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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare facility CDI program analysis | 8.33% | - Patient Safety Indicators - CDI specialist productivity metrics - Basic computer and software application skills - CDI program forecasting - Hospital Value-Based Purchasing measures - Severity of illness and risk of mortality - High-frequency DRGs - Provider response rates - CC/MCC capture - Publicly reported data - Hospital-specific financial data - Case mix index (CMI) - Tracking and trending physician, department, and hospital performance - PEPPER data - Physician performance measurement |
| Topic 2: Official Guidelines for Coding and Reporting | 14.17% | - Coding guidelines for principal diagnosis selection - Official Guidelines for Coding and Reporting updates - Hospital-acquired conditions - AHA Coding Clinic - Principal diagnosis assignment - Secondary diagnosis assignment - Present on admission indicators - Discharge dispositions and transfers - Working DRG assignment for multiple diagnoses |
| Topic 3: Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - HIV infections - Diseases and disorders of the hepatobiliary system - Diseases and disorders of the musculoskeletal system - Medications as clinical indicators - Standard medical abbreviations - Pharmaceuticals and disease processes - Clinical indicators and query opportunities by Major Diagnostic Category - Mental diseases and disorders - Diseases and disorders of the respiratory system - Diagnostic tests as clinical indicators - Diseases and disorders of the circulatory system - Diseases and disorders of the skin, subcutaneous tissue, and breast - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Diseases and disorders of the blood and blood-forming organs and immunological disorders - Endocrine, nutritional, and metabolic diseases and disorders - Injuries, poisonings, and toxic effects of drugs - Diseases and disorders of the nervous system - Infectious and parasitic diseases - Diseases and disorders of the digestive system - Myeloproliferative diseases and disorders and poorly differentiated neoplasms - Diseases and disorders of the kidney and urinary tract |
| Topic 4: Communication skills | 9.17% | - Educational presentations for healthcare departments and administration - Physician education forms and tools - Roles and responsibilities of coders working with CDI departments - Effective and non-confrontational physician communication - Verbal versus written physician communication - Reconciling CDI working DRGs with final coded DRGs - Roles and responsibilities of CDI specialists |
| Topic 5: Impact of reportable diagnoses on quality of care | 8.33% | - Patient Safety Indicators - Quality data from record abstraction and claims data - Documentation and code assignment impact on mortality index - CDI impact on Hospital Value-Based Purchasing - Hospital Value-Based Purchasing - Healthcare-associated infections and complication codes - 30-day mortality measures - Mortality reviews and observed/expected ratios - Hospital Readmissions Reduction Program - Coded data elements affecting Patient Safety Indicators - Hospital Inpatient Quality Reporting Program - Hospital-Acquired Condition Reduction Program |
| Topic 6: Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Medical staff and clinical staff documentation responsibilities - Coding and billing practices vulnerable to denial - Inpatient admission criteria and CMS Two-Midnight Rule - Major complication/comorbidity (MCC) - Principal diagnosis and medical necessity - Documentation and medical necessity of setting - Medicare contractors and their impact on CDI - Complication/comorbidity (CC) - IPPS and its updates and revisions - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Documentation impact on IPPS reimbursement - Case mix index (CMI) |
| Topic 7: Medical record documentation | 19.17% | - Documentation requiring clarification - Physician query formats - Types of physician queries - Situations in which queries are not appropriate - Clinical indicators - Compliant and noncompliant queries - Translating clinical indicators into compliant queries - When a physician query is warranted - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice - Provider role and diagnosis code assignment - Health record elements used for diagnosis and procedure code assignment - Addressing diagnoses without clinical support |
| Topic 8: Professionalism, ethics, and compliance | 9.17% | - Leading queries - DRG compliance initiatives - Potential DRG creep - CDI department goals beyond reimbursement - Medical record confidentiality - Compliance risks indicated by PEPPER |
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NEW QUESTION # 68
A patient is admitted with hypertension and acute systolic heart failure. The provider does not explicitly link the two conditions and does not state that they are unrelated. Which coding principle applies?
Answer: D
Explanation:
ICD-10-CM presumes a causal relationship between hypertension and qualifying heart disease, including heart failure, because the conditions are linked under "hypertension, with" in the Alphabetic Index. The presumed relationship applies unless the provider clearly documents that the heart disease is unrelated to hypertension.
Accordingly, hypertensive heart disease is coded using the appropriate I11.- category, with an additional I50.- code identifying the specific type and acuity of heart failure.
This convention differs from conditions for which ICD-10-CM does not provide a presumed causal link. In those circumstances, provider documentation must explicitly establish the relationship.
The CDI specialist therefore should not routinely query merely to obtain wording such as "hypertensive heart failure" when both hypertension and a qualifying heart-failure diagnosis are already documented and no statement says they are unrelated.
However, CDI may still need clarification when heart-failure type or acuity is incomplete, documentation is contradictory, or the physician expressly disputes a hypertensive relationship.
Recognizing these classification-based presumptions reduces unnecessary queries and supports accurate working-code and MS-DRG assignment.
CCDS Reference Topics: Hypertensive heart disease; heart failure; presumed relationships; coding conventions; query necessity.
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NEW QUESTION # 69
A CDI manager notes that the physician query response rate is 98%, but only 55% of queries are answered before discharge. Which metric should receive the MOST immediate workflow analysis?
Answer: D
Explanation:
The overall response rate is excellent at 98%, but the fact that only 55% of queries are resolved before discharge indicates a meaningful concurrent-workflow issue.
Concurrent CDI is most effective when clarification occurs while the patient remains hospitalized and the physician has immediate access to the clinical context. Delayed responses can contribute to retrospective work, final-bill holds, coding delays, and administrative escalation.
The CDI manager should determine whether delays cluster by provider, specialty, query type, unit, day of week, discharge timing, or electronic-query process. Other factors may include insufficient notification, physician workflow, poor escalation protocols, or queries being issued too late in the stay.
CMI and MCC volume do not directly measure response timeliness and should not substitute for analysis of the actual operational problem.
Importantly, programs should not pressure physicians into rapid but clinically superficial responses. Query timing initiatives must preserve thoughtful provider judgment and compliant communication.
ACDIS identifies medical-record review, communication, query technique, and data-mining/reporting functions among core CCDS competencies.
CCDS Reference Topics: Query timeliness; concurrent CDI; physician engagement; workflow analysis; program metrics.
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NEW QUESTION # 70
A CDI manager is evaluating physician participation in the program. Which metric most strongly indicates poor physician engagement?
Answer: A
Explanation:
A high volume of unanswered queries most directly indicates inadequate provider engagement. This question is adapted from the current ACDIS Candidate Handbook's publicly released CCDS sample questions.
A provider may legitimately agree or disagree with a CDI query. Disagreement does not necessarily indicate poor engagement because the purpose of a query is clarification, not obtaining a predetermined diagnosis. A physician who reviews the clinical information and documents that the condition is ruled out, clinically undetermined, or otherwise different from the proposed possibilities is still participating appropriately.
Likewise, the number of queries generated is primarily a CDI workload or opportunity metric. It does not demonstrate whether physicians are responding.
A persistent nonresponse rate is more concerning because unanswered queries can delay final coding, create unresolved ambiguity, affect billing timeliness, reduce documentation completeness, and indicate weaknesses in provider communication or organizational query escalation procedures.
A CDI manager should not evaluate engagement from a single metric in isolation. Response time, response rate, education participation, documentation trends, service-line differences, and escalation frequency provide additional useful context.
CCDS Reference Topics: Physician engagement; query-response metrics; CDI analytics; program effectiveness.
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NEW QUESTION # 71
During a quarter, a CDI department issued 800 provider queries. Providers answered 720 queries, and 540 of those responses agreed with the clarification proposed by the clinical evidence. What was the provider query response rate?
Answer: A
Explanation:
The provider query response rate is calculated by dividing answered queries by total queries issued:
720 ÷ 800 × 100 = 90%.
Therefore, the correct answer is 90%.
The 540 responses agreeing with the clarification are relevant to a different measure: provider agreement rate.
If agreement were calculated against answered queries, it would be 540 ÷ 720 = 75%.
These metrics should not be confused. Response rate measures whether providers participate in the clarification process, whereas agreement rate measures the proportion of responses that substantively agree with the diagnosis or clarification being evaluated.
A lower agreement rate is not necessarily evidence of poor CDI performance. Providers should remain free to disagree, document another supported diagnosis, rule out a condition, or indicate that the issue cannot be determined.
A CDI manager should trend response rate, agreement rate, response time, unanswered-query aging, retrospective-query percentage, and query type together rather than judging program success from a single number.
The 2026 ACDIS/AHIMA guidance reinforces provider independence as a fundamental aspect of a compliant query process.
CCDS Reference Topics: Query response rate; agreement rate; CDI metrics; provider engagement; program analysis.
NEW QUESTION # 72
The attending physician documents "acute systolic heart failure," while a consultant documents "chronic diastolic heart failure" for the same episode of care. Which provider should ultimately clarify the conflicting diagnostic documentation for coding purposes?
Answer: D
Explanation:
The attending physician is the correct answer and this scenario is adapted from an official ACDIS CCDS sample item addressing conflicting medical-record documentation.
ICD-10-CM coding depends on provider documentation, but when clinically significant documentation conflicts within the record, the discrepancy must be clarified rather than resolved independently by the coder or CDI specialist. The FY 2026 Official Guidelines specifically state that when medical-record documentation conflicts, the patient's provider should be queried for clarification.
In the inpatient environment, the attending provider is generally responsible for synthesizing the patient's diagnoses and final clinical picture. A consultant's documentation may supply essential clinical information and may support code assignment when there is no conflict, but conflicting descriptions of heart-failure type or acuity should not simply be selected based on which diagnosis produces the higher-severity code.
The query should identify the conflicting statements objectively and request clarification of the clinically appropriate diagnosis. It should not suggest which diagnosis should be selected or mention reimbursement consequences.
This concept is central to CDI because unresolved contradictions can affect MS-DRG assignment, risk adjustment, severity measurement, quality reporting, and the clinical integrity of the record.
CCDS Reference Topics: Conflicting documentation; provider clarification; heart-failure specificity; medical-record integrity.
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NEW QUESTION # 73
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