHide answer for CRC-16

Answer: A. A physician office record needs provider authentication. For this audit, CMS allows a valid CMS-generated attestation to address a missing signature or credentials in physician and hospital outpatient records; option A has neither.

  • Why not B: The provider has signed the note and supplied credentials.
  • Why not C: The provider has authenticated the electronic note.
  • Why not D: The provider has authenticated and signed the encounter entry.

Source: CMS, Payment Year 2024 RADV Audit Methods and Instructions, Sec. 6, p. 6, footnote 15; Sec. 6.4, pp. 9-10

CRC-17 · Compliance

The medication list shows levothyroxine. Nowhere in the signed provider documentation is hypothyroidism or any thyroid condition diagnosed. Can the coder report hypothyroidism?

  • A. Yes. Levothyroxine treats hypothyroidism.
  • B. Yes, if the plan's software flagged it as a suspected condition.
  • C. No. A medication alone doesn't establish a diagnosis; the provider has to document the condition.
  • D. Yes, as long as the medication is still active on the list.
Show answerHide answer for CRC-17

Answer: C. Code assignment rests on the provider's statement that a condition exists. A drug on a list isn't that statement. If the condition might be present, the compliant route is a query, not a code.

  • Why not A: Infers a diagnosis from a drug.
  • Why not B: An automated suggestion isn't provider documentation.
  • Why not D: An active medication still isn't a diagnosis.

Source: ICD-10-CM Official Guidelines, FY 2026, Introduction, p. 1; Sec. I.A.19, p. 12

Documentation improvement

CRC-18 · Documentation improvement

Which provider query is compliant?

  • A. "Adding heart failure would raise this patient's HCC score. Please document it."
  • B. "Your 9/13/2026 assessment documents heart failure without a type. Clinical indicators: EF 30% on the 9/12/2026 echocardiogram; furosemide and carvedilol in the 9/13/2026 medication list; 2+ leg edema in the 9/13/2026 examination. Based on your clinical judgment, please clarify the type of heart failure for this encounter, or state if you cannot determine it."
  • C. "Does the patient have CHRONIC SYSTOLIC HEART FAILURE? Yes / No" (sent when heart failure isn't documented anywhere)
  • D. "Please add CHF to the problem list."
Show answerHide answer for CRC-18

Answer: B. A compliant query gives patient-specific clinical indicators and identifies where they appear in the record. This open-ended query asks the provider to clarify an already-documented condition without supplying an unsupported subtype or a preferred answer.

  • Why not A: Mentions HCC impact. Queries must never include payment information.
  • Why not C: Uses a yes/no format and emphasis to get a new diagnosis. That's leading.
  • Why not D: Tells the provider what to document.

Source: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice (2026 Update), Sec. V.I.A-C, pp. 7-8; Sec. V.II.B-C, pp. 12-14

CRC-19 · Documentation improvement

A dietitian documents BMI 41. The provider's note doesn't mention weight or obesity. Can the coder report morbid obesity?

  • A. Yes. A BMI of 40 or higher defines morbid obesity.
  • B. Yes, if the dietitian is credentialed.
  • C. Yes, because codes are assigned from clinical criteria.
  • D. No. The BMI can come from another clinician, but the obesity diagnosis has to be documented by the patient's provider.
Show answerHide answer for CRC-19

Answer: D. BMI is one of the few items a non-provider clinician can document for coding. The diagnosis it relates to isn't, so it has to come from the provider. The BMI code also needs an associated reportable diagnosis documented by the provider. Query if it's clinically appropriate.

  • Why not A: Diagnoses from a number instead of the provider's statement.
  • Why not B: Credentials don't let a dietitian establish the diagnosis.
  • Why not C: Codes are assigned from the provider's diagnostic statement, not from clinical criteria.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.B.14, pp. 15-16; I.A.19, p. 12; I.C.21.c.3, p. 95

CRC-20 · Documentation improvement

A lab report in the chart shows A1c 9.2%. The provider's face-to-face note from that visit doesn't mention glucose or diabetes. What should the coder do?

  • A. Don't assign diabetes from the lab report. The provider has to document the condition in the encounter (query per your organization's policy).
  • B. Assign E11.65
  • C. Assign R73.09, other abnormal glucose
  • D. Assign Z13.1, encounter for diabetes screening
Show answerHide answer for CRC-20

Answer: A. A lab value isn't a provider diagnosis. The record gives no provider-documented diabetes or interpretation that supports another diagnosis code. Query per your organization's policy rather than assigning a diagnosis from the number.

  • Why not B: Diagnoses diabetes from a lab number.
  • Why not C: Still codes from the lab report alone.
  • Why not D: No screening encounter is documented.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.A.19, p. 12; Sec. IV.K, p. 114; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: E11.65, R73.09, Z13.1

CRC-21 · Documentation improvement

In the same visit note, the assessment says "CKD stage 3b" and the problem list says "CKD stage 4." Neither entry is clarified. What should the coder do?

  • A. Report stage 4, the more severe stage
  • B. Report whichever stage appears first
  • C. Query the provider to clarify the stage
  • D. Report N18.9, unspecified CKD
Show answerHide answer for CRC-21

Answer: C. When the record conflicts, the guidelines tell you to query the provider. Don't pick a stage based on severity or payment.

  • Why not A: Picks a stage based on severity.
  • Why not B: Picks a stage based on where it appears in the note.
  • Why not D: The record isn't missing detail; it contradicts itself, so you query instead of falling back to unspecified.

Source: ICD-10-CM Official Guidelines, FY 2026, Sec. I.A.19, p. 12; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular: N18.9

Risk adjustment models

CRC-22 · Risk adjustment models

For a continuing enrollee whose CMS-HCC score uses diagnosis data, the raw model score is built from:

  • A. The number of diagnosis codes submitted
  • B. Demographic and disease (HCC) factors, plus applicable interaction and payment-condition count factors
  • C. CPT procedure volume
  • D. The plan's Star Rating
Show answerHide answer for CRC-22

Answer: B. The model is additive. It sums demographic and disease factors, plus interaction and payment-condition count factors when they apply. New-enrollee models use a different, demographic-based calculation.

  • Why not A: More diagnosis codes do not automatically raise the score. The relevant inputs are model categories and applicable factors, not the number of submitted codes.
  • Why not C: Procedure volume isn't a model input.
  • Why not D: Star Ratings measure quality and aren't a model input.

Source: CMS, Report to Congress: Risk Adjustment in Medicare Advantage (December 2024), Sec. 2.4.2-2.5, pp. 22-28; Sec. 2.6.2, pp. 32-33

CRC-23 · Risk adjustment models

Which statement about the HHS-HCC model used for ACA risk adjustment in non-grandfathered individual and small-group plans is correct?

  • A. It's concurrent: diagnoses from a benefit year predict costs for that same year
  • B. It's prospective, like CMS-HCC
  • C. It's the standard model for Medicaid managed care
  • D. It uses only age and sex
Show answerHide answer for CRC-23

Answer: A. CMS's documentation of the model describes HHS-HCC as concurrent. CMS-HCC, by contrast, is prospective.

  • Why not B: That describes CMS-HCC.
  • Why not C: That's closer to CDPS.
  • Why not D: HHS-HCC is built on diagnoses, not just demographics.

Source: Kautter et al., The HHS-HCC Risk Adjustment Model (CMS MMRR, 2014), pp. E3-E4; CMS, 2025 Benefit Year HHS Risk Adjustment DIY Instructions, pp. 1-2

CRC-24 · Risk adjustment models

A Medicaid managed care program adjusts plan payments with a diagnosis-based model developed at UC San Diego, sometimes combined with a pharmacy model. Which model is it?

  • A. CMS-HCC
  • B. HHS-HCC
  • C. HEDIS
  • D. CDPS (CDPS+Rx when combined with the pharmacy model)
Show answerHide answer for CRC-24

Answer: D. CDPS is a diagnosis-based model widely used to adjust capitated payments to plans that enroll Medicaid beneficiaries. CDPS+Rx adds pharmacy data.

  • Why not A: CMS-HCC is the Medicare Advantage model.
  • Why not B: HHS-HCC is the ACA model.
  • Why not C: HEDIS is a set of quality measures, not a payment model.

Source: UC San Diego, Chronic Illness and Disability Payment System, Overview

Purpose and use of risk adjustment models

CRC-25 · Purpose and use of risk adjustment models

For a continuing enrollee whose CMS-HCC score uses prior-year diagnoses, why must a supported risk-adjusting chronic condition be captured in the applicable data-collection year to contribute to the next payment year's score?

  • A. ICD-10-CM codes expire every year.
  • B. RADV requires a new diagnosis every year.
  • C. CMS-HCC is prospective. The data-collection year's eligible diagnoses contribute to the following payment year's risk score; diagnoses do not automatically carry forward from earlier years.
  • D. Star Ratings require it.
Show answerHide answer for CRC-25

Answer: C. CMS uses a base year's diagnoses to predict the following year's costs. That does not make an old problem-list entry automatically reportable: the actual encounter must support the diagnosis under the applicable coding guidelines.

  • Why not A: Codes are updated, but they don't expire each year.
  • Why not B: Misstates what RADV does.
  • Why not D: Star Ratings measure quality and don't drive risk scores.

Source: CMS, Report to Congress: Risk Adjustment in Medicare Advantage (December 2024), Sec. 2.6.2, pp. 32-33; Sec. 4.1.1, p. 67; ICD-10-CM Official Guidelines, FY 2026, Sec. IV.I-IV.J, p. 114

CRC-26 · Purpose and use of risk adjustment models

In one data-collection year, a member has documented diabetes with a chronic complication at one visit and diabetes without complications at another. In the model specified for this question, the chronic-complication category ranks above the uncomplicated category in the same hierarchy. How do they count?

  • A. Both diabetes categories add to the score
  • B. Only the diagnosis from the most recent visit counts
  • C. Neither counts without an inpatient stay
  • D. Only the higher-ranked, more severe diabetes category counts
Show answerHide answer for CRC-26

Answer: D. This hierarchy keeps the higher-ranked category and removes the lower-ranked category from the score. Supported diagnoses are still coded for their encounters under the coding guidelines; the model applies its hierarchy after that.

  • Why not A: Counts the same disease twice.
  • Why not B: Visit order doesn't matter.
  • Why not C: No inpatient stay is required.

Source: CMS, Report to Congress: Risk Adjustment in Medicare Advantage (December 2024), Sec. 2.4.2, pp. 22-23; ICD-10-CM Official Guidelines, FY 2026, Sec. IV.I-IV.J, p. 114

CRC-27 · Purpose and use of risk adjustment models

A plan uses its members' coded chronic conditions to predict who will likely need high-cost care next year, then enrolls those members in care management. What is this an example of?

  • A. A RADV audit
  • B. Predictive modeling
  • C. A HEDIS hybrid review
  • D. Retrospective coding
Show answerHide answer for CRC-27

Answer: B. Using captured diagnoses to forecast future cost and need is predictive modeling, and forecasting is what these models are built to do.

  • Why not A: RADV checks that diagnoses are supported.
  • Why not C: HEDIS reviews measure quality of care.
  • Why not D: Retrospective coding is a coding workflow, not a forecast.

Source: CMS, Report to Congress: Risk Adjustment in Medicare Advantage (December 2024), Sec. 2.1, pp. 11-12; Kautter et al., The HHS-HCC Risk Adjustment Model (CMS MMRR, 2014), p. E3

Quality and terminology

CRC-28 · Quality of care

Which statement is correct?

  • A. HEDIS is NCQA's set of performance measures, and several HEDIS measures feed CMS Star Ratings for Medicare Advantage plans.
  • B. HEDIS calculates a member's risk score.
  • C. Star Ratings rate only Medicaid plans.
  • D. HEDIS and HHS-HCC are the same program.
Show answerHide answer for CRC-28

Answer: A. NCQA owns HEDIS. CMS Star Ratings cover Medicare Advantage (Part C) and Part D plans, and they use HEDIS measures.

  • Why not B: Mixes up quality measurement with risk adjustment.
  • Why not C: Stars rate Medicare plans.
  • Why not D: HEDIS measures quality; HHS-HCC is a payment model.

Source: NCQA, Health Plan Ratings vs. CMS Stars FAQ (2026), pp. 1-3; Table 2

CRC-29 · Pathophysiology/medical terminology/anatomy

A chart says "right hemiparesis." What does that mean?

  • A. Paralysis of the right side
  • B. Loss of sensation on the right side
  • C. Weakness of the right side
  • D. Seizures on the right side
Show answerHide answer for CRC-29

Answer: C. Hemiparesis means weakness on one side of the body. Hemiplegia means paralysis on one side. ICD-10-CM groups them in the same codes, but you still need to read the chart correctly.

  • Why not A: That's hemiplegia.
  • Why not B: Loss of sensation is a different finding.
  • Why not D: Seizures are a different finding.

Source: National Library of Medicine, MeSH: Hemiplegia (D006429), Scope Note; CMS/NCHS, FY 2026 ICD-10-CM Tabular List and Alphabetic Index (ZIP), Tabular headings: G81 and I69.35

CRC-30 · Pathophysiology/medical terminology/anatomy

What does an A1C (HbA1c) result reflect?

  • A. Blood sugar at the moment of the blood draw
  • B. Average blood sugar over roughly the past three months
  • C. Kidney filtration rate
  • D. Thyroid hormone level
Show answerHide answer for CRC-30

Answer: B. A1C reflects average blood glucose over about the previous three months. A result like this still doesn't become a coded diagnosis without provider documentation (see CRC-20).

  • Why not A: That describes a single glucose reading.
  • Why not C: That's eGFR.
  • Why not D: A1C is not a thyroid hormone measurement.

Source: NIDDK, The A1C Test & Diabetes, What is the A1C test?; ICD-10-CM Official Guidelines, FY 2026, Sec. I.A.19, p. 12

Worked example: reading a chart note

Here's a fictional office note from February 2026, then how we'd read it.

Assessment and plan

  1. Type 2 diabetes with diabetic CKD stage 4. A1c 7.8, eGFR 24. Continue insulin glargine; nephrology follow-up next month.
  2. Heart failure. Euvolemic today on furosemide; continue.
  3. History of colon cancer, resected 2019, completed chemotherapy 2020, surveillance colonoscopy normal; surveillance plan reviewed today.
  4. Possible early dementia. Memory testing ordered.
  5. Left below-knee amputation (2017); prosthesis and gait needs reviewed today.
  6. BMI 36 (per dietitian note).
Worked example: reading a chart note
Line Read it as Why
1 Report: diabetes with diabetic CKD, the CKD stage, and long-term insulin use Documented, assessed and treated. The diabetes-CKD link is documented, and long-term insulin use gets a status code (Sec. I.A.15, I.C.4.a.3)
2 Report: heart failure Documented and managed. The type isn't stated, so the unspecified code applies, or a query if your process allows (Sec. I.B.18)
3 Report as history, not active cancer Resected, treatment finished, no evidence of disease (Sec. I.C.2.m)
4 Don't code dementia "Possible" in an outpatient note isn't coded. Code any documented symptom instead (Sec. IV.H)
5 Report the status code for acquired absence of the left leg below the knee A status code tells the reader about an ongoing condition (Sec. I.C.21.c.3)
6 Don't report obesity or a BMI code from the BMI alone The BMI can come from the dietitian, but a BMI code needs an associated reportable diagnosis documented by the provider (Sec. I.B.14 and I.C.21.c.3)

Two more things to notice. The note never mentions hypertension, so you don't report it even if a med list shows lisinopril. And you'd confirm every code in the Tabular List before answering — the walkthrough names the decisions, not a code list to memorize.

Worked example: how a risk score is built

The numbers below are made up to show the arithmetic. They aren't CMS coefficients. This simplified continuing-enrollee example adds demographic factors, disease factors, and an illustrative interaction. It assumes the two diabetes categories share the stated hierarchy and no payment-condition count factor applies. Actual CMS-HCC models include applicable interaction and payment-condition count factors (CMS report to Congress, Sec. 2.4.2-2.5). Within the hierarchy shown here, the higher-ranked category suppresses the lower-ranked category.

Worked example: how a risk score is built
Input Illustrative factor Counts?
Demographic factor (age, sex, other demographic variables) 0.400 Yes
Diabetes with chronic complications 0.200 Yes
Diabetes without complications (same disease group, lower rank) 0.150 No — dropped by the hierarchy
Heart failure 0.300 Yes
Diabetes + heart failure interaction (illustrative) 0.100 Yes
Illustrative raw factor total 1.000 0.400 + 0.200 + 0.300 + 0.100

Adding every row would give 1.150. That's the "double counting" mistake that hierarchy questions test. This is a simplified raw factor total, before payment-year normalization or other applicable adjustments; it is not a real member's score or a payment amount (CMS report, Table 2-3; CMS 2026 Rate Announcement, pp. 4-5). Real coefficients and category lists come from CMS's annual model files and change between model versions. This practice set focuses on the logic, so the questions on this page don't ask you to memorize category numbers.

The models side by side

The models side by side
Model Who it covers Timing / inputs Source
CMS-HCC Medicare Advantage (Part C) Prospective for diagnosis-based continuing-enrollee scores: one year's diagnoses predict the next year's costs CMS report, Sec. 2.6.2
HHS-HCC Non-grandfathered individual and small-group plans covered by ACA risk adjustment Concurrent: a benefit year's diagnoses predict that same year's costs CMS MMRR 2014, pp. E3-E4; 2025 benefit-year instructions, pp. 1-2
CDPS (CDPS+Rx) Plans enrolling Medicaid beneficiaries Diagnosis-based; CDPS+Rx adds pharmacy data UC San Diego
Private payer models Whatever the question defines Read the population, inputs and rules the question gives you —

Watch the vocabulary. Prospective and concurrent describe a model's timing. When a question discusses an audit or chart review, use the timing given in that scenario. Do not substitute the model's prediction year for the review's timing.

Your six-week CRC study plan

Assumptions: 24 sessions of about 60 minutes, four a week, for someone who already codes ICD-10-CM — about 24 hours in all. AAPC calls the CRC a high-level exam and highly recommends two years of experience in the field; that experience is recommended, not an eligibility requirement (AAPC prerequisites). If diagnosis coding is new to you, build that first and stretch this plan out.

Each session: about 10 minutes recalling the last session from memory, 20 minutes learning (the page section and the guideline in your own code book), 20 minutes of practice, and 10 minutes logging misses.

Your six-week CRC study plan
Week Session Focus Do this
1 1 Orientation Work CRC-01 cold. Read the content map. Start your miss log.
1 2 Index and Tabular Work CRC-02. In your own book, find guideline Sections I.A, I.B and IV, and tab them.
1 3 What's codable in outpatient records Work CRC-03 and CRC-17. Write the IV.H rule in your own words.
1 4 Diabetes Work CRC-04 to CRC-06. Read the diabetes guidelines, Sec. I.C.4.a.
2 5 Cancer, HIV, manifestations Work CRC-07 to CRC-09.
2 6 Hypertension and CKD Work CRC-10. Read Sec. I.C.9.a and I.C.14.a in your book.
2 7 Stroke sequelae and status codes Work CRC-11 and CRC-12. Read Sec. I.C.9.d and the status-code section.
2 8 Retrieval review Redo CRC-01 to CRC-12 without looking at answers. Tab your book using the condition map below.
3 9 Risk score structure Rework the risk score example on paper. Work CRC-22.
3 10 Model types Rebuild the model table from memory. Work CRC-23 and CRC-24.
3 11 Purpose and hierarchies Work CRC-25 to CRC-27.
3 12 Reading a chart Cover the right column of the chart walkthrough and redo it.
4 13 RADV and overpayments Work CRC-13 and CRC-14.
4 14 Record standards Work CRC-15 and CRC-16.
4 15 Documentation gaps Work CRC-19 and CRC-20.
4 16 Queries and conflicts Work CRC-18 and CRC-21. Write your own compliant query for line 2 of the chart walkthrough.
5 17 Quality and terminology Work CRC-28 to CRC-30. Build a 10-term glossary from chart abbreviations you meet.
5 18 AAPC's named conditions, part 1 Use the condition map below. For the first half of the list, find the codes in your book and note the documentation each one needs.
5 19 AAPC's named conditions, part 2 The second half of the list.
5 20 Mixed retrieval All 30 questions in 45 minutes, without answers. Spend 15 minutes on the misses.
6 21 Repair Redo every entry in your miss log. Explain each answer out loud, with its guideline section.
6 22-23 Timed rehearsal Do two 60-minute mixed blocks at about 2.4 minutes per question. You can reuse this set for retrieval practice. If you already have a full-length practice exam, you can replace these two sessions with one four-hour block using your exam code book; that option adds two hours, for about 26 hours total.
6 24 Exam-day check Confirm your book year and format and your ID (see below). Light review only.

This is an editorial plan, not an AAPC requirement, and it doesn't guarantee a result. Your miss log should decide where your extra time goes.

Adjust the plan

  • Recent CPC, coding diagnoses daily: compress Weeks 1-2 into one week. Keep every model, compliance, documentation and quality session.
  • Less than a year of diagnosis coding: spread the same 24 sessions over 10-12 weeks and repeat sessions 2-8.
  • Retaking the exam: start with the areas your score report flagged (AAPC exam results). Check the voucher and retake rules (AAPC retake policy). Don't try to reconstruct remembered exam questions; AAPC prohibits recording or reconstructing exam content.
  • Only two sessions a week: the same plan takes 12 weeks. Keep the order.

Keep a miss log

Keep a miss log
Item My answer Correct Why I missed it Rule to reread Next task
CRC-01 B A Treated "possible hypothyroidism" as confirmed FY 2026 guidelines, Sec. IV.H Re-explain the outpatient uncertain-diagnosis rule before session 3

Useful labels for "why": record reading, coding rule, model, version or year, terminology, timing. Two or three misses with the same label tell you what to study next.

Set up your code book and your time

Which book year

AAPC builds its exams on the current calendar year's code sets and updates them every January. For printed references, you can use the current year's or the previous year's books. Books more than a year old, and books for an upcoming year, aren't allowed (AAPC, which year's books). AAPC also pauses exams each year from December 30 while it puts the updates in place. Testing resumes on the second Monday of January (AAPC blackout period).

Which book year
Your exam date Book that matches the exam Also allowed Not allowed
Remaining 2026 test dates 2026 ICD-10-CM 2025 2027
2027 (after the January update) 2027 ICD-10-CM 2026 2028

That catch matters this fall: a 2027 ICD-10-CM book isn't allowed for an exam you sit in 2026. If you retake in the next calendar year, you take that year's exam (AAPC, which year's books).

The clinical coding calendar is different. FY 2027 ICD-10-CM guidelines apply to encounters from October 1, 2026, through September 30, 2027. That does not change AAPC's 2026 exam-book rule. This page's February 2026 coding vignettes use the FY 2026 guidelines.

  • The only reference allowed is one ICD-10-CM code book, from any publisher. No other code books or references (AAPC Help Center).
  • You can choose print or eBook and switch formats until 48 hours before the exam (AAPC eBooks). The current-year exam eBook comes from a shared library: your personal notes and highlights are not available, though search is (AAPC shared eBooks).
  • AAPC allows brief print-book notes related to daily coding, highlighting, and tabs that only label a page. It prohibits long passages of added information, altered pages used to add information, and written practice or exam questions (AAPC book rules). Check the current examinee instructions before exam day.

Where AAPC's named diagnosis-coding conditions live

Tab these. AAPC lists the conditions (AAPC); the locations below are starting points in the official FY 2026 classification, not an exhaustive list of codes. Confirm each in your own book's Index and Tabular List.

Where AAPC's named diagnosis-coding conditions live
Condition (AAPC's list) Where to look in ICD-10-CM
Diabetes and its manifestations E08-E13
Hypertension, hypertensive heart and kidney disease I10-I1A
CHF I50 (plus I11/I13 when the hypertension relationship applies)
CKD N18
CVA/stroke and its sequelae I60-I63 (acute, by type), I69 (sequelae); Z86.73 for history of TIA/cerebral infarction or stroke NOS without residual deficits
Atherosclerosis I70; coronary I25.1-; cerebral I67.2
DVT / pulmonary embolism I82 / I26
COPD / pneumonia / pulmonary fibrosis J44 / J12-J18 / J84.1-
Dementia / depression / other mental disorders F01-F03 / F32-F33 / Chapter 5 (F01-F99)
Seizures G40 (epilepsy), R56 (convulsions)
Malnutrition E40-E46
Neoplasms Neoplasm Table, then C00-D49
Pressure ulcers / other skin ulcers L89 / L97, L98.4-
Amputations / artificial openings Z89 / Z93 (status)
Complications of devices T82-T85
AV fistulas Start at "Fistula, arteriovenous" in the Index and follow it to the right chapter

Pacing four hours

Four hours for 100 questions averages 2.4 minutes each (240 ÷ 100). The 10 cases come last, so leave time to read the longer records. A workable target is questions 1-90 in about three hours, which leaves about an hour for the cases. If a question passes three minutes, mark your best guess, flag it, and move on. Those targets are our suggestion, not an AAPC rule.

CRC exam facts

U.S. candidate information, checked against AAPC's published sources on October 21, 2026.

CRC exam facts
Item Current rule Source
Credential AAPC Certified Risk Adjustment Coder (CRC) AAPC
Questions 100 multiple choice, including 10 cases at the end AAPC
Time 4 hours, one sitting AAPC Help Center
Passing 70% overall: at least 70 correct (more than 30 wrong fails) AAPC
Where Online with a live remote proctor, or at a testing center AAPC Help Center
Allowed book One ICD-10-CM code book; nothing else AAPC Help Center
Fee $425 for one attempt, or $499 for two (AAPC-listed student pricing $400 / $475); membership is separate AAPC exam cost
To register Current AAPC membership, an unused exam voucher, and a government photo ID whose first and last names exactly match your exam confirmation AAPC prerequisites
Prerequisite credential None. CRC is a stand-alone certification; you don't need the CPC first AAPC prerequisites
Keeping it Annual AAPC membership; 36 CEUs per standard two-year cycle if CRC is your only credential. Your CEU Tracker gives your actual total and deadline, including multiple credentials or a prorated first cycle AAPC CEU policy

For the process steps, see our guides to AAPC exam registration, AAPC exam results, the AAPC retake policy, and AAPC certification renewal.

Common questions

Is the CRC harder than the CPC?

AAPC's published outlines do not provide a difficulty ranking. Here's how they differ. The CRC covers ICD-10-CM diagnosis coding plus risk adjustment models, compliance, documentation, quality and medical terminology. The CPC adds procedure and supply coding with CPT and HCPCS (CRC outline; CPC outline). If diagnosis coding is already familiar, use the model, compliance, documentation and quality questions here to choose your next review task. For the CPC itself, see our CPC exam prep guide.

Do I need to memorize HCC numbers?

Nothing in AAPC's outline asks you to recite category numbers. It asks you to apply models, hierarchies and the elements of a risk score (AAPC). Category numbers and weights also change between model versions, which is why the questions here teach the logic instead.

Does AAPC publish a CRC pass rate?

AAPC's CRC Help Center states that 80% of AAPC students pass on their first attempt. That describes AAPC's own trainees, not everyone who sits the exam. The article does not give a reporting period, cohort size or a CRC-only cohort definition, so it does not establish an overall CRC pass rate (AAPC Help Center).

What if I don't pass?

AAPC's two-attempt purchase includes a second try (AAPC exam cost). Start with the weak areas on your score report, then follow the AAPC retake policy.

Sources

Last verified: October 21, 2026. We checked AAPC's published CRC format, content breakdown, fees, registration requirements and book rules, and the coding, CMS and model sources linked above.

By the Castleport Test Prep Editorial Team.

AI tools assisted drafting and source checking. See our editorial standards.

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by AAPC. CRC and other exam and credential names are used only to identify their subjects; trademarks belong to their owners. The practice questions on this page are original and are not AAPC exam questions. Nothing here guarantees passing, certification or employment.

AAPC CRC Exam Prep: Free Study Guide + 30 Practice Questions