Certified Risk Adjustment Coder (CRC)

If you were using predictive modeling and the results were two claims related to a quick-relief inhaler and a pulmonary function test, which diagnosis might you predict?

1. Diabetes mellitus

2. Asthma

3. Osteoporosis

4. Hypertension

The correct answer is: Asthma

The correct answer is focused on the clear clinical connection between the claims mentioned and the likely associated diagnosis. Quick-relief inhalers are primarily used to alleviate symptoms associated with respiratory conditions, particularly asthma, and they are commonly prescribed to individuals with this condition to manage acute episodes of wheezing or shortness of breath. Similarly, pulmonary function tests are diagnostic tools that assess lung function and are often employed to diagnose and monitor asthma, as they help in evaluating how well the lungs are working. The presence of claims related to both a quick-relief inhaler and a pulmonary function test strongly suggests a connection to asthma, as these are standard components of asthma management and care. The other diagnoses listed (diabetes mellitus, osteoporosis, and hypertension) do not have a direct correlation with the claims mentioned. For example, while diabetes mellitus is related to metabolic regulation, osteoporosis concerns bone density, and hypertension deals with blood pressure, none of these conditions typically involve the use of inhalers or pulmonary function testing as a standard part of their management or diagnosis. Therefore, predicting asthma as the most likely diagnosis based on the claims provided is a logical conclusion.