現在の社会の中で優秀な人材が揃てIT人材も多く、競争もとても大きくて、だから多くのIT者はにIT関する試験に参加するIT業界での地位のために奮闘しています。CCDS試験はACDISの一つ重要な認証試験で多くのIT専門スタッフが認証される重要な試験です。
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Communication skills | 9.17% | - Physician education forms and tools - Roles and responsibilities of coders working with CDI departments - Roles and responsibilities of CDI specialists - Effective and non-confrontational physician communication - Educational presentations for healthcare departments and administration - Reconciling CDI working DRGs with final coded DRGs - Verbal versus written physician communication |
| Topic 2: Professionalism, ethics, and compliance | 9.17% | - DRG compliance initiatives - Leading queries - Compliance risks indicated by PEPPER - Medical record confidentiality - CDI department goals beyond reimbursement - Potential DRG creep |
| Topic 3: Healthcare facility CDI program analysis | 8.33% | - Physician performance measurement - Provider response rates - Severity of illness and risk of mortality - Patient Safety Indicators - CDI program forecasting - CDI specialist productivity metrics - Publicly reported data - Basic computer and software application skills - Hospital Value-Based Purchasing measures - Hospital-specific financial data - High-frequency DRGs - PEPPER data - Case mix index (CMI) - CC/MCC capture - Tracking and trending physician, department, and hospital performance |
| Topic 4: Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - Diseases and disorders of the digestive system - Diseases and disorders of the respiratory system - Injuries, poisonings, and toxic effects of drugs - Infectious and parasitic diseases - Diseases and disorders of the hepatobiliary system - Endocrine, nutritional, and metabolic diseases and disorders - Diseases and disorders of the musculoskeletal system - Diseases and disorders of the kidney and urinary tract - HIV infections - Clinical indicators and query opportunities by Major Diagnostic Category - Diseases and disorders of the nervous system - Myeloproliferative diseases and disorders and poorly differentiated neoplasms - Pharmaceuticals and disease processes - Diseases and disorders of the blood and blood-forming organs and immunological disorders - Standard medical abbreviations - Diagnostic tests as clinical indicators - Diseases and disorders of the circulatory system - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Mental diseases and disorders - Medications as clinical indicators - Diseases and disorders of the skin, subcutaneous tissue, and breast |
| Topic 5: Impact of reportable diagnoses on quality of care | 8.33% | - Mortality reviews and observed/expected ratios - CDI impact on Hospital Value-Based Purchasing - Healthcare-associated infections and complication codes - Patient Safety Indicators - Hospital Inpatient Quality Reporting Program - Hospital Value-Based Purchasing - Coded data elements affecting Patient Safety Indicators - Hospital-Acquired Condition Reduction Program - Hospital Readmissions Reduction Program - Quality data from record abstraction and claims data - 30-day mortality measures - Documentation and code assignment impact on mortality index |
| Topic 6: Official Guidelines for Coding and Reporting | 14.17% | - Present on admission indicators - Working DRG assignment for multiple diagnoses - Coding guidelines for principal diagnosis selection - Secondary diagnosis assignment - Discharge dispositions and transfers - Official Guidelines for Coding and Reporting updates - Hospital-acquired conditions - Principal diagnosis assignment - AHA Coding Clinic |
| Topic 7: Medical record documentation | 19.17% | - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice - Types of physician queries - Documentation requiring clarification - Compliant and noncompliant queries - Provider role and diagnosis code assignment - Clinical indicators - Health record elements used for diagnosis and procedure code assignment - Situations in which queries are not appropriate - Addressing diagnoses without clinical support - Translating clinical indicators into compliant queries - When a physician query is warranted - Physician query formats |
| Topic 8: Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Medicare contractors and their impact on CDI - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Medical staff and clinical staff documentation responsibilities - Major complication/comorbidity (MCC) - Coding and billing practices vulnerable to denial - Principal diagnosis and medical necessity - Inpatient admission criteria and CMS Two-Midnight Rule - Complication/comorbidity (CC) - Case mix index (CMI) - IPPS and its updates and revisions - Documentation and medical necessity of setting - Documentation impact on IPPS reimbursement |
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質問 # 124
A patient with abdominal pain and melena is found to have a duodenal ulcer with hemorrhage. The CDI specialist would look for clinical indicators to support which of the following conditions?
正解：A
解説：
A bleeding duodenal ulcer creates a direct risk for acute posthemorrhagic anemia, making option D the most clinically appropriate condition for the CDI specialist to assess. Melena indicates gastrointestinal bleeding, and an acute hemorrhage can produce a clinically important decline in hemoglobin and hematocrit, tachycardia, hypotension, weakness, transfusion requirement, or other manifestations of acute blood loss.
"Blood loss anemia" is less specific. If the evidence demonstrates an acute hemorrhagic event and the provider clinically identifies acute blood-loss anemia, the more specific diagnosis is acute posthemorrhagic anemia. CDI should evaluate serial hemoglobin/hematocrit values, baseline laboratory data, transfusions, fluid resuscitation, symptoms, hemodynamic changes, and the provider's assessment.
Iron deficiency anemia generally develops through chronic iron depletion and should not be assumed simply because gastrointestinal bleeding is present. Hemolytic anemia results from premature destruction of red blood cells and has a different clinical profile, potentially including elevated LDH, decreased haptoglobin, indirect hyperbilirubinemia, or reticulocytosis.
The CDI specialist does not diagnose anemia independently; clinically supported indicators establish the basis for provider clarification.
CCDS Reference Topics: GI hemorrhage; acute blood-loss anemia; clinical indicators; diagnostic specificity.
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質問 # 125
Which of the following conditions demonstrates the greatest risk of mortality in a 77-year-old patient?
正解：A
解説：
Among the choices presented, sepsis associated with a urinary tract infection represents the strongest overall mortality-risk condition. Sepsis is a systemic, potentially life-threatening response to infection and is associated with substantially greater mortality risk than an uncomplicated localized infection, particularly in an elderly patient.
Risk of mortality in CDI is not determined merely by whether a diagnosis is a CC or MCC. Risk-adjustment systems evaluate the complete clinical profile, including principal diagnosis, secondary diagnoses, age, organ dysfunction, severity interactions, and other patient characteristics. Thus, reimbursement severity and predicted mortality are related concepts but are not interchangeable.
The history of mastectomy ten years earlier does not itself materially increase the current acute severity unless active malignancy or another relevant condition is present. The principal acute concern in option D is sepsis.
COPD with respiratory failure and NSTEMI with acute systolic heart failure are also high-risk presentations and require complete documentation; however, the question's intended risk-adjustment comparison identifies the septic presentation as carrying the greatest mortality concern.
If acute organ dysfunction were linked to sepsis, documentation of severe sepsis would further increase the represented clinical severity.
CCDS Reference Topics: Risk of mortality; severity adjustment; sepsis; quality reporting; distinction between MS-DRG severity and ROM.
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質問 # 126
A CDI manager finds that cardiology providers receive repeated queries for heart-failure acuity and type.
Which educational intervention is MOST appropriate?
正解：C
解説：
The most effective intervention is targeted, service-line-specific physician education based on actual documentation trends and clinically relevant examples.
Repeated queries for the same issue usually indicate a systematic documentation opportunity rather than isolated provider mistakes. Education should therefore show cardiologists how documentation of heart-failure type-such as systolic, diastolic, or combined-and acuity-acute, chronic, or acute on chronic- communicates the patient's clinical condition more precisely.
Using deidentified examples from the service line makes the education immediately relevant and enables physicians to recognize which clinical circumstances frequently generate clarification. Aggregate query data can demonstrate where documentation gaps occur without criticizing individual providers.
Sending an entire code book places coding responsibility on physicians and is unlikely to change documentation behavior. Stopping queries leaves unresolved clinical ambiguity. Framing the education around reduced reimbursement is also inappropriate because the goal of CDI education is accurate clinical representation, not coaching physicians toward higher-paying diagnoses.
The 2026 ACDIS/AHIMA query guidance identifies accurate representation of the patient's clinical status as the underlying purpose of CDI clarification.
CCDS Reference Topics: Physician education; communication; heart-failure specificity; query trend analysis.
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質問 # 127
Under the FY 2026 Hospital-Acquired Condition Reduction Program, which hospitals are subject to the program's payment reduction?
正解：D
解説：
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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質問 # 128
A patient undergoes colorectal surgery. On postoperative day 2, the physician documents "ileus." The record shows absent bowel sounds and abdominal distention, but the surgeon also states that delayed bowel function is expected at this stage of recovery. Which action is MOST appropriate?
正解：C
解説：
The record contains uncertainty regarding whether the documented ileus represents expected postoperative physiology or a clinically significant complication, making provider clarification appropriate.
Temporary impairment of gastrointestinal motility is common following abdominal surgery. Therefore, the mere occurrence of an ileus after surgery does not automatically establish a complication of care. Conversely, prolonged or clinically significant postoperative ileus requiring substantial treatment, extended hospitalization, nasogastric decompression, or other interventions may warrant distinct documentation.
The CDI specialist must not infer the complication relationship solely from timing. The Official Guidelines emphasize that a condition occurring after medical or surgical care is not automatically classified as a complication; appropriate provider documentation of the relationship and clinical significance is required where applicable.
Option C is also incorrect because postoperative ileus can be a reportable condition when clinically significant and appropriately documented. Option D substitutes a separate diagnosis without provider support.
The query should provide relevant duration, symptoms, imaging, diet status, nasogastric tube use, treatment, and expected postoperative course while allowing the surgeon to characterize the condition.
CCDS Reference Topics: Postoperative ileus; complications of care; postoperative documentation; clinical clarification.
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質問 # 129
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