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| Section | Weight | Objectives |
|---|---|---|
| Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Documentation and medical necessity of setting - IPPS and its updates and revisions - Complication/comorbidity (CC) - Documentation impact on IPPS reimbursement - Inpatient admission criteria and CMS Two-Midnight Rule - Coding and billing practices vulnerable to denial - Medicare contractors and their impact on CDI - Case mix index (CMI) - Principal diagnosis and medical necessity - Medical staff and clinical staff documentation responsibilities - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Major complication/comorbidity (MCC) |
| Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - Mental diseases and disorders - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Diseases and disorders of the respiratory system - HIV infections - Endocrine, nutritional, and metabolic diseases and disorders - Diseases and disorders of the digestive system - Diagnostic tests as clinical indicators - Clinical indicators and query opportunities by Major Diagnostic Category - Diseases and disorders of the nervous system - Myeloproliferative diseases and disorders and poorly differentiated neoplasms - Diseases and disorders of the musculoskeletal system - Injuries, poisonings, and toxic effects of drugs - Diseases and disorders of the skin, subcutaneous tissue, and breast - Infectious and parasitic diseases - Diseases and disorders of the circulatory system - Diseases and disorders of the kidney and urinary tract - Diseases and disorders of the hepatobiliary system - Standard medical abbreviations - Medications as clinical indicators - Pharmaceuticals and disease processes - Diseases and disorders of the blood and blood-forming organs and immunological disorders |
| Impact of reportable diagnoses on quality of care | 8.33% | - Hospital Inpatient Quality Reporting Program - 30-day mortality measures - Hospital Value-Based Purchasing - Hospital-Acquired Condition Reduction Program - Mortality reviews and observed/expected ratios - Quality data from record abstraction and claims data - Hospital Readmissions Reduction Program - CDI impact on Hospital Value-Based Purchasing - Coded data elements affecting Patient Safety Indicators - Patient Safety Indicators - Documentation and code assignment impact on mortality index - Healthcare-associated infections and complication codes |
| Professionalism, ethics, and compliance | 9.17% | - Compliance risks indicated by PEPPER - Potential DRG creep - Medical record confidentiality - CDI department goals beyond reimbursement - Leading queries - DRG compliance initiatives |
| Healthcare facility CDI program analysis | 8.33% | - Tracking and trending physician, department, and hospital performance - Hospital-specific financial data - Publicly reported data - Severity of illness and risk of mortality - Provider response rates - CDI program forecasting - PEPPER data - CDI specialist productivity metrics - Hospital Value-Based Purchasing measures - Case mix index (CMI) - Patient Safety Indicators - CC/MCC capture - Physician performance measurement - High-frequency DRGs - Basic computer and software application skills |
| Medical record documentation | 19.17% | - Health record elements used for diagnosis and procedure code assignment - Documentation requiring clarification - Compliant and noncompliant queries - Clinical indicators - Physician query formats - Types of physician queries - Situations in which queries are not appropriate - Translating clinical indicators into compliant queries - Provider role and diagnosis code assignment - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice - Addressing diagnoses without clinical support - When a physician query is warranted |
| Official Guidelines for Coding and Reporting | 14.17% | - AHA Coding Clinic - Secondary diagnosis assignment - Hospital-acquired conditions - Working DRG assignment for multiple diagnoses - Coding guidelines for principal diagnosis selection - Discharge dispositions and transfers - Principal diagnosis assignment - Official Guidelines for Coding and Reporting updates - Present on admission indicators |
| Communication skills | 9.17% | - Physician education forms and tools - Educational presentations for healthcare departments and administration - Roles and responsibilities of CDI specialists - Reconciling CDI working DRGs with final coded DRGs - Effective and non-confrontational physician communication - Verbal versus written physician communication - Roles and responsibilities of coders working with CDI departments |
TopexamのIT専門家たちは受験生の皆さんのニーズを満たすように彼らの豊富な知識と経験を活かして試験トレーニング資料の品質をずっと高めています。受験生の皆さんが一回でACDISのCCDS試験に合格することを保証します。Topexamの製品を購入したら、あなたはいつでも最新かつ最正確な試験情報を得ることができます。Topexamの資料のカバー率が高くて、受験生に便宜を与えられます。それに、問題集の合格率が１００パーセントに達するのですから、あなたは安心に試験を受けることができます。
質問 # 86
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?
正解：A
解説：
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.
質問 # 87
A physician responds to a clinically supported CDI query by stating that the proposed diagnosis does not apply and documents a different diagnosis supported by the patient's condition. What is the BEST action by the CDI specialist?
正解：B
解説：
The CDI specialist should respect the provider's independent clinical judgment, provided the response clearly addresses the query and the resulting documentation is clinically coherent.
A query is a request for clarification-not a mechanism for compelling the provider to select CDI's preferred diagnosis. Physician disagreement is therefore not inherently a failed query. The provider may appropriately document another condition, rule out a suspected condition, or explain why the indicators have another clinical interpretation.
Repeatedly querying until a desired diagnosis appears creates serious compliance risk and can undermine the integrity of the documentation process. Escalation may be appropriate in defined circumstances-for example, unresolved contradictions, unanswered high-priority queries, or persistent clinical-validation issues-but should follow organizational policy and should not occur merely because CDI dislikes the provider's answer.
The 2026 ACDIS/AHIMA guidance is the current foundational query-practice standard and emphasizes compliant clarification across healthcare settings.
Effective CDI communication requires clinical knowledge, professional dialogue, and recognition that final diagnostic determinations belong to the responsible provider.
CCDS Reference Topics: Physician communication; query responses; provider independence; escalation; professional conduct.
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質問 # 88
At discharge, the physician documents, "Possible gram-negative pneumonia." No later documentation rules out the condition. How should the diagnosis generally be handled for an inpatient admission?
正解：C
解説：
In the inpatient hospital setting, an uncertain diagnosis documented at discharge using terminology such as possible, probable, suspected, likely, questionable, compatible with, or consistent with may generally be coded as though the condition existed or was established.
Therefore, "possible gram-negative pneumonia" may be coded in accordance with the inpatient uncertain- diagnosis guideline when it remains the final diagnostic conclusion.
The rationale is that inpatient diagnostic evaluation and treatment frequently occur before absolute confirmation is available, and the patient may have been managed as though the suspected disease were present.
This rule is materially different from outpatient coding, where uncertain diagnoses are generally not coded as established and the documented signs, symptoms, or confirmed conditions are reported instead.
The presence of the uncertain terminology alone does not mandate a query. A query would be appropriate if documentation is contradictory, if the diagnosis is clinically unsupported, or if another documentation issue prevents correct code assignment.
CDI specialists need to recognize this inpatient-specific rule because unnecessary queries for "possible" or
"probable" diagnoses can create physician burden without improving coding accuracy.
CCDS Reference Topics: Uncertain inpatient diagnoses; discharge documentation; pneumonia; inpatient versus outpatient coding.
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質問 # 89
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?
正解：C
解説：
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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質問 # 90
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?
正解：D
解説：
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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質問 # 91
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