2023 Clinical Applications of Key HCCs in Primary Care – Post Test

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Question 1 of 10

1. Question
1. Select each that is TRUE?
- a. The albumin(mg/L) to creatinine (mg/L) ratio persistently above 30 indicates diabetic nephropathy even though the eGFR is normal
- b. A diabetic patient with hyperlipidemia is assumed to have a “specified chronic complication” unless specifically noted to the contrary by the primary care provider
- c. A patient with occasional leg pain/cramps, reduced hair growth from the mid-shins down, and discolored/hypertrophic nails may need further work-up because of underlying peripheral angiopathy, a diabetic complication.
- d. The HCC score for uncomplicated diabetes is the same as diabetes with nephropathy
Question 2 of 10

2. Question
2. A 65-year-old female developed a nodule on the left thyroid gland that was removed surgically after FNA showed malignancy. It was completely excised and lymph nodes were removed and all negative. She was released from ENT back to her PCP for long term management. This occurred last year and as her PCP, you are seeing her for the first time this year. You diagnose her with a “History of Papillary Thyroid Cancer”. She is stable on Levothyroxine. Which of the following is correct?
- a. This should not be listed “history of” because it has not been five years post thyroidectomy
- b. This should not be listed “history of” because the patient is actively being managed with levothyroxine
- c. “History of” is correct and the cancer HCC score still is applied at 100%
- d. “History of” is correct and the HCC score for this condition will be 0.
Question 3 of 10

3. Question
3. CMS uses risk adjustment when calculating the relative performance of a Medicare-enrolled provider on such metrics as (select ALL that are correct):
- a. Per capita costs for Medicare patients attributed to the provider
- b. Per capita costs for Medicare patients with specific conditions (DM, COPD, etc.)
- c. All-cause hospital readmissions of a provider’s Medicare patients
- d. Ancillary Service Use (ASU) per capita (DME, labs, xrays) per Medicare patient
Question 4 of 10

4. Question
4. A right-handed patient presents to your office for a routine follow-up of his hypertension, diabetes, and hyperlipidemia. He had a CVA four years ago with residual paresis in his left hand and left upper extremity. Physical therapy has completed their work. With respect to the stroke condition, the best way to capture that diagnosis is to use a code for
- a. History of CVA
- b. History of CVA with left arm weakness
- c. Residual left non-dominant arm weakness due to past CVA
- d. Acute CVA
Question 5 of 10

5. Question
5. Chronic kidney disease can be found in certain conditions like diabetes and hypertension. When eGFR is below 60 cc/min/1.73m², the patient can be diagnosed with Stage I-V chronic kidney disease
- a. After a first-of-day urine specimen confirmation of microalbumin of >13
- b. After 2 eGFRs show < 60 cc/min/1.73m2 for > 3 months
- c. Once the creatinine is above 1.05 on any one lab test
- d. After the initial eGFR is below 60 cc/min/1.73m2 in the context of hypertension or diabetes
Question 6 of 10

6. Question
6. A type II diabetic of 11 years is well controlled with an A1c today of 6.2, eGFR of 66, urine albumin to creatinine of 12, and a blood pressure (on ACE-I) chronically 120s/70s. He is on a statin and the last LDL was 92. He has noted his blood sugars over the past two months to be running 120-140s and this week he had one glucose fasting of 151. He has been totally asymptomatic with all of this but is concerned. He sees you today for follow-up. He was previously diagnosed with diabetes without complications, what should you do with his diabetic diagnosis now?
- a. Given the fact that he has had documented hyperglycemia, he now can be coded as having an “acute” complication which has added clinical weight
- b. His current diabetic diagnosis is still correct, this hyperglycemia manifestation is not considered a complication
- c. Given his eGFR and LDL, the diabetic diagnosis “without complications” is incorrect and should be changed
- d. The diabetic diagnosis should reflect the “statin failure” code given the LDL
Question 7 of 10

7. Question
7. A type II diabetic of 11 years is well controlled with an A1c today of 6.2, eGFR of 66, urine albumin to creatinine of 12, and a blood pressure (on ACE-I) chronically 120s/70s. He is on a statin and the last LDL was 92. Two weeks ago, he suffered a NSTEMI, had a heart catheterization, and had one stent placed. He sees you today for follow-up. He was previously diagnosed with diabetes without complications, what should you do with his diabetic diagnosis now?
- a. His current diabetic diagnosis is still correct
- b. Recheck an A1c and microalbumin to make sure his diabetes is still stable without complications
- c. His diabetes diagnosis should now reflect diabetic cardiomyopathy due to the coronary artery disease unless you clinically feel the two are unrelated
- d. The diabetic diagnosis should reflect the “statin failure” code given the LDL and NSTEMI
Question 8 of 10

8. Question
8. Correct documentation and coding of obesity requires
- a. Needing the ICD-10 diagnosis (like “Morbid Obesity”) and the ICD-10 diagnosis associated with the BMI # captured on the claim (in the assessment/plan)
- b. Needing either the ICD-10 diagnosis (like “Morbid Obesity”) or the ICD-10 diagnosis associated with the BMI # captured on the claim (in the assessment/plan)
- c. Needing the ICD-10 diagnosis (like “Morbid Obesity”) and the ICD-10 diagnosis associated with the BMI # and the Social Determinants of Health code to qualify for HCC capture
- d. Documentation of all comorbid conditions and notation of failed conservative therapy (dietary counseling) in the note to qualify for HCC capture
Question 9 of 10

9. Question
9. Regarding stroke/neurologic syndrome condition capture, select the correct statements:
- a. We should classify strokes outside of the 30-day window as “history of” only, regardless of sequela.
- b. Residual effects of strokes should be our focus with attention to monoplegia (one extremity) hemiplegia (one side) or hemiparesis (weakness)
- c. Dysphagia (I69.321) or mentation issues (I69.31x) need to be captured because they add clinical weight and HCC risk to the condition severity.
- d. Documentation of the affected side (L/R), location (upper/lower) and dominance is important
Question 10 of 10

10. Question
10. Which of the following clinical conditions of chronic kidney disease is weighed with an HCC score, thus showing added clinical significance? (select ALL that are correct)
- a. Stage II eGFR 60-89ml/min
- b. Stage III eGFR 30-59 ml/min
- c. Stage IV eGFR 15-29 ml/min
- d. Stage V eGFR < 15 ml/min

2023 Clinical Applications of Key HCCs in Primary Care – Post Test

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