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| Section | Weight | Objectives |
|---|---|---|
| Communication skills | 9.17% | - Effective and non-confrontational physician communication - Roles and responsibilities of coders working with CDI departments - Roles and responsibilities of CDI specialists - Reconciling CDI working DRGs with final coded DRGs - Physician education forms and tools - Verbal versus written physician communication - Educational presentations for healthcare departments and administration |
| Professionalism, ethics, and compliance | 9.17% | - CDI department goals beyond reimbursement - DRG compliance initiatives - Potential DRG creep - Medical record confidentiality - Compliance risks indicated by PEPPER - Leading queries |
| Official Guidelines for Coding and Reporting | 14.17% | - Secondary diagnosis assignment - Working DRG assignment for multiple diagnoses - Hospital-acquired conditions - Principal diagnosis assignment - Discharge dispositions and transfers - Official Guidelines for Coding and Reporting updates - AHA Coding Clinic - Coding guidelines for principal diagnosis selection - Present on admission indicators |
| Medical record documentation | 19.17% | - Addressing diagnoses without clinical support - Situations in which queries are not appropriate - Documentation requiring clarification - Provider role and diagnosis code assignment - Types of physician queries - Health record elements used for diagnosis and procedure code assignment - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice - Clinical indicators - When a physician query is warranted - Physician query formats - Compliant and noncompliant queries - Translating clinical indicators into compliant queries |
| Healthcare facility CDI program analysis | 8.33% | - Hospital-specific financial data - PEPPER data - Provider response rates - Tracking and trending physician, department, and hospital performance - High-frequency DRGs - CC/MCC capture - CDI specialist productivity metrics - Severity of illness and risk of mortality - Publicly reported data - Patient Safety Indicators - Case mix index (CMI) - Physician performance measurement - Hospital Value-Based Purchasing measures - Basic computer and software application skills - CDI program forecasting |
| Impact of reportable diagnoses on quality of care | 8.33% | - Quality data from record abstraction and claims data - 30-day mortality measures - Mortality reviews and observed/expected ratios - Hospital Inpatient Quality Reporting Program - Hospital Value-Based Purchasing - Documentation and code assignment impact on mortality index - Healthcare-associated infections and complication codes - CDI impact on Hospital Value-Based Purchasing - Patient Safety Indicators - Coded data elements affecting Patient Safety Indicators - Hospital Readmissions Reduction Program - Hospital-Acquired Condition Reduction Program |
| Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Medicare contractors and their impact on CDI - Inpatient admission criteria and CMS Two-Midnight Rule - IPPS and its updates and revisions - Complication/comorbidity (CC) - Documentation impact on IPPS reimbursement - Principal diagnosis and medical necessity - Major complication/comorbidity (MCC) - Case mix index (CMI) - Coding and billing practices vulnerable to denial - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Medical staff and clinical staff documentation responsibilities - Documentation and medical necessity of setting |
| Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - HIV infections - Diseases and disorders of the blood and blood-forming organs and immunological disorders - Medications as clinical indicators - Diseases and disorders of the skin, subcutaneous tissue, and breast - Diseases and disorders of the nervous system - Diseases and disorders of the kidney and urinary tract - Standard medical abbreviations - Diseases and disorders of the digestive system - Diseases and disorders of the respiratory system - Myeloproliferative diseases and disorders and poorly differentiated neoplasms - Diseases and disorders of the musculoskeletal system - Diagnostic tests as clinical indicators - Pharmaceuticals and disease processes - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Mental diseases and disorders - Diseases and disorders of the circulatory system - Infectious and parasitic diseases - Clinical indicators and query opportunities by Major Diagnostic Category - Diseases and disorders of the hepatobiliary system - Endocrine, nutritional, and metabolic diseases and disorders - Injuries, poisonings, and toxic effects of drugs |
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NEW QUESTION # 48
A CDI specialist reviews the MS-DRG mismatch report and notes a difference in a case. The coder noted that a current Coding Clinic affects the final coding of the record, which changed the MS-DRG assignment. To BEST understand this discrepancy, the specialist should FIRST:
Answer: C
Explanation:
The CDI specialist should first review the final coded record together with the Coding Clinic guidance identified by the coder. This provides an objective basis for understanding why the final MS-DRG differs from the CDI working DRG.
A mismatch does not automatically indicate that either CDI or coding made an error. Working DRGs are provisional and may change after complete review of discharge documentation, operative reports, pathology, final diagnostic information, coding conventions, official guidelines, or authoritative Coding Clinic advice.
Reviewing the applicable guidance before contacting the coder promotes an informed and efficient reconciliation process. Once the specialist understands the coding rule, discussion with the coder may still be useful if ambiguity remains. Immediately escalating to the coding manager is unnecessary unless the issue cannot be resolved through normal collaboration. Forwarding the record without investigating the mismatch would defeat the purpose of a reconciliation process and could allow recurring education opportunities to remain unidentified.
Mismatch analysis is a valuable CDI quality metric because it can identify documentation gaps, coding- knowledge issues, changes in authoritative guidance, and opportunities to improve CDI/coding alignment.
CCDS Reference Topics: MS-DRG reconciliation; CDI/coder collaboration; Coding Clinic application; CDI program analysis.
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NEW QUESTION # 49
The amount of the IPPS Indirect Medical Education Adjustment is determined by teaching intensity as measured by the hospital's number of residents compared to:
Answer: C
Explanation:
Medicare's Indirect Medical Education (IME) adjustment uses the hospital's resident-to-bed ratio as the principal measure of teaching intensity. CMS explains that the IME adjustment factor is calculated using a hospital's ratio of residents to beds. Therefore, the correct answer is inpatient beds.
IME is an additional IPPS payment intended to recognize the higher indirect patient-care costs associated with operating an approved teaching program. These costs are distinguished from Direct Graduate Medical Education payments, which reimburse qualifying direct costs associated with residency training.
The number of admissions is not the denominator in the IME teaching-intensity calculation. Likewise, emergency-department beds are not simply combined with inpatient beds for the standard resident-to-bed ratio, and disproportionate-share payment rates represent a separate IPPS adjustment related principally to hospitals caring for substantial numbers of low-income patients.
For the CCDS examination, the important distinction is that IPPS reimbursement involves more than the base MS-DRG payment. Adjustments may include IME, disproportionate-share hospital provisions, wage-index effects, outlier payments, and other statutory mechanisms.
CCDS Reference Topics: IPPS reimbursement; teaching hospitals; IME adjustment; resident-to-bed ratio.
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NEW QUESTION # 50
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 # 51
A 34-year-old female was admitted from a group home with uncontrolled diabetes. A CDI specialist must query to specify the patient's mental incapacity since it makes management of the diabetes more difficult.
Which of the following terminology recognized by ICD-10-CM could result in the assignment of a comorbid condition?
Answer: A
Explanation:
Severe intellectual disability is recognized ICD-10-CM terminology and maps to F72, Severe intellectual disabilities. The other phrases are not equivalent standardized ICD-10-CM diagnostic terminology.
This distinction is highly relevant to CDI. Terms used conversationally in the clinical record do not necessarily provide sufficient specificity or map cleanly to reportable ICD-10-CM diagnoses. When a patient's cognitive or developmental condition affects treatment, monitoring, self-management, nursing requirements, or the complexity of care, the CDI specialist should seek clinically appropriate provider documentation using recognized diagnostic terminology.
For FY 2026 MS-DRG logic, CMS identifies F72 as a CC, meaning it can qualify as a complication
/comorbidity when it meets secondary-diagnosis reporting requirements. That does not mean the CDI specialist should query merely for reimbursement impact. The query must be clinically justified by the record and should allow the provider to determine the correct diagnosis.
"Severe mental challenge," "acute mental incapacity," and "acute intellectual disability" do not represent the same codable disease classification.
CCDS Reference Topics: Medical terminology; mental/behavioral and neurodevelopmental disorders; CC recognition; clinically supported query opportunities.
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NEW QUESTION # 52
Under the IPPS Post-Acute Care Transfer policy, which documentation element is particularly important because it can affect whether transfer-payment methodology applies?
Answer: D
Explanation:
Accurate discharge disposition is critical to application of the Post-Acute Care Transfer policy because the patient's destination after the acute inpatient stay can determine whether transfer-payment methodology applies.
Qualifying discharges to certain post-acute settings can be subject to transfer-payment rules when other criteria are met. These settings can include skilled nursing facilities and other specified post-acute arrangements, depending on applicable CMS requirements and the MS-DRG involved.
Therefore, an incorrectly documented discharge destination can affect reimbursement even when the diagnoses, procedures, and MS-DRG are otherwise accurate.
The PACT concept demonstrates why CDI and coding accuracy extend beyond diagnosis capture. The inpatient claim also relies on accurate demographic, procedural, discharge-status, and utilization information.
Dietary preference, physician experience, and the number of daily progress notes do not determine whether PACT methodology applies.
CDI specialists should recognize when conflicting documentation exists regarding whether a patient went home, to skilled nursing, rehabilitation, another acute facility, hospice, or another destination and collaborate with the appropriate departments to ensure the final record accurately reflects the actual disposition.
CCDS Reference Topics: PACT; discharge disposition; IPPS transfer rules; reimbursement; data integrity.
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NEW QUESTION # 53
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