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ACDIS CCDS Exam Syllabus Topics:

SectionWeightObjectives
Topic 1: Medical record documentation19.17%- Documentation clarification and compliant physician queries
- Documentation requirements and diagnosis or procedure code assignment
Topic 2: Professionalism, ethics, and compliance9.17%- Confidentiality, DRG compliance, and ethical CDI practices
- Query compliance, DRG creep, and audit risks
Topic 3: Impact of reportable diagnoses on quality of care8.33%- Mortality, severity of illness, and risk of mortality
- Quality metrics, reporting programs, and financial impact
Topic 4: Healthcare regulations, reimbursement, and documentation requirements related to the IPPS12.5%- CC/MCC, CMI, Medicare contractors, and compliance
- IPPS, MS-DRGs, reimbursement, and medical necessity
Topic 5: Official Guidelines for Coding and Reporting14.17%- Coding guidelines, AHA Coding Clinic, HACs, and POA indicators
- Principal and secondary diagnosis assignment
Topic 6: Anatomy and physiology, pathophysiology, pharmacology, and medical terminology19.17%- Anatomy, physiology, pathophysiology, pharmacology, and terminology
- Clinical conditions and clinical indicators
Topic 7: Communication skills9.17%- CDI and coding roles and interdisciplinary collaboration
- Physician education and effective communication
Topic 8: Healthcare facility CDI program analysis8.33%- Data analysis, forecasting, and performance measurement
- CDI productivity, provider response, CMI, and program metrics

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ACDIS Certified Clinical Documentation Specialist Sample Questions (Q14-Q19):

NEW QUESTION # 14
A patient's hemoglobin decreases from 13.1 g/dL before surgery to 7.4 g/dL afterward. Estimated intraoperative blood loss is 1,200 mL, and the patient receives two units of packed red blood cells. The physician documents only "postoperative anemia." Which clarification is MOST appropriate?

Answer: B

Explanation:
The significant hemoglobin decline, documented surgical blood loss, and transfusion requirement create a strong clinical basis to clarify whether the patient has acute blood loss anemia or another form of postoperative anemia.
However, neither the hemoglobin value nor transfusion independently establishes the diagnosis. The provider must determine the clinical significance and etiology. A postoperative hemoglobin decline can reflect actual hemorrhage, hemodilution, preexisting anemia, expected procedural blood loss, or multiple factors.
A compliant query could present baseline and postoperative hemoglobin levels, estimated blood loss, transfusion, hemodynamic findings, and relevant treatment, then ask the provider to characterize the anemia.
The CDI specialist should also distinguish anemia from a postprocedural complication. Even if acute blood loss anemia is documented, that does not automatically mean a surgical complication occurred. Complication status may require separate provider clarification depending on the record.
Hemolytic anemia has a different pathophysiology involving red-cell destruction, while chronic iron deficiency cannot be inferred from the acute postoperative course.
CCDS Reference Topics: Acute blood loss anemia; postoperative documentation; transfusion; clinical indicators; complications of care.
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NEW QUESTION # 15
Under the FY 2026 Hospital-Acquired Condition Reduction Program, which hospitals are subject to the program's payment reduction?

Answer: A

Explanation:
Under the FY 2026 Hospital-Acquired Condition Reduction Program (HACRP), applicable subsection (d) hospitals in the worst-performing quartile based on the Total HAC Score receive a 1% payment reduction on applicable Medicare fee-for-service payments. CMS defines the worst-performing quartile as hospitals whose Total HAC Score is above the 75th percentile.
The FY 2026 program incorporates the CMS Patient Safety and Adverse Events Composite (PSI 90) plus five healthcare-associated infection measures: CLABSI, CAUTI, specified surgical-site infection, MRSA bacteremia, and C. difficile infection.
A single HAC does not automatically trigger the hospital-wide 1% HACRP reduction. Likewise, CMI is not the criterion used to determine HACRP penalties.
It is also important for CCDS candidates to distinguish the HAC Reduction Program from the separate DRA HAC/POA payment provision. CMS explicitly identifies them as distinct programs.
Accurate documentation and coding are important because quality measures rely on reliable clinical data, but CDI activity must remain focused on accurately representing the clinical record rather than manipulating quality metrics.
CCDS Reference Topics: HAC Reduction Program; PSI 90; HAI measures; quality payment; hospital performance.
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NEW QUESTION # 16
A patient undergoes outpatient surgery at 9:00 AM. At 1:00 PM, while still in outpatient status, the patient develops an acute complication. The physician writes an inpatient admission order at 4:00 PM. The complication remains present at that time. How is the condition generally treated for POA purposes?

Answer: B

Explanation:
POA status is determined in relation to the time of inpatient admission, not the patient's physical arrival at the hospital. Therefore, a condition that develops during outpatient surgery, emergency-department care, or observation and remains present when the inpatient admission order occurs is generally considered present on admission for inpatient POA reporting.
This concept can be counterintuitive because the condition technically developed after the patient entered the hospital building. However, CMS's POA framework distinguishes outpatient care from the subsequent inpatient admission.
The fact that the condition is a complication does not automatically make it POA = N. POA status and classification as a complication are separate concepts.
A "U" indicator signifies insufficient documentation to determine whether the condition was present at admission; it should not be selected merely because a condition arose during outpatient care before admission.
CDI specialists frequently need to establish precise clinical timelines involving emergency services, observation, procedures, admission orders, and onset of complications. Clear timing supports accurate POA assignment and is especially important when diagnoses intersect with CMS HAC payment logic.
The CCDS framework specifically expects knowledge of POA and inpatient reimbursement regulations.
CCDS Reference Topics: POA; outpatient-to-inpatient transition; admission timing; HAC policy.
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NEW QUESTION # 17
A patient presents with crushing substernal chest pain, diaphoresis, ST-segment depression, and a significant rise and fall in cardiac troponin. The cardiologist documents acute coronary syndrome but does not specify the final diagnosis. Which clarification is MOST clinically appropriate?

Answer: A

Explanation:
The clinical picture presents an appropriate opportunity to clarify whether the patient has NSTEMI, unstable angina, or another acute coronary diagnosis.
A significant rise and/or fall in cardiac troponin consistent with acute myocardial injury, together with ischemic symptoms and ECG abnormalities, strongly raises concern for acute myocardial infarction. In contrast, unstable angina generally refers to ischemia without the biomarker evidence required for myocardial infarction.
Nevertheless, CDI should not make the diagnosis independently. Troponin elevations can occur in multiple conditions, including myocarditis, pulmonary embolism, sepsis, tachyarrhythmia, renal disease, and other forms of myocardial injury.
Therefore, the cardiologist should be asked to clarify the final diagnosis based on the complete clinical evaluation.
GERD, chronic stable angina, and old MI do not adequately reflect the acute findings described.
For CCDS preparation, cardiovascular questions frequently require distinguishing symptoms from established diagnoses and understanding the clinical indicators associated with NSTEMI, STEMI, type 2 MI, and other myocardial injury categories.
The ACDIS candidate handbook identifies anatomy, physiology, pharmacology, pathophysiology, and clinical record analysis as essential examination competencies.
CCDS Reference Topics: NSTEMI; acute coronary syndrome; troponin; myocardial ischemia; diagnostic clarification.
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NEW QUESTION # 18
Which CMS program can reduce an eligible hospital's Medicare base operating DRG payments by as much as
3% because of excess readmissions?

Answer: B

Explanation:
The Hospital Readmissions Reduction Program (HRRP) reduces payments to applicable hospitals with excess readmissions for specified conditions and procedures. CMS calculates a payment adjustment factor ranging from 1.0 to 0.97, meaning the maximum reduction is 3%.
The adjustment applies to applicable Medicare fee-for-service base operating DRG payments rather than solely to the readmission cases themselves.
This differs from the HAC Reduction Program, which applies a 1% reduction to hospitals in the worst- performing quartile based on defined hospital-acquired-condition measures. Hospital Value-Based Purchasing uses another methodology in which 2% of participating hospitals' base operating DRG payments funds value- based incentive payments.
For CDI professionals, readmission programs demonstrate how clinical documentation can influence more than individual MS-DRG reimbursement. Accurate documentation of comorbidities, principal diagnoses, complications, discharge circumstances, and disease severity contributes to reliable risk-adjusted data.
However, CDI intervention must remain focused on clinical accuracy rather than attempting to alter readmission metrics through unsupported diagnoses.
CCDS Reference Topics: HRRP; readmissions; quality reimbursement; IPPS; risk adjustment.
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NEW QUESTION # 19
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