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ACDIS CCDS Exam Syllabus Topics:

SectionWeightObjectives
Official Guidelines for Coding and Reporting14.17%- Principal and secondary diagnosis assignment
- Coding guidelines, AHA Coding Clinic, HACs, and POA indicators
Medical record documentation19.17%- Documentation clarification and compliant physician queries
- Documentation requirements and diagnosis or procedure code assignment
Communication skills9.17%- CDI and coding roles and interdisciplinary collaboration
- Physician education and effective communication
Healthcare regulations, reimbursement, and documentation requirements related to the IPPS12.5%- CC/MCC, CMI, Medicare contractors, and compliance
- IPPS, MS-DRGs, reimbursement, and medical necessity
Healthcare facility CDI program analysis8.33%- CDI productivity, provider response, CMI, and program metrics
- Data analysis, forecasting, and performance measurement
Anatomy and physiology, pathophysiology, pharmacology, and medical terminology19.17%- Anatomy, physiology, pathophysiology, pharmacology, and terminology
- Clinical conditions and clinical indicators
Professionalism, ethics, and compliance9.17%- Query compliance, DRG creep, and audit risks
- Confidentiality, DRG compliance, and ethical CDI practices
Impact of reportable diagnoses on quality of care8.33%- Quality metrics, reporting programs, and financial impact
- Mortality, severity of illness, and risk of mortality

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ACDIS Certified Clinical Documentation Specialist Sample Questions (Q135-Q140):

NEW QUESTION # 135
After a month of intermittent antibiotic use, the patient is admitted. An infectious-control physician documents a diagnosis of Clostridium difficile in the inpatient medical record. Which domain of the MOST current Hospital Value-Based Purchasing program would this diagnosis impact?

Answer: A

Explanation:
The relevant Hospital Value-Based Purchasing domain is the Safety domain, corresponding most closely to option D. CMS's FY 2026 Hospital VBP program maintains a Safety domain that includes healthcare- associated infection performance measures, including C. difficile infection. CMS's current VBP Safety dataset specifically identifies C. difficile among its healthcare-associated infection measures.
It is important to distinguish the domain from an individual measure. "Hospital-acquired infection" describes the type of quality measure, but the formal broader scoring domain is Safety. PSI 90 is also associated with patient safety measurement, but it is not the name of the overall VBP domain.
From a CDI standpoint, documentation accuracy matters because coded and quality-reporting data can influence organizational performance assessment. However, documentation of C. difficile alone does not automatically establish that an infection qualifies as a hospital-onset event for every quality program. Timing and the applicable measure specifications determine whether an individual episode enters a particular healthcare-associated infection metric.
Therefore, CDI professionals should accurately capture the infection and its clinical circumstances without attempting to classify an event as hospital acquired solely to influence quality scores.
CCDS Reference Topics: Hospital VBP; Safety domain; healthcare-associated infections; C. difficile; quality reporting.
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NEW QUESTION # 136
A patient with COPD normally has a PaCO# of approximately 45 mmHg. The patient is admitted with increasing somnolence and respiratory distress. Arterial blood gas results are pH 7.27, PaCO# 68 mmHg, and PaO# 58 mmHg. BiPAP is initiated. Which condition is MOST appropriate for the CDI specialist to consider as a clarification opportunity?

Answer: A

Explanation:
The findings strongly support a clarification opportunity for acute hypercapnic respiratory failure. The patient has a substantial acute rise in PaCO# above the documented baseline, respiratory acidemia with a pH of 7.27, hypoxemia, altered mental status, respiratory distress, and escalation to noninvasive ventilatory support.
In chronic CO# retention, renal compensation commonly increases serum bicarbonate and may allow a relatively preserved pH. A pronounced fall in pH in conjunction with a significant increase in PaCO# suggests an acute ventilatory deterioration. The need for BiPAP provides additional evidence of clinically significant respiratory compromise.
Option C is incorrect because the acidemia is driven primarily by elevated carbon dioxide, indicating respiratory rather than metabolic acidosis. Option A fails to capture the apparent acute deterioration from the patient's baseline. Option D is inconsistent with the physiologic abnormalities and treatment intensity.
The CDI specialist must still obtain provider documentation rather than independently diagnose respiratory failure. The CCDS examination specifically includes acute/chronic respiratory failure, COPD, ventilation support, and diagnostic-test interpretation among expected clinical competencies.
CCDS Reference Topics: Acute respiratory failure; hypercapnia; ABG interpretation; COPD; noninvasive ventilation.
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NEW QUESTION # 137
Which of the following is a characteristic of a reportable secondary diagnosis?

Answer: A

Explanation:
Increased nursing care is specifically included in the UHDDS/ICD-10-CM definition of a clinically significant reportable secondary diagnosis. A secondary condition is reportable when it affects patient care by requiring clinical evaluation, therapeutic treatment, diagnostic procedures, an extended length of stay, or increased nursing care and/or monitoring.
This distinction prevents conditions that merely appear in the record but have no relevance to the current encounter from automatically becoming reportable secondary diagnoses. For example, a historical diagnosis that does not influence treatment, monitoring, evaluation, or length of stay generally should not be coded simply because it appears in a problem list.
Option A is imprecise. A secondary condition may extend the hospitalization, but it does not need to be the condition that originally "required hospital stay." Option B is the opposite of the guideline criterion, which refers to extended, not decreased, length of stay. Option C is also insufficient by itself: provider documentation establishes diagnoses, but documentation alone does not necessarily make every historical or clinically irrelevant condition reportable.
CDI specialists must therefore evaluate both provider documentation and the clinical significance of secondary conditions.
CCDS Reference Topics: Reporting additional diagnoses; UHDDS; secondary diagnosis criteria; resource utilization.
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NEW QUESTION # 138
The table below shows physician performance:

Which of the following physicians will have the most favorable mortality rate on a public website, such as Healthgrades.com?

Answer: C

Explanation:
Physician 4 has the most favorable risk-adjusted mortality rate, at 1.3, compared with Physician 1 at 1.5, Physician 2 at 2.0, and Physician 3 at 2.5. Although Physician 1 has fewer observed deaths and an observed mortality rate of 1.6%, public outcome comparisons commonly incorporate risk adjustment rather than relying solely on raw mortality. Risk adjustment attempts to account for differences in patient complexity, comorbid disease burden, demographic factors, and other characteristics that influence expected outcomes.
This is directly relevant to CDI because incomplete documentation of clinically significant comorbidities can understate patient severity and therefore adversely affect the expected mortality component of risk-adjusted performance calculations. Conversely, accurate documentation allows coded data to represent the actual severity and risk of the population being treated. Healthgrades specifically states that its mortality methodology adjusts for patient risk factors to permit more meaningful comparisons of clinical outcomes.
The CCDS content outline specifically requires knowledge of mortality indices, severity of illness/risk of mortality, physician performance, and the effect of documentation on publicly reported data.
CCDS Reference Topics: Impact of reportable diagnoses on quality of care; Healthcare facility CDI program analysis; mortality index and risk adjustment.
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NEW QUESTION # 139
A CDI program reports the following monthly results:
- Provider response rate: 97%
- Provider agreement rate: 84%
- Queries issued after discharge: 38%
- CDI/coder agreement: 96%
Which metric presents the clearest opportunity to improve concurrent CDI workflow?

Answer: A

Explanation:
The 38% post-discharge query rate represents the clearest workflow opportunity because a large proportion of clarification is occurring after the concurrent hospitalization period.
A 97% provider response rate reflects strong physician participation, while a 96% CDI/coder agreement rate indicates substantial alignment between concurrent CDI review and final coding. An 84% agreement rate is not inherently problematic because providers must remain free to disagree with a query based on their clinical judgment.
A high retrospective-query percentage can indicate that cases are being reviewed too late, that certain documentation opportunities are not recognized during hospitalization, that discharge documentation introduces unresolved diagnoses, or that staffing/workflow does not adequately prioritize cases before discharge.
A CDI manager should drill further into the metric by service line, query type, day of stay, weekday/weekend discharge, provider group, and reason for retrospective clarification. This analysis helps distinguish unavoidable retrospective queries from remediable process problems.
The objective is not to eliminate every post-discharge query. Some documentation issues become apparent only after final testing, pathology, procedures, or discharge summaries are completed.
CCDS Reference Topics: CDI program metrics; concurrent versus retrospective review; workflow analysis; performance improvement.
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NEW QUESTION # 140
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