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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: CDI Metrics & Statistics | 14–18% | - DRG comparison and denial analysis - Benchmarking and reporting - Query response and volume tracking - Quality audits and compliance monitoring |
| Topic 2: Clinical Coding Practice | 22–26% | - Principal and secondary diagnosis identification - Payer requirements and reimbursement models - Coding software and reference resources - ICD-10-CM/PCS coding conventions and guidelines - DRG, CPT, and HCPCS code assignment |
| Topic 3: Research & Education | 11–15% | - Regulatory and guideline updates - Best practice research and implementation - Documentation improvement training materials - Provider and staff education |
| Topic 4: Compliance | 4–8% | - Compliance monitoring and reporting - Legal and ethical documentation practices - Fraud and abuse prevention - AHIMA standards and regulatory requirements |
| Topic 5: Leadership | 17–22% | - Policy and procedure creation - Provider engagement and communication - CDI program development and promotion - Interdisciplinary collaboration |
| Topic 6: Record Review & Document Clarification | 24–28% | - Ethical provider query development - Query tracking and follow-up - POA, HAC, SOI, ROM clarification - Compliance with query standards - Identify documentation gaps and specificity issues |
1. A patient is admitted for chronic obstructive pulmonary disease (COPD) exacerbation. The patient is on 3L of home oxygen and is treated during admission with 3L of oxygen. The most appropriate action is to
A) query the provider to see if acute on chronic respiratory failure is supported by the health record
B) code the diagnoses of COPD exacerbation and chronic respiratory failure
C) query the provider to see if chronic respiratory failure is supported by the health record
D) query the provider to see if respiratory insufficiency is supported by the health record
2. Tracking denials within the clinical documentation integrity program is important to
A) identify documentation improvement opportunities and educate as necessary
B) determine coding inaccuracies and educate as necessary
C) file a timely appeal if the medical center disagrees with the RAC findings
D) confirm reimbursement was appropriate
3. The best approach in resolving unanswered queries is to
A) notify the coding team of the physician's unanswered query
B) review the facility's query policies and procedures
C) contact the physician repeatedly until he/she responds to the query
D) notify the physician advisor/champion that the physician has not responded to the query
4. When there are comparative contrasting diagnoses supported by clinical criteria, the correct action is to
A) not code either diagnosis
B) query for clarification
C) code the first condition listed
D) code both diagnoses
5. A noncompliant query includes querying the provider regarding
A) morbid obesity due to BMI of 40.9 documented on the history and physical
B) gram-negative pneumonia on every pneumonia case, regardless of documented clinical indicators
C) acute blood loss anemia due to low hemoglobin treated with iron supplements
D) sepsis that was present on admission because sepsis was only documented in the discharge summary
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: B | Question # 4 Answer: D | Question # 5 Answer: B |
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