Free ACDIS CCDS-O Practice Exam with Questions & Answers | Set: 2

RVUs are the foundation of Medicare’s physician fee schedule methodology and are built from three core components: physician work (wRVU), practice expense (peRVU), and malpractice (mpRVU). The malpractice expense RVU reflects the relative professional liability insurance cost associated with providing a service and is a defined element of the RVU calculation used to determine payment rates. In outpatient documentation and CDI education, it’s important to distinguish what drivescode selectionversus what is apayment calculation ingredient. Time with the patient and medical decision making influence E/M code selection under current E/M rules, but they are not standalone components of the RVU formula itself—they contribute indirectly by determining which CPT code is billed, and each CPT code has preassigned RVUs. Physician specialty type also is not a direct RVU component, even though specialty patterns can affect typical service mix and overall wRVU productivity. Therefore, among the options, malpractice expense is the explicit RVU component used in the calculation.

For ICD-10-CM injury coding, fracture codes require the correct 7th character to reflect the encounter type and healing status. Because the patient is being seen in the officeaftersurgical treatment (ORIF) and the orthopedist documents the fracture is “healing well without any complication,” this is asubsequent encounter for routine healing, not an initial encounter. Therefore, options A and B are incorrect because they use “initial encounter.” Next, the injury is described as acompound fracture, which is synonymous with anopen fracture. That makes a closed-fracture option inappropriate, eliminating option C. The remaining correct choice is the subsequent-encounter routine-healing option that also identifies the fracture as open. Outpatient CDI principles emphasize ensuring providers document key fracture elements—laterality, anatomic site, open vs closed, and healing status—because these drive compliant code assignment and correct sequencing for follow-up care. While real-world documentation ideally includes Gustilo type specificity, based on the provided choices, the best match is routine healing, subsequent encounter, open fracture.

To support a query foralcohol dependence in remission, outpatient CDI practice looks for indicators that reflect adocumented history of dependenceplus evidence the patient isactively maintaining sobrietyor being followed for recovery status. Attendance atAA meetingstogether with a documented history of excessive alcohol use is a strong, direct indicator of recovery efforts and ongoing monitoring of a prior substance use disorder. This combination supports clarifying whether the provider intends to diagnosealcohol dependence in remission(versus current dependence, use without dependence, or no current disorder). By contrast, cirrhosis and elevated liver enzymes (option A) can be caused by many etiologies and do not, by themselves, establish dependence or remission status. Nausea, vomiting, and abdominal distention (option D) are nonspecific and may suggest acute illness or liver disease but are not specific to remission. Occasional social drinking with recreational drug use (option C) suggests current substance use and would not support “in remission” without additional documentation. Therefore, option B best supports a remission-related query.

This documentation presents a key outpatient CDI problem:hemiparesis is present, but two potential causal conditions are referenced—history of CVAandintracranial trauma—without clear linkage. In ICD-10-CM, correct reporting of hemiparesis often depends on identifying whether it is alate effect (sequela)of a prior stroke, a residual from traumatic brain injury, or due to another neurologic condition. Coding hemiparesis automatically as a CVA sequela (option A) would be assumptive and potentially inaccurate, because the clinician has not documented the relationship. Likewise, simply coding hemiparesis alone (option D) may miss important etiologic specificity, and coding both histories without clarifying the cause (option B) still leaves the main clinical ambiguity unresolved. Outpatient CDI best practice is to issue anon-leading queryrequesting provider clarification of theetiology/sourceof the hemiparesis (e.g., due to prior CVA, due to prior intracranial trauma, both, or other/undetermined). This supports accurate diagnosis reporting, appropriate sequencing, and defensible risk/quality representation.

CDI staff do not alter the legal health record and should not “code it as is” when documentation is unclear, conflicting, or incomplete in a way that impacts accurate reporting. The compliant next step is to issue a provider query for clarification, ensuring the final record accurately reflects the provider’s clinical judgment. ACDIS-guided outpatient CDI emphasizes that queries are a quality and compliance tool: they reconcile discrepancies (e.g., conflicting diagnoses across notes, missing linkage between symptoms and conditions, unclear acuity such as “CHF” without type/status, or ambiguous infection documentation). The query should be supported by clinical indicators from the chart and should ask the provider to document the clarified diagnosis/status in the record (progress note, addendum, or appropriate attestation). Escalation to compliance is reserved for patterns of nonresponse, suspected integrity concerns, or systemic issues, not routine discrepancies. The objective is to achieve a complete, consistent clinical story that supports coding, risk adjustment, quality reporting, and medical necessity—through provider clarification, not CDI edits.

The record contains conflicting documentation: the problem list includes both “type 2 diabetes without complications” and diabetes with complications (erectile dysfunction association), while the most recent clinic note indicates the provider addressed “DM2 with autonomic neuropathy,” which is clearly a diabetic complication. In outpatient CDI, the first priority is to resolve internal inconsistency so coding accurately reflects the patient’s current clinical status and what was evaluated/managed at the encounter. A query should therefore focus on whether the patient’s diabetes iswith complications(and which complications are active/being addressed) versus trulywithout complications, because “without complications” is generally not appropriate when neuropathy/other manifestations are present and being managed. CDI staff also should not unilaterally remove items from the provider-maintained problem list, and asking the patient is not a reliable documentation/coding source for establishing diagnoses. Once the provider clarifies diabetes complication status, a follow-up clarification can address specific linkages (e.g., erectile dysfunction due to diabetes) if needed for correct code assignment

Under CMS-HCC methodology, risk adjustment is driven by ICD-10-CM diagnoses that map to HCC categories and are supported as active conditions addressed at the encounter.CKD stage 3is a classic HCC-qualifying chronic condition because it represents ongoing kidney disease severity and expected resource use, and in this note it is actively assessed with labs reviewed and a nephrology referral. Achronic non-pressure foot ulceris also typically HCC-qualifying when documented as ongoing and requiring management, which is supported here by home care/wound assessment planning. In contrast,“depression”(without specification such as major depressive disorder severity/status) commonly does not qualify for HCC in the way major depressive/bipolar categories do, making it less reliable as a risk-adjusting diagnosis. Likewise,“renal failure”is nonspecific and potentially conflicting with CKD stage 3; CDI best practice would be to clarify acuity/severity (acute kidney injury vs CKD stage vs ESRD) rather than assume “renal failure” as an HCC driver. Therefore, the validated HCC-qualifying pair is CKD 3 and chronic non-pressure ulcer.

In outpatient CDI, diagnoses reported for an encounter must be supported as current and clinically relevant to that visit (evaluated, monitored, assessed, treated, or otherwise affecting care). The note documents ahistoryof sick sinus syndrome with pacemaker placement in 2016 and indicates the current rhythm ispaced. The most clearly reportable, present condition is thepresence of a cardiac pacemaker, which is a status that can affect clinical decision-making (e.g., interpretation of rhythm findings, medication choices, procedures, and future cardiac evaluation) and is appropriate to code when documented. However, the documentation does not show that sick sinus syndrome itself was actively assessed or managed during this visit; it is referenced as a past condition leading to the device. Because outpatient coding does not assume an active diagnosis solely from historical mention, the best action is to capture thepacemaker statuscode only. Retrospective amendment requests or rebilling steps are not the first-line CDI action when the documentation does not support active management of the underlying arrhythmia.

A Stage 4 pressure ulcer (pressure injury) is characterized byfull-thickness tissue losswithextensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. The key phrase in the question—“necrosis of soft tissue through the underlying muscle”—signals a depth of injury that extends beyond the subcutaneous tissue and involves muscle, which is consistent with Stage 4. By comparison, Stage 2 involves partial-thickness skin loss with exposed dermis (no necrosis through deeper structures). Stage 3 involves full-thickness skin loss where adipose may be visible, butmuscle, tendon, or bone are not exposed; undermining and tunneling may occur, yet the defining line is that it does not extend to muscle/bone involvement. “Stage 5” is not part of standard pressure ulcer staging used in coding and documentation. Outpatient CDI practice emphasizes documenting the exact stage, anatomic location, laterality when applicable, and whether the ulcer is healing or complicated (infection/osteomyelitis) because stage drives specificity, severity capture, and appropriate care planning documentation.

In outpatient risk adjustment (commonly Medicare Advantage), the patient’s predicted cost is derived from the Risk Adjustment Factor (RAF), which is the sum of component risk contributions. Here, the RAF is calculated by adding the HCC diagnoses score (0.166), disease interactions (0.112), and demographic score (0.330). That total equals 0.608. The PMPM (per-member-per-month) baseline cost is $800. To estimate the patient’s expected monthly cost, multiply PMPM by RAF: $800 × 0.608 = $486.40 per month. The question asks for the expected yearly cost, so convert PMPM to annual: $486.40 × 12 = $5,836.80. ACDIS outpatient CDI teaching emphasizes that accurate documentation and compliant coding directly affect RAF through captured HCCs and interactions (when supported), which in turn drives expected resource needs and plan payment. Missing or unsupported diagnoses can understate RAF; vague documentation can prevent valid HCC capture.