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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Complication/comorbidity (CC) - Documentation impact on IPPS reimbursement - IPPS and its updates and revisions - Medicare contractors and their impact on CDI - Principal diagnosis and medical necessity - Major complication/comorbidity (MCC) - Case mix index (CMI) - Medical staff and clinical staff documentation responsibilities - Documentation and medical necessity of setting - Coding and billing practices vulnerable to denial - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Inpatient admission criteria and CMS Two-Midnight Rule |
| Topic 2: Professionalism, ethics, and compliance | 9.17% | - Medical record confidentiality - Compliance risks indicated by PEPPER - Potential DRG creep - DRG compliance initiatives - Leading queries - CDI department goals beyond reimbursement |
| Topic 3: Communication skills | 9.17% | - Physician education forms and tools - Verbal versus written physician communication - Roles and responsibilities of coders working with CDI departments - Roles and responsibilities of CDI specialists - Educational presentations for healthcare departments and administration - Effective and non-confrontational physician communication - Reconciling CDI working DRGs with final coded DRGs |
| Topic 4: Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - Standard medical abbreviations - Diseases and disorders of the circulatory system - Diseases and disorders of the nervous system - Myeloproliferative diseases and disorders and poorly differentiated neoplasms - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Pharmaceuticals and disease processes - Mental diseases and disorders - Injuries, poisonings, and toxic effects of drugs - Infectious and parasitic diseases - Diseases and disorders of the musculoskeletal system - Diseases and disorders of the respiratory system - Diseases and disorders of the skin, subcutaneous tissue, and breast - Medications as clinical indicators - HIV infections - Clinical indicators and query opportunities by Major Diagnostic Category - Diagnostic tests as clinical indicators - Diseases and disorders of the blood and blood-forming organs and immunological disorders - Diseases and disorders of the hepatobiliary system - Diseases and disorders of the kidney and urinary tract - Diseases and disorders of the digestive system - Endocrine, nutritional, and metabolic diseases and disorders |
| Topic 5: Official Guidelines for Coding and Reporting | 14.17% | - AHA Coding Clinic - Official Guidelines for Coding and Reporting updates - Secondary diagnosis assignment - Discharge dispositions and transfers - Hospital-acquired conditions - Coding guidelines for principal diagnosis selection - Principal diagnosis assignment - Present on admission indicators - Working DRG assignment for multiple diagnoses |
| Topic 6: Impact of reportable diagnoses on quality of care | 8.33% | - Hospital Inpatient Quality Reporting Program - Documentation and code assignment impact on mortality index - Patient Safety Indicators - Hospital Value-Based Purchasing - Healthcare-associated infections and complication codes - Coded data elements affecting Patient Safety Indicators - CDI impact on Hospital Value-Based Purchasing - Mortality reviews and observed/expected ratios - 30-day mortality measures - Hospital Readmissions Reduction Program - Quality data from record abstraction and claims data - Hospital-Acquired Condition Reduction Program |
| Topic 7: Healthcare facility CDI program analysis | 8.33% | - CDI program forecasting - CC/MCC capture - Severity of illness and risk of mortality - Basic computer and software application skills - Physician performance measurement - Patient Safety Indicators - PEPPER data - Case mix index (CMI) - Provider response rates - Hospital Value-Based Purchasing measures - CDI specialist productivity metrics - Publicly reported data - Tracking and trending physician, department, and hospital performance - High-frequency DRGs - Hospital-specific financial data |
| Topic 8: Medical record documentation | 19.17% | - Documentation requiring clarification - Provider role and diagnosis code assignment - Types of physician queries - Clinical indicators - When a physician query is warranted - Translating clinical indicators into compliant queries - Physician query formats - Addressing diagnoses without clinical support - Situations in which queries are not appropriate - Health record elements used for diagnosis and procedure code assignment - Compliant and noncompliant queries - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice |
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質問 # 142
Which CMS program can reduce an eligible hospital's Medicare base operating DRG payments by as much as
3% because of excess readmissions?
正解：D
解説：
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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質問 # 143
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?
正解：C
解説：
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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質問 # 144
A patient is admitted with fever, productive cough, and hypotension. The attending physician documents sepsis due to pneumonia. Acute kidney injury develops and is documented as due to sepsis. Which of the following is the MOST appropriate sequencing concept?
正解：D
解説：
When sepsis due to a localized infection is responsible for the admission, the systemic infection is generally sequenced first, followed by the localized infection. If acute organ dysfunction is documented as associated with the sepsis, severe sepsis coding additionally requires the appropriate R65.2- code and code(s) for the acute organ dysfunction.
The severe-sepsis code itself is not sequenced as principal diagnosis. The underlying systemic infection precedes it. In this case, the patient's AKI has specifically been linked to sepsis, supporting the severe-sepsis framework.
Pneumonia remains important because it identifies the localized source of infection, but it does not generally precede the systemic infection when sepsis is present on admission and is responsible for the hospitalization.
The CDI specialist should verify that the documentation clearly establishes the relationship between the acute organ dysfunction and sepsis. Organ dysfunction occurring in a patient with sepsis is not automatically attributable to sepsis when another cause is documented or clinically plausible.
The FY 2026 ICD-10-CM Official Guidelines govern these sequencing principles.
CCDS Reference Topics: Sepsis; severe sepsis; principal diagnosis; acute organ dysfunction; sequencing.
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質問 # 145
A patient with cirrhosis presents with confusion and asterixis. Ammonia is elevated and the patient improves after lactulose administration. The physician documents "altered mental status due to liver disease." Which clarification would provide the MOST clinically specific documentation?
正解：B
解説：
The findings create a strong clarification opportunity for hepatic encephalopathy. Cirrhosis, altered mental status, asterixis, elevated ammonia, and improvement with lactulose collectively support an encephalopathic process related to hepatic dysfunction.
The CDI specialist should not independently diagnose hepatic encephalopathy from the findings. Instead, the physician should be asked to clarify the condition represented by the documented phrase "altered mental status due to liver disease." Hepatic encephalopathy is clinically more specific than a nonspecific symptom such as altered mental status and has a distinct ICD-10-CM classification. Elevated ammonia alone is not sufficient to establish the diagnosis because ammonia levels do not always correlate directly with the severity of encephalopathy. The entire clinical picture must be considered.
Dementia generally represents a chronic neurocognitive disorder and does not adequately explain the acute presentation. Alcohol withdrawal requires an appropriate history of cessation or reduction plus characteristic withdrawal manifestations. Metabolic acidosis concerns acid-base physiology and is not supported by the described findings.
This is an example of CDI moving documentation from a nonspecific symptom to a clinically meaningful diagnosis without directing the provider to a predetermined answer.
CCDS Reference Topics: Hepatic encephalopathy; cirrhosis; neurologic manifestations; clinical indicators; documentation specificity.
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質問 # 146
An MS-DRG family is divided into three severity levels: with MCC, with CC, and without CC/MCC.
Assuming all other grouper conditions are identical, which secondary diagnosis category generally results in the highest severity-level assignment?
正解：B
解説：
An MCC-major complication or comorbidity-represents the highest secondary-diagnosis severity category within the standard three-tier MS-DRG hierarchy. CMS describes MCCs as diagnoses with the highest level of severity affecting hospital resource use, CCs as conditions with a moderate level, and non-CC diagnoses as the lowest severity level.
When an MS-DRG family is divided into "with MCC," "with CC," and "without CC/MCC," the presence of a qualifying MCC generally moves the case into the highest severity subdivision, assuming no exclusion or other grouper rule prevents that effect.
This does not mean every MCC always increases payment. Some secondary diagnoses are excluded as MCCs or CCs in particular circumstances because of principal-diagnosis exclusions or DRG-specific logic. CMS's FY 2026 Definitions Manual specifically contains exclusion lists and severity logic for such situations.
CDI specialists should understand MCC/CC logic to interpret working DRGs, but query activity must be driven by clinical accuracy rather than the financial value of a severity level.
CCDS Reference Topics: MS-DRGs; MCC; CC; severity subdivisions; resource utilization; reimbursement compliance.
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質問 # 147
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