I am reviewing the CRC study guide for my eventual test. I came across a test question on one of the practice exams which looked like this:

Within the progress note it stated:

PMH:

Medical Problems:

Hypertension, Atrial Fibrillation, Non-insulin Dependent Diabetes

Current Meds: Indomethacin 50 mg. Lanoxin 0.125 mg. Iron 325 mg. Lasic 40 ma Glyburide 2.5mg. Xalatan 0.005 %. Synthroid 125 meg, Lisinopril 40mg, Mag-Tab SR 84 mg. Ditropan 5 mg, Vitamin B-^ 50 mg.

Assessment:

#1 Atrial Fibrillation – on digoxin – Plan = Med Current: Lanoxin 0.125 mg 1 po q d

#2 Arthritis Climacteric Multiple Sites – Plan = Med Current: indomethacin 50 mg take as needed

#3 Congestive Heart Failure Unspecified – Comments: digoxin, no edema

#4 Insomnia

#5 Adjustment Disorder with Depression – Comments: situational, with sleep issues. Med Current: Remeron 15 mg 1 po hs

#6 Cough – Comments: Has infiltrates vs CHF on CXR’s. CXR next week

Choice Answers:

A. I48.91, M13.89, I11.0, I50.9, G47.00, F43.21, R05, E11.9, Z79.84

B. I48.91, M12.9, I50.9, G47.00, F32.9, E11.9, Z79.4, R05

C. I48.91, I50.9, F43.21, G47.00, E11.9, Z79.84

D. I48.91, M12.9, I10, I50.9, G47.00

The correct answer is A.

Question#1: I would like to know what risk adjustment guidelines state as far as "linking" the "Diabetes and Hypertension" mentioned within the "Medical Problems" listed above with the CHF and why the Diabetes was allowed to be included.

Question#2: Since the Hypertensive Heart Failure code (E11.0) and the Diabetes code (E11.9) are also appropriate to code, how does this affect an E/M note…..if the HTN and DM are not under the assessment and plan, wouldn’t an insurance company ding a provider if they included these codes for which there is no stated assessment and plan?

I hope this isn’t too confusing, but I am working in a risk adjustment position at the moment but also am a former E/M coder and am conflicted with this scenario.

Any help clarifying this situation is greatly appreciated.

Thanks!!