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ACDIS CCDS-O Exam Overview:

Certification Vendor:ACDIS (Association of Clinical Documentation Integrity Specialists)
Exam Name:ACDIS Certified Clinical Documentation Specialist – Outpatient (CCDS-O) Examination
Exam Number:CCDS-O
Passing Score:85 out of 120 scored questions
Related Certifications:Certified Clinical Documentation Specialist (CCDS)
Real Exam Qty:140 questions (120 scored)
Exam Format:Multiple-choice, Computer-based exam
Available Languages:English
Recommended Training:ACDIS CCDS-O Exam Candidate Handbook (download via official site)
ACDIS Official Certification Resources
Exam Registration:CCDS-O Certification Information
ACDIS Certification Page
Sample Questions:ACDIS CCDS-O Sample Questions
Exam Way:Computer-based testing via Prometric test centers or remote proctoring (ProProctor).
Pre Condition:Must meet education and experience requirements (e.g., RN, MD, DO, or HIM/coding credential such as RHIA, RHIT, CCS, CPC, CRC, COC) plus approximately 1–2 years of outpatient clinical documentation experience using U.S. reimbursement systems.
Official Syllabus URL:https://acdis.org/certification/ccds-o

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ACDIS CCDS-O Exam Syllabus Topics:

TopicDetails
Topic 1
  • Diseases and Disease Processes and Application to the Clinical Chart Review: Covers clinical indicators across all ICD-10-CM chapters, applied to chart reviews, with recognition of medications, diagnostic tests, and abbreviations as documentation clarification triggers.
Topic 2
  • CDI Program Concepts: Department Metrics and Provider Education: Covers provider education development, CDI performance metrics including query rates, RAF progression, HCC capture, ACO
  • MSSP impact, and physician documentation's effect on quality reporting.
Topic 3
  • Quality, Regulatory, and Health Initiatives: Covers population health, MSSP, ACO models, MACRA
  • MIPS, compliant query development, RADV audits, OIG compliance, problem list maintenance, and HIPAA requirements in outpatient CDI.
Topic 4
  • Healthcare regulations, reimbursement, and documentation requirements related to the Official Guidelines for
Topic 5
  • and billing: Covers Official Coding Guidelines, OPPS reimbursement (APCs), and professional billing concepts including CPT E
  • M codes and Medicare Physician Fee Schedule documentation.

ACDIS Certified Clinical Documentation Specialist-Outpatient Sample Questions (Q29-Q34):

NEW QUESTION # 29
Which of the following section(s) of the Official Guidelines for Coding and Reporting are applicable to outpatient settings?

Answer: B

Explanation:
In outpatient CDI and coding, the Official ICD-10-CM Guidelines that apply are the universal rules plus the outpatient-specific rules. Section I contains conventions, general coding guidelines, and chapter-specific guidance that govern code assignment in every setting (e.g., code structure, "use additional code," laterality, sequencing instructions, and condition-specific rules). Section IV is specifically written for outpatient services and drives core outpatient behaviors such as selecting the "first-listed" diagnosis based on the main reason for the encounter, reporting additional diagnoses that are evaluated/assessed/treated or impact care, and applying outpatient-only restrictions (for example, diagnoses documented as "rule out," "probable," or "suspected" generally are not coded in outpatient the way they may be for inpatient reporting). ACDIS outpatient CDI education emphasizes teaching providers to document clearly the reason for visit, the assessment/clinical relevance of each condition addressed, and the linkage between conditions and services rendered so Section I and Section IV rules can be applied accurately for compliant reimbursement and reporting.


NEW QUESTION # 30
A patient receives treatment for diabetes during a primary care visit. He has a glucose level of 240 and A1C of 7.9. The patient is prescribed Gabapentin 100mg TID. Which of the following should the CDI specialist query for?

Answer: C

Explanation:
In outpatient CDI chart review, a key skill is recognizing when medications and treatment plans suggest a specific diabetic complication that is not explicitly documented. Gabapentin is commonly prescribed for neuropathic pain, and in a diabetic patient it is frequently used to treat diabetic peripheral neuropathy symptoms (burning, tingling, numbness, shooting pain). ACDIS outpatient CDI guidance supports querying when there are strong clinical indicators that a more specific, clinically relevant diagnosis may be present and is being treated at the encounter, because diabetes codes require complication specificity when supported (e.g., "diabetes with neuropathy" rather than unspecified diabetes). The elevated glucose and A1C confirm ongoing diabetes management but do not, by themselves, indicate CKD, macular degeneration, or ketoacidosis. Ketoacidosis would require documentation of acute metabolic decompensation and supporting clinical/lab findings, which are not provided here. Therefore, the most appropriate clarification is whether the patient has diabetic peripheral neuropathy (and whether it is painful neuropathy) being managed with gabapentin, so the provider can document the condition clearly and accurately.


NEW QUESTION # 31
Which of the following health record elements impacts HHS-HCC risk scores?

Answer: A

Explanation:
The HHS-HCC risk adjustment model (used for ACA Marketplace plans) calculates a member's risk score using a combination of demographic factors and diagnosis codes that map to HHS-HCCs. Among the listed health record elements, gender is a core demographic variable used in the model's coefficients because expected healthcare utilization and cost patterns differ by age/sex groupings. In outpatient CDI terms, this is why accurate demographic data capture (including sex) matters alongside complete and specific condition reporting. CPT codes do not drive HHS-HCC risk scores; the model relies on diagnosis reporting (ICD-10-CM) rather than procedure codes for risk category assignment. Discharge status is an encounter/billing element relevant to certain facility payment and quality measures, but it is not a standard HHS-HCC risk score input. Ethnicity is not used as a direct risk adjustment variable in the HHS-HCC model for score calculation. Therefore, gender is the correct element that impacts HHS-HCC risk scores.


NEW QUESTION # 32
In which of the following ways does payment determination (risk score calculation) differ between HHS-HCCs and CMS-HCCs?

Answer: B

Explanation:
A key ambulatory CDI distinction between the two major risk models is timing. The HHS-HCC model (used for ACA Marketplace risk adjustment) is commonly described as a concurrent model: it uses the enrollee's demographics and diagnoses from the same benefit year to reflect morbidity and support that year's risk transfer/payment balancing. In contrast, the CMS-HCC model (commonly applied in Medicare Advantage) is prospective: conditions documented and coded in the prior data collection year are used to predict expected cost for the following payment year. From an outpatient CDI perspective, this timing difference affects operational priorities. For CMS-HCC, accurate annual capture and recapture of active chronic conditions is essential because last year's documented conditions drive next year's risk score and revenue. For HHS-HCC, complete documentation and coding during the current year impacts the current year's risk measurement. Options referencing CPT codes are not correct for the core HCC risk score calculation, which is driven by demographics and ICD diagnosis reporting mapped to HCC categories.


NEW QUESTION # 33
Which of the following tools or processes is MOST appropriate to share with providers and administrators during a department meeting when demonstrating documentation and coding patterns?

Answer: C

Explanation:
When the goal is to demonstrate documentation and coding patterns to a mixed audience of providers and administrators, the most effective tool is one that clearly displays comparisons and trends in an easily interpretable way. A bar graph is ideal because it can quickly show differences in rates or volumes-such as unspecified diagnosis utilization, HCC capture rates, query response/agree rates, denial categories, or condition specificity-across providers, clinics, or time periods. This supports outpatient CDI education by making variation visible and actionable while keeping the discussion focused on documentation behaviors and opportunities for improvement. A spaghetti diagram is used for mapping physical workflow movement and inefficiencies, not coding patterns. The PDSA cycle is a structured improvement method for testing changes, but it is not primarily a visualization tool for presenting pattern data. The Donabedian model (structure-process-outcome) is a quality framework that helps organize improvement thinking, but it doesn't display coding/documentation pattern performance as directly as a bar graph.


NEW QUESTION # 34
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