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ACDIS CCDS-O Exam Syllabus Topics:

TopicDetails
Topic 1
  • Healthcare regulations, reimbursement, and documentation requirements related to the Official Guidelines for
Topic 2
  • and billing: Covers Official Coding Guidelines, OPPS reimbursement (APCs), and professional billing concepts including CPT E
  • M codes and Medicare Physician Fee Schedule documentation.
Topic 3
  • Coding and Reporting, the Outpatient Prospective Payment System (OPPS), and provider coding
Topic 4
  • Risk Adjustment Models and Impact of Documentation and Coding: Covers CMS-HCC model fundamentals, RAF scoring, Medicare Advantage payments, hierarchies, disease interactions, and compliant HCC reporting requirements.
Topic 5
  • 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.

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ACDIS Certified Clinical Documentation Specialist-Outpatient Sample Questions (Q131-Q136):

NEW QUESTION # 131
A 67-year-old male patient has been seen by a PCP multiple times this year. Diagnoses reported are diabetes with nephropathy with an HCC weight of 0.166; diabetes with retinopathy with an HCC weight of 0.166; atrial fibrillation with an HCC weight of 0.299, and a demographic risk factor weight of 0.332. Which of the following is this patient's final RAF score for these diagnoses?

Answer: D

Explanation:
The patient's RAF is calculated by adding the applicable HCC weights plus the demographic factor, but only after applying the HCC model's hierarchy rules. In outpatient risk adjustment education (as emphasized in ACDIS-based training), certain condition groups are hierarchical-meaning multiple related diagnoses in the same hierarchy do not "stack." Instead, only the highest-ranked HCC in that disease group contributes to the RAF. Here, "diabetes with nephropathy" and "diabetes with retinopathy" both carry the same HCC weight (0.166) and fall within the diabetes complication hierarchy, so they do not add together; only one 0.166 value is counted. Atrial fibrillation contributes separately (0.299), and the demographic risk factor contributes (0.332). Therefore, the final RAF is 0.166 + 0.299 + 0.332 = 0.797. This illustrates why outpatient CDI focuses on documenting all clinically supported conditions for care accuracy, while understanding that some related diagnoses won't increase RAF beyond the highest applicable HCC in that hierarchy.


NEW QUESTION # 132
A patient is seen at the clinic for a fever, and the provider documents possible Zika virus. A CDI specialist reviews the record and notes that a positive serology test indicates the Zika virus. Which of the following should the CDI specialist do NEXT?

Answer: B

Explanation:
In the outpatient setting, diagnoses documented as uncertain (e.g., "possible," "probable," "suspected," "rule out") are generally not coded as confirmed conditions; instead, coding is based on confirmed diagnoses or, when not confirmed, the presenting signs/symptoms. Here, the provider documented only "possible Zika," which is not a confirmed diagnosis for outpatient reporting. Even though the CDI specialist sees a positive serology result, lab data alone does not replace provider diagnostic confirmation in the assessment/plan. The appropriate next step is to query the provider to confirm whether Zika is the established diagnosis based on the positive test (and whether it is clinically addressed during the encounter). If confirmed, Zika can be coded appropriately and sequenced based on the reason for the visit; if not confirmed or still under evaluation, the symptom (fever) remains first-listed. Option B is incorrect because coders do not "code the result" of a serology test as a diagnosis; they code the condition the test supports once clinically confirmed.


NEW QUESTION # 133
An elderly patient with a PMH of CHF, DM type 1, arthritis, and HTN is seen in the clinic for a follow-up appointment after a recent hospitalization. After an evaluation of the patient's current health status, the provider documents the following: "HFrEF: lungs clear, no edema, continue meds. DM: no changes to insulin pump. Arthritis: asymptomatic joint destruction. HTN: BP stable. Continue meds." Which of the following is the clarification opportunity in the above scenario?

Answer: D

Explanation:
This encounter documents both hypertension and heart failure management, creating a key outpatient documentation/coding clarification opportunity: whether the heart failure is related to hypertension (hypertensive heart disease with heart failure). Outpatient CDI principles emphasize capturing the true clinical relationships that affect code assignment, risk adjustment, and longitudinal disease management. When HTN and HF coexist, coding may require combination coding and correct sequencing, plus an additional heart failure code to describe the specific HF type. Provider documentation that explicitly links (or explicitly rules out) a causal relationship supports compliant selection of the most accurate diagnosis codes and reduces ambiguity during chart review. The other options are weaker: the provider already documents HFrEF (type), and while added severity detail can help, the scenario's primary clarification "opportunity" is the HTN-HF relationship. DM type 1 inherently involves insulin, so "insulin status" is not the key outpatient clarification point here, and there is no typical direct linkage between DM and arthritis supported by the note.


NEW QUESTION # 134
An established patient is defined as one who has received professional services from the same or another physician or qualified healthcare professional from the exact same specialty and sub-specialty and belongs to the same group practice, within the past how many years?

Answer: D

Explanation:
For outpatient E/M reporting, "new vs. established patient" status is determined using a lookback period based on prior professional services. An established patient is one who has received face-to-face (or other qualifying professional) services from the same physician or another physician/qualified healthcare professional of the same specialty and subspecialty in the same group practice within the previous three years. This definition is critical for compliant coding because it drives which E/M code family is available (new patient codes vs established patient codes), and it affects relative valuation, documentation expectations, and audit risk. Outpatient CDI education emphasizes helping providers document the medical necessity and complexity of the visit regardless of patient status, but also ensuring correct administrative classification so coders select the correct code set. The three-year window prevents inappropriate use of new patient codes when the patient has an ongoing clinical relationship with the practice/specialty, supporting accurate reimbursement and consistent reporting.


NEW QUESTION # 135
Provider documentation states: "A patient is seen today with DM type 2, peripheral neuropathy with diabetic ulcer of the left great toe, hypertension, and BMI 43. O2 dependent, chronic respiratory failure due to COPD, stopped smoking 2 years ago - 84 packs per year smoking habit." Which of the following query opportunities will impact risk adjustment?

Answer: A

Explanation:
In ambulatory CDI, "risk adjustment impact" means the clarification can change whether an HCC-relevant condition is captured accurately (or captured at all) based on ICD-10-CM reporting rules. Here, "DM2 with peripheral neuropathy with diabetic ulcer" already establishes diabetes with complications, so querying option B adds little-complications are already documented. "Nicotine dependence" is not supported because the patient stopped smoking two years ago; at most, this supports a history of nicotine dependence, which generally does not drive HCC risk scoring. "Morbid obesity" may be clinically relevant (BMI 43 supports it), but obesity typically does not produce meaningful CMS-HCC risk adjustment impact compared with other chronic categories. The diabetic ulcer does matter: correct reporting requires an additional L97.- code that depends on ulcer severity/depth (skin breakdown, fat layer exposed, necrosis of muscle/bone). Clarifying depth supports accurate ulcer severity coding and can affect HCC capture/validation for chronic ulcer burden.


NEW QUESTION # 136
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