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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Communication skills | 9.17% | - Physician education and effective communication - CDI and coding roles and interdisciplinary collaboration |
| Topic 2: Healthcare regulations, reimbursement, and documentation requirements related to the IPPS | 12.5% | - CC/MCC, CMI, Medicare contractors, and compliance - IPPS, MS-DRGs, reimbursement, and medical necessity |
| Topic 3: Official Guidelines for Coding and Reporting | 14.17% | - Coding guidelines, AHA Coding Clinic, HACs, and POA indicators - Principal and secondary diagnosis assignment |
| Topic 4: Medical record documentation | 19.17% | - Documentation requirements and diagnosis or procedure code assignment - Documentation clarification and compliant physician queries |
| Topic 5: Healthcare facility CDI program analysis | 8.33% | - CDI productivity, provider response, CMI, and program metrics - Data analysis, forecasting, and performance measurement |
| Topic 6: Professionalism, ethics, and compliance | 9.17% | - Confidentiality, DRG compliance, and ethical CDI practices - Query compliance, DRG creep, and audit risks |
| Topic 7: Anatomy and physiology, pathophysiology, pharmacology, and medical terminology | 19.17% | - Clinical conditions and clinical indicators - Anatomy, physiology, pathophysiology, pharmacology, and terminology |
| Topic 8: Impact of reportable diagnoses on quality of care | 8.33% | - Quality metrics, reporting programs, and financial impact - Mortality, severity of illness, and risk of mortality |
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NEW QUESTION # 84
Which of the following principal diagnoses groups to MS-DRG 884, Organic Disturbances and Intellectual Disability?
Answer: C
Explanation:
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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NEW QUESTION # 85
A patient presents with crushing substernal chest pain, diaphoresis, ST-segment depression, and a significant rise and fall in cardiac troponin. The cardiologist documents acute coronary syndrome but does not specify the final diagnosis. Which clarification is MOST clinically appropriate?
Answer: A
Explanation:
The clinical picture presents an appropriate opportunity to clarify whether the patient has NSTEMI, unstable angina, or another acute coronary diagnosis.
A significant rise and/or fall in cardiac troponin consistent with acute myocardial injury, together with ischemic symptoms and ECG abnormalities, strongly raises concern for acute myocardial infarction. In contrast, unstable angina generally refers to ischemia without the biomarker evidence required for myocardial infarction.
Nevertheless, CDI should not make the diagnosis independently. Troponin elevations can occur in multiple conditions, including myocarditis, pulmonary embolism, sepsis, tachyarrhythmia, renal disease, and other forms of myocardial injury.
Therefore, the cardiologist should be asked to clarify the final diagnosis based on the complete clinical evaluation.
GERD, chronic stable angina, and old MI do not adequately reflect the acute findings described.
For CCDS preparation, cardiovascular questions frequently require distinguishing symptoms from established diagnoses and understanding the clinical indicators associated with NSTEMI, STEMI, type 2 MI, and other myocardial injury categories.
The ACDIS candidate handbook identifies anatomy, physiology, pharmacology, pathophysiology, and clinical record analysis as essential examination competencies.
CCDS Reference Topics: NSTEMI; acute coronary syndrome; troponin; myocardial ischemia; diagnostic clarification.
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NEW QUESTION # 86
A patient accidentally takes twice the prescribed dose of warfarin and develops gastrointestinal bleeding.
Which coding concept applies?
Answer: D
Explanation:
Taking more medication than prescribed constitutes poisoning under ICD-10-CM drug-event rules. The drug may have been correctly prescribed, but the patient took an incorrect amount.
For poisoning, the applicable poisoning code is generally sequenced first, followed by codes identifying manifestations such as gastrointestinal bleeding.
This differs from an adverse effect, in which a drug is correctly prescribed and properly administered but causes an undesirable reaction. In adverse-effect scenarios, the nature of the adverse effect is coded first, followed by the drug code with the appropriate adverse-effect character.
Underdosing applies when the patient takes less of a medication than prescribed, whether intentionally or unintentionally. It does not describe excessive dosing.
For CDI specialists, determining whether an event represents poisoning, adverse effect, or underdosing requires careful review of how the medication was prescribed and actually taken. Phrases such as "warfarin- related bleeding" may not always provide enough information to determine the correct classification.
A clarification query may therefore be appropriate when dose, intent, or medication-use circumstances are unclear.
CCDS Reference Topics: Poisoning; adverse effects; underdosing; medication events; sequencing.
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NEW QUESTION # 87
Which of the following conditions demonstrates the greatest risk of mortality in a 77-year-old patient?
Answer: A
Explanation:
Among the choices presented, sepsis associated with a urinary tract infection represents the strongest overall mortality-risk condition. Sepsis is a systemic, potentially life-threatening response to infection and is associated with substantially greater mortality risk than an uncomplicated localized infection, particularly in an elderly patient.
Risk of mortality in CDI is not determined merely by whether a diagnosis is a CC or MCC. Risk-adjustment systems evaluate the complete clinical profile, including principal diagnosis, secondary diagnoses, age, organ dysfunction, severity interactions, and other patient characteristics. Thus, reimbursement severity and predicted mortality are related concepts but are not interchangeable.
The history of mastectomy ten years earlier does not itself materially increase the current acute severity unless active malignancy or another relevant condition is present. The principal acute concern in option D is sepsis.
COPD with respiratory failure and NSTEMI with acute systolic heart failure are also high-risk presentations and require complete documentation; however, the question's intended risk-adjustment comparison identifies the septic presentation as carrying the greatest mortality concern.
If acute organ dysfunction were linked to sepsis, documentation of severe sepsis would further increase the represented clinical severity.
CCDS Reference Topics: Risk of mortality; severity adjustment; sepsis; quality reporting; distinction between MS-DRG severity and ROM.
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NEW QUESTION # 88
A CDI specialist's working MS-DRG differs from the final coder-assigned MS-DRG in 18% of reviewed cases. What is the BEST initial management response?
Answer: A
Explanation:
A significant mismatch rate should trigger structured CDI/coding reconciliation, not an assumption that either department is wrong.
Working MS-DRGs are provisional. Final coding may change because of discharge-summary diagnoses, operative reports, pathology results, late physician clarification, Coding Clinic guidance, sequencing conventions, final procedure coding, CC/MCC exclusions, or other grouper logic unavailable during the concurrent CDI review.
The manager should categorize mismatch causes. Useful categories include principal-diagnosis differences, missed secondary diagnoses, procedure-code differences, coding-guideline interpretation, query results, discharge documentation, and technical grouper issues.
Patterns can then identify whether education is needed for CDI specialists, coding professionals, physicians, or multiple groups.
Requiring coding staff to adopt the CDI working DRG would undermine coding independence and final coding accountability. Excluding mismatches from metrics would conceal an important quality indicator.
CMS confirms that the FY 2026 MS-DRG Definitions Manual contains the complete grouper logic for Version 43.1, making current grouper rules essential when evaluating discrepancies.
CCDS Reference Topics: MS-DRG reconciliation; CDI/coder agreement; program analysis; education; grouper logic.
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NEW QUESTION # 89
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