2024 Clinical Applications of Key HCCs in Primary Care (21) – Post Test – Cyatl Courses

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Question 1 of 10

1. Question
1. Select each that is TRUE?
- a. The albumin to creatinine ratio persistently (90d or more) above 30mg/g on two lab assessments indicates nephropathy even though the eGFR may be normal
- b. Diabetes is an obesity-related chronic condition and having this with a BMI of 35-39 is indicative of “morbid obesity”
- c. In 2024 risk-adjustment with CMS-HCC, having a thoracic abdominal aortic aneurysm of 5.6 cm that is not leaking or dissected, is still risk adjusted
- d. For 2024, the HCC score for uncomplicated diabetes is the same as diabetes with nephropathy
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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 you are seeing her for the first time this year and you diagnose her with a “History of Papillary Thyroid Cancer”. She is stable on thyroxine. 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 thyroxine
- 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
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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:
- 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
- d. All of the above
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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. Code the HTN , DM, hyperlipidemia, and history of CVA
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Question 5 of 10

5. Question
5. Constraining in Version 28 of the CMS-HCC risk calculation means
- a. The number of diagnoses in a hierarchy are “constrained” into one condition for ease in HCC calculation
- b. The clinical weight (HCC value) of a hierarchy has had several disease groups “constrained” to be equal to each other
- c. CMS has limited this HCC risk adjustment score to 33% as part of the three year glidepath to Version 28 HCC
- d. The number of clinical conditions that apply to a hierarchy are limited because there was no downstream clinical value in those “constrained”
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Question 6 of 10

6. Question
6. A type II diabetic of 11 years has developed atrial fibrillation. His initial diagnosis from the ED was “paroxysmal atrial fibrillation”. You see him in follow-up at your office 13 days later and do an EKG which shows continued atrial fibrillation, rate of 119. He is hemodynamically stable. Your diagnosis of is condition is
- a. Paroxysmal (intermittent) atrial fibrillation
- b. Persistent atrial fibrillation
- c. Longstanding atrial fibrillation
- d. Permanent atrial fibrillation
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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
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Question 8 of 10

8. Question
8. Correct documentation and coding of obesity requires (choose ALL that are correct)
- a. 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. For 2024, we need 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
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Question 9 of 10

9. Question
9. Regarding stroke/neurologic syndrome condition capture (select all that are correct)
- a. We should classify strokes outside of the 30-day window as “history of” only
- 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 not recommended as it adds no clinical. value
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Question 10 of 10

10. Question
10. Which condition is associated with the most HCC-associated disease interactions?
- a. Hypertension
- b. Chronic Lung Disease
- c. Heart Failure
- d. Chronic Kidney Disease
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2024 Clinical Applications of Key HCCs in Primary Care (21) – Post Test

2024 Clinical Applications of Key HCCs in Primary Care (21) – Post Test

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