CCDS学習教材自体については、学習者が学習教材をさまざまな角度から効率的に学習できるように複数の機能を強化します。たとえば、試験を刺激する機能は、受験者が実際のCCDS試験の雰囲気とペースに精通し、予期しない問題の発生を回避するのに役立ちます。簡単に言えば、当社のCCDSトレーニングガイドは品質とサービスを優先し、ACDISお客様にCCDS試験に合格するための新しい体験と快適な気持ちをお届けします。
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - Complication/comorbidity (CC) - Inpatient admission criteria and CMS Two-Midnight Rule - Major complication/comorbidity (MCC) - Medicare contractors and their impact on CDI - Medical staff and clinical staff documentation responsibilities - Case mix index (CMI) - Documentation impact on IPPS reimbursement - Medicare Severity Diagnosis Related Groups (MS-DRGs) - Principal diagnosis and medical necessity - Documentation and medical necessity of setting - Coding and billing practices vulnerable to denial - IPPS and its updates and revisions |
| Topic 2: Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - Medications as clinical indicators - Diseases and disorders of the kidney and urinary tract - Injuries, poisonings, and toxic effects of drugs - Endocrine, nutritional, and metabolic diseases and disorders - Diseases and disorders of the nervous system - HIV infections - Diseases and disorders of the blood and blood-forming organs and immunological disorders - Diseases and disorders of the musculoskeletal system - Standard medical abbreviations - Alcohol/drug use and alcohol/drug-induced organic brain disorders - Diseases and disorders of the hepatobiliary system - Diseases and disorders of the circulatory system - Diseases and disorders of the skin, subcutaneous tissue, and breast - Pharmaceuticals and disease processes - Diseases and disorders of the digestive system - Diagnostic tests as clinical indicators - Diseases and disorders of the respiratory system - Infectious and parasitic diseases - Clinical indicators and query opportunities by Major Diagnostic Category - Mental diseases and disorders - Myeloproliferative diseases and disorders and poorly differentiated neoplasms |
| Topic 3: Professionalism, ethics, and compliance | 9.17% | - Potential DRG creep - CDI department goals beyond reimbursement - Medical record confidentiality - Compliance risks indicated by PEPPER - DRG compliance initiatives - Leading queries |
| Topic 4: Official Guidelines for Coding and Reporting | 14.17% | - Discharge dispositions and transfers - Working DRG assignment for multiple diagnoses - Official Guidelines for Coding and Reporting updates - Present on admission indicators - AHA Coding Clinic - Hospital-acquired conditions - Principal diagnosis assignment - Coding guidelines for principal diagnosis selection - Secondary diagnosis assignment |
| Topic 5: Medical record documentation | 19.17% | - Documentation requiring clarification - Translating clinical indicators into compliant queries - Compliant and noncompliant queries - Clinical indicators - Health record elements used for diagnosis and procedure code assignment - Types of physician queries - ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice - Provider role and diagnosis code assignment - Addressing diagnoses without clinical support - When a physician query is warranted - Situations in which queries are not appropriate - Physician query formats |
| Topic 6: Communication skills | 9.17% | - Roles and responsibilities of CDI specialists - Roles and responsibilities of coders working with CDI departments - Reconciling CDI working DRGs with final coded DRGs - Effective and non-confrontational physician communication - Physician education forms and tools - Verbal versus written physician communication - Educational presentations for healthcare departments and administration |
| Topic 7: Healthcare facility CDI program analysis | 8.33% | - Hospital-specific financial data - CDI program forecasting - Tracking and trending physician, department, and hospital performance - CDI specialist productivity metrics - High-frequency DRGs - CC/MCC capture - Physician performance measurement - Basic computer and software application skills - Case mix index (CMI) - Hospital Value-Based Purchasing measures - Publicly reported data - Patient Safety Indicators - Severity of illness and risk of mortality - PEPPER data - Provider response rates |
| Topic 8: Impact of reportable diagnoses on quality of care | 8.33% | - Hospital Readmissions Reduction Program - Mortality reviews and observed/expected ratios - Healthcare-associated infections and complication codes - Coded data elements affecting Patient Safety Indicators - Patient Safety Indicators - Hospital-Acquired Condition Reduction Program - Hospital Inpatient Quality Reporting Program - CDI impact on Hospital Value-Based Purchasing - Quality data from record abstraction and claims data - Documentation and code assignment impact on mortality index - 30-day mortality measures - Hospital Value-Based Purchasing |
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質問 # 18
A patient's baseline creatinine is 1.0 mg/dL. Following prolonged hypotension, creatinine rises to 3.8 mg/dL.
Urinalysis demonstrates granular casts, and the nephrologist documents "acute renal failure" but does not specify the underlying renal lesion. Which condition would be MOST appropriate to consider in a clinically supported clarification query?
正解：A
解説：
The clinical pattern supports consideration of acute tubular necrosis (ATN) as a clarification opportunity.
Prolonged hypotension can cause renal ischemia severe enough to injure tubular epithelial cells. A substantial acute creatinine increase and granular or "muddy brown" casts are classic clinical findings associated with ATN.
The provider has already documented acute renal failure, so the purpose of the query would be to clarify the underlying type of acute kidney injury when clinically appropriate-not to create AKI from laboratory data alone.
Stage 5 chronic kidney disease requires evidence of chronic, persistent severe renal dysfunction and cannot be inferred from an acute creatinine rise following hypotension. Nephrotic syndrome is characterized principally by substantial proteinuria, hypoalbuminemia, edema, and other findings not described here. Pyelonephritis would ordinarily require evidence of upper urinary infection.
A CDI specialist should review the complete clinical record, including baseline renal function, hemodynamic course, nephrology notes, urinalysis, fluid management, nephrotoxic exposures, and renal replacement therapy when applicable.
The CCDS competency framework includes renal failure, laboratory interpretation, and recognition of clinically supported opportunities for diagnostic specificity.
CCDS Reference Topics: Acute kidney injury; acute tubular necrosis; renal pathophysiology; clinical indicators; diagnostic specificity.
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質問 # 19
Which pressure-ulcer category is specifically included in the traditional CMS HAC payment policy when the condition is not present on admission?
正解：B
解説：
CMS's Hospital-Acquired Condition payment framework specifically identifies Stage III and Stage IV pressure ulcers among the defined HAC categories when applicable conditions are not present on admission.
The distinction is important because not every pressure injury automatically triggers HAC payment treatment.
Stage and POA status therefore require accurate documentation.
A hospital-acquired pressure ulcer remains reportable even when HAC payment provisions apply. CMS does not instruct hospitals to suppress or omit such conditions. Instead, defined HAC diagnoses that are not POA may lose the CC/MCC payment effect they otherwise would contribute to the MS-DRG, subject to applicable grouper rules.
The CDI specialist should ensure that wound location, laterality when relevant, stage, progression, and timing are accurately documented. Qualified wound-care nurse documentation may be used for pressure-ulcer staging under the ICD-10-CM non-provider documentation exception, while the diagnosis itself remains subject to provider-documentation requirements.
CDI professionals must also distinguish the HAC/POA MS-DRG payment provision from the separate HAC Reduction Program, which reduces applicable hospital payments by 1% for hospitals in the worst-performing quartile.
CCDS Reference Topics: HACs; pressure ulcers; POA; MS-DRG adjustment; wound documentation.
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質問 # 20
Which statement BEST defines the principal diagnosis for an inpatient hospitalization?
正解：B
解説：
The principal diagnosis is the condition established after study to be chiefly responsible for occasioning the patient's admission to the hospital for care. This is the UHDDS definition used in the ICD-10-CM Official Guidelines for inpatient principal-diagnosis selection.
"After study" is critical. The diagnosis initially suspected in the emergency department may change after diagnostic testing, consultation, treatment response, surgery, pathology, or other evaluation. The final principal diagnosis therefore may differ from the first diagnosis documented.
Relative weight does not determine principal diagnosis. A hospital cannot select a higher-paying condition merely because it produces a more favorable MS-DRG. Similarly, medication volume is not a principal- diagnosis criterion.
For CDI specialists, principal-diagnosis review requires understanding the circumstances surrounding admission, the diagnostic workup, final provider documentation, sequencing conventions, and any chapter- specific guidelines. When two conditions are documented and it is unclear which chiefly occasioned the admission, a provider query may be warranted.
The CCDS content outline specifically tests the principles and application of principal-diagnosis assignment.
CCDS Reference Topics: Principal diagnosis; UHDDS; inpatient sequencing; working MS-DRG.
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質問 # 21
Which of the following programs specifically reduces applicable Medicare payments by 1% for hospitals in the worst-performing quartile based on hospital-acquired-condition measures?
正解：D
解説：
The Hospital-Acquired Condition Reduction Program (HACRP) imposes a 1% reduction in applicable Medicare fee-for-service payments on subsection (d) hospitals ranking in the worst-performing quartile based on the Total HAC Score.
For the current program, CMS uses six measures: the CMS Patient Safety and Adverse Events Composite (PSI 90) and five healthcare-associated infection measures-CLABSI, CAUTI, specified surgical-site infection, MRSA bacteremia, and C. difficile infection.
HACRP must be distinguished from the separate DRA Hospital-Acquired Condition/Present-on-Admission payment provision. CMS explicitly states that these are different programs.
Hospital Value-Based Purchasing also links quality performance with hospital payment, but its structure is different: it is funded through a 2% reduction of participating hospitals' base operating DRG payments that is redistributed through value-based incentives.
For CDI professionals, accurate clinical documentation helps ensure that quality data appropriately represent the patient's condition and hospital course. CDI should not attempt to suppress valid complications or create unsupported comorbidities to change quality performance.
CCDS Reference Topics: HACRP; PSI 90; HAIs; quality reimbursement; CMS quality programs.
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質問 # 22
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 # 23
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