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| Section | Weight | Objectives |
|---|---|---|
| Healthcare facility CDI program analysis | 8.33% | - High-frequency DRGs - Physician performance measurement - Patient Safety Indicators - Basic computer and software application skills - Provider response rates - Hospital-specific financial data - PEPPER data - Case mix index (CMI) - Hospital Value-Based Purchasing measures - CDI specialist productivity metrics - Tracking and trending physician, department, and hospital performance - Publicly reported data - Severity of illness and risk of mortality - CC/MCC capture - CDI program forecasting |
| Official Guidelines for Coding and Reporting | 14.17% | - Hospital-acquired conditions - Discharge dispositions and transfers - Principal diagnosis assignment - Official Guidelines for Coding and Reporting updates - Secondary diagnosis assignment - Working DRG assignment for multiple diagnoses - Coding guidelines for principal diagnosis selection - AHA Coding Clinic - Present on admission indicators |
| Professionalism, ethics, and compliance | 9.17% | - CDI department goals beyond reimbursement - Compliance risks indicated by PEPPER - Potential DRG creep - DRG compliance initiatives - Leading queries - Medical record confidentiality |
| Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - Diseases and disorders of the hepatobiliary system - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Diseases and disorders of the nervous system - Diseases and disorders of the digestive system - Myeloproliferative diseases and disorders and poorly differentiated neoplasms - Pharmaceuticals and disease processes - Diseases and disorders of the musculoskeletal system - Infectious and parasitic diseases - Diseases and disorders of the respiratory system - Injuries, poisonings, and toxic effects of drugs - Diseases and disorders of the blood and blood-forming organs and immunological disorders - Diseases and disorders of the skin, subcutaneous tissue, and breast - HIV infections - Clinical indicators and query opportunities by Major Diagnostic Category - Diagnostic tests as clinical indicators - Endocrine, nutritional, and metabolic diseases and disorders - Mental diseases and disorders - Medications as clinical indicators - Diseases and disorders of the circulatory system - Standard medical abbreviations - Diseases and disorders of the kidney and urinary tract |
| Medical record documentation | 19.17% | - Translating clinical indicators into compliant queries - Health record elements used for diagnosis and procedure code assignment - Compliant and noncompliant queries - Types of physician queries - Clinical indicators - Physician query formats - Documentation requiring clarification - When a physician query is warranted - Provider role and diagnosis code assignment - Situations in which queries are not appropriate - Addressing diagnoses without clinical support - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice |
| Communication skills | 9.17% | - Reconciling CDI working DRGs with final coded DRGs - Physician education forms and tools - Effective and non-confrontational physician communication - Roles and responsibilities of coders working with CDI departments - Educational presentations for healthcare departments and administration - Roles and responsibilities of CDI specialists - Verbal versus written physician communication |
| Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Medicare contractors and their impact on CDI - Documentation and medical necessity of setting - Coding and billing practices vulnerable to denial - Principal diagnosis and medical necessity - Major complication/comorbidity (MCC) - Case mix index (CMI) - Medical staff and clinical staff documentation responsibilities - IPPS and its updates and revisions - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Inpatient admission criteria and CMS Two-Midnight Rule - Documentation impact on IPPS reimbursement - Complication/comorbidity (CC) |
| Impact of reportable diagnoses on quality of care | 8.33% | - Mortality reviews and observed/expected ratios - 30-day mortality measures - Quality data from record abstraction and claims data - Documentation and code assignment impact on mortality index - Hospital-Acquired Condition Reduction Program - Hospital Readmissions Reduction Program - Coded data elements affecting Patient Safety Indicators - Patient Safety Indicators - Healthcare-associated infections and complication codes - Hospital Inpatient Quality Reporting Program - Hospital Value-Based Purchasing - CDI impact on Hospital Value-Based Purchasing |
数年以来弊社のPass4TestのIT試験分野での研究を通して、弊社はこの職業での重要な存在になります。弊社の開発したソフトは非常に全面的です。ACDISのCCDS試験ソフトは販売量が一番高いソフトの一で、受験生をよく助けて受験生に試験に合格させます。知られているのはACDISのCCDS試験に合格すればITという職業でよく発展しています。
質問 # 22
A CDI specialist submits a neutral query regarding possible acute blood loss anemia. The physician answers
"clinically unable to determine." The CDI specialist believes documenting the diagnosis would increase reimbursement substantially. What is the MOST appropriate next action?
正解：A
解説：
The provider's response should be respected unless new information or a genuine unresolved documentation issue creates a legitimate reason for additional clarification.
"Clinically unable to determine" is an acceptable professional conclusion when the available evidence does not permit the provider to confidently establish a diagnosis. A CDI specialist must not continue sending essentially the same query simply because a different response would produce more favorable reimbursement.
Likewise, CDI cannot alter the provider's response or instruct coding personnel to assign a diagnosis that the provider declined to establish.
The 2026 ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice supersede all previous versions and serve as the current foundational resource for query processes. The query process is intended to improve the accuracy, completeness, and integrity of documentation-not to secure a predetermined financial result.
A legitimate follow-up could occur if new laboratory values, operative findings, transfusion information, pathology, or other material information emerges after the original response and creates a materially different clarification question.
Professional CDI practice requires balancing clinical advocacy with provider autonomy, ethical conduct, and regulatory compliance.
CCDS Reference Topics: Provider query responses; ethical CDI practice; repeated queries; provider independence; compliance.
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質問 # 23
A patient presents with fever, productive cough, and infiltrates in the right upper lobe per chest x-ray. The history and physical notes that the patient has pneumonia and hypotension. Cultures are drawn and the patient is admitted for IV antibiotics. On day 2, the patient's condition worsens, and the patient is transferred to the ICU for closer monitoring. The ICU physician documents sepsis. Which of the following statements is MOST accurate?
正解：D
解説：
The key issue is whether the sepsis documented on hospital day 2 was present on admission (POA) or developed after admission. The admission already contains potentially relevant indicators-fever, pneumonia, hypotension, cultures, and IV antibiotic treatment-but a CDI specialist cannot independently determine from those indicators that sepsis was POA. Provider clarification is necessary.
This distinction directly affects principal-diagnosis sequencing. When sepsis and a localized infection such as pneumonia are both responsible for admission, the systemic infection is generally sequenced before the localized infection. Conversely, when the patient is admitted with pneumonia and sepsis develops only after admission, pneumonia is sequenced first.
The POA guidelines also emphasize that a diagnosis may not be recognized until days after admission and that delayed documentation does not automatically mean the condition was hospital-acquired. When timing is unclear, querying the provider is appropriate.
There is no evidence supporting aspiration pneumonia, so option B would introduce an unsupported concept.
Options C and D prematurely determine principal diagnosis without resolving the timing of sepsis.
CCDS Reference Topics: Sepsis sequencing; POA assignment; principal diagnosis; compliant clarification of timing.
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質問 # 24
An 82-year-old patient with a urinary infection develops an acute fluctuating disturbance in attention, disorganized thinking, and altered level of consciousness. The family states the patient was cognitively normal three days earlier. Which condition is MOST consistent with this presentation?
正解：C
解説：
The presentation is most consistent with delirium, an acute and fluctuating disturbance in attention, awareness, and cognition that frequently develops in medically ill hospitalized patients.
The abrupt onset over several days and fluctuating cognitive state distinguish delirium from most forms of dementia, which generally develop progressively over months or years. Infection, medications, metabolic abnormalities, dehydration, hypoxia, and organ dysfunction are common precipitants.
A urinary infection may be a contributing clinical factor, but CDI should not automatically establish a cause- and-effect relationship between infection and delirium unless supported by provider documentation.
The CDI specialist should also recognize that terms such as "altered mental status" are symptoms rather than equivalent substitutes for a more specific diagnosis. When the clinical record contains sufficient indicators and the provider has documented only nonspecific mental-status terminology, a query may be warranted.
Intellectual disability represents a developmental condition rather than an acute change in cognition. A persistent vegetative state represents profound and persistent impairment of consciousness and is inconsistent with the described fluctuating presentation.
CCDS Reference Topics: Delirium; altered mental status; cognitive disorders; clinical indicators; documentation specificity.
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質問 # 25
Which of the following principal diagnoses groups to MS-DRG 884, Organic Disturbances and Intellectual Disability?
正解：C
解説：
Vascular dementia is the correct answer. CMS MS-DRG logic places qualifying vascular dementia diagnoses from category F01.- within MS-DRG 884, Organic Disturbances and Intellectual Disability. The FY 2026 CMS MS-DRG Definitions Manual specifically lists vascular dementia codes among the principal diagnoses assigned to MS-DRG 884.
MS-DRG assignment depends on the principal diagnosis code, major diagnostic category, procedures when applicable, and other grouper logic. Therefore, clinically related forms of dementia do not necessarily group to the same MS-DRG. Alzheimer's disease is classified primarily as a neurologic degenerative disorder and requires appropriate dementia manifestations where applicable. Alcohol-induced dementia is classified within substance-related mental and behavioral disorders, while Wernicke encephalopathy is associated with thiamine deficiency and follows different classification logic.
For CCDS practice, this question illustrates why documentation of dementia etiology and type matters.
Simply documenting "dementia" can produce a less specific code and may affect MS-DRG assignment, risk adjustment, severity representation, and quality data.
The CDI specialist should seek clarification only when the clinical record supports a more specific dementia type.
CCDS Reference Topics: MS-DRG assignment; mental disorders; dementia specificity; IPPS reimbursement.
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質問 # 26
Two MS-DRGs have relative weights of 0.85 and 2.10. Which statement is MOST accurate?
正解：A
解説：
An MS-DRG relative weight principally represents relative expected resource consumption. Therefore, a DRG with a relative weight of 2.10 is associated with greater average resource intensity than one with a relative weight of 0.85.
The weight does not determine the hospital's billed charges, nor is it a direct mortality score. Clinically complex patients may often fall into higher-weight DRGs because they require more resources, but resource intensity, severity of illness, and risk of mortality are conceptually distinct.
The relative weight contributes to IPPS payment calculations when multiplied through the applicable standardized-payment methodology and adjusted by hospital-specific factors and other payment rules.
CMS publishes current MS-DRG weighting factors as part of the FY 2026 IPPS Final Rule materials.
For CDI professionals, understanding relative weight helps explain why accurate diagnoses and procedures can influence reimbursement. However, reimbursement consequences must never become the justification for obtaining unsupported documentation. The objective remains accurate representation of the patient's clinical condition and resources required.
CCDS Reference Topics: Relative weight; resource consumption; IPPS; MS-DRG payment; severity concepts.
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質問 # 27
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