Free ACDIS CCDS Practice Exam with Questions & Answers

Complete clinical documentation is the foundation of accurate MS-DRG assignment. The coding process translates provider documentation into ICD-10-CM and ICD-10-PCS codes, and those codes drive the MS-DRG grouper. If the record does not accurately capture the principal diagnosis, secondary diagnoses, acuity, etiologies, complications, procedures, and clinically relevant relationships, the resulting MS-DRG may not accurately represent the patient's hospitalization.

CMS explains that MS-DRG assignment depends on factors including diagnoses, procedures, complicating conditions, age, sex, and discharge status. Each resulting MS-DRG has a payment weight representing relative resource requirements.

POA documentation is important, particularly for HAC payment logic, but it is only one component of overall documentation completeness. Quality indicators and patient-satisfaction information serve other important organizational purposes but do not substitute for complete provider documentation when grouping the inpatient claim.

The role of CDI is therefore broader than capturing CCs or MCCs. CDI professionals work to ensure that the entire medical record provides a precise clinical description of the patient and services rendered, allowing coding, quality reporting, risk adjustment, utilization review, and reimbursement to be based on the same accurate clinical story.

CCDS Reference Topics: Documentation integrity; MS-DRG assignment; principal/secondary diagnoses; CDI fundamentals.

=========

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.

=========

The findings create a strong clarification opportunity for hepatic encephalopathy. Cirrhosis, altered mental status, asterixis, elevated ammonia, and improvement with lactulose collectively support an encephalopathic process related to hepatic dysfunction.

The CDI specialist should not independently diagnose hepatic encephalopathy from the findings. Instead, the physician should be asked to clarify the condition represented by the documented phrase “altered mental status due to liver disease.”

Hepatic encephalopathy is clinically more specific than a nonspecific symptom such as altered mental status and has a distinct ICD-10-CM classification. Elevated ammonia alone is not sufficient to establish the diagnosis because ammonia levels do not always correlate directly with the severity of encephalopathy. The entire clinical picture must be considered.

Dementia generally represents a chronic neurocognitive disorder and does not adequately explain the acute presentation. Alcohol withdrawal requires an appropriate history of cessation or reduction plus characteristic withdrawal manifestations. Metabolic acidosis concerns acid-base physiology and is not supported by the described findings.

This is an example of CDI moving documentation from a nonspecific symptom to a clinically meaningful diagnosis without directing the provider to a predetermined answer.

CCDS Reference Topics: Hepatic encephalopathy; cirrhosis; neurologic manifestations; clinical indicators; documentation specificity.

=========

The high-risk practice is destroying unanswered queries. Query retention should be governed by an established organizational policy and should not depend on whether the provider answers the query. Selectively destroying unanswered queries can create significant compliance, audit, and record-integrity concerns because it removes evidence of the documentation-clarification process.

ACDIS/AHIMA guidance has consistently required organizations to establish query-retention policies. Queries may be retained as part of the permanent health record or maintained as a retrievable business record according to organizational policy and legal requirements. The current 2026 ACDIS/AHIMA query practice guidance supersedes all previous editions, reinforcing the importance of a standardized, defensible query process.

Keeping queries in the health record is not inherently problematic when policy defines them as part of that record. Likewise, a new diagnosis may be included in a multiple-choice query when it is supported by patient-specific clinical indicators and the choices remain nonleading. A yes/no query can also be compliant in defined circumstances, such as clarification of a diagnosis or relationship already documented.

Selective destruction is therefore the clear compliance risk.

CCDS Reference Topics: Query retention; compliance; organizational query policy; audit integrity.

=========

Acute on chronic systolic heart failure is the intended answer. This scenario is adapted from an official ACDIS CCDS sample question, which uses dyspnea, edema, elevated BNP, reduced ejection fraction, and left-ventricular dysfunction to test appropriate heart-failure clarification.

The ejection fraction of 25% and documented left ventricular systolic dysfunction support a systolic phenotype. The patient's significant dyspnea and edema are consistent with acute decompensation superimposed on the established history of heart failure. Together, these findings create a legitimate opportunity to clarify type and acuity.

The CDI specialist must nevertheless avoid diagnosing acute-on-chronic systolic failure independently. The provider determines whether the findings represent acute decompensation, chronic disease, another heart-failure phenotype, or another explanation entirely.

Option A would require evidence supporting both systolic and diastolic dysfunction. Option B fails to capture the apparent acute decompensation. Option D conflicts with the documented systolic dysfunction and reduced EF.

This question illustrates a frequent CCDS theme: translating clinical indicators into a neutral clarification opportunity rather than assigning a diagnosis based solely on test results.

CCDS Reference Topics: Heart-failure acuity and type; ejection fraction; BNP; compliant query development.

=========

The documented acute mental-status change associated with systemic infection creates a reasonable clarification opportunity for acute metabolic encephalopathy, assuming the complete clinical record supports that diagnosis.

Encephalopathy represents diffuse cerebral dysfunction arising from systemic, metabolic, toxic, hypoxic, infectious, or other causes. Acute confusion, impaired attention, fluctuating cognition, and absence of a focal lesion can support an encephalopathic process.

However, the CDI specialist cannot convert “altered mental status” into encephalopathy independently. The provider must determine whether the patient's presentation represents metabolic encephalopathy, delirium, medication effect, dementia, another neurologic condition, or simply a nonspecific symptom.

Chronic dementia does not fit the acute fluctuating pattern unless underlying dementia is separately documented. Cerebral infarction would generally require compatible focal neurologic findings and clinical or imaging evidence. Transient global amnesia typically presents with prominent acute memory disturbance rather than generalized encephalopathy.

A compliant query should include the mental-status findings, infectious process, relevant laboratory data, neurologic evaluation, treatment, and clinical course.

CCDS Reference Topics: Encephalopathy; altered mental status; infection; neurologic clinical indicators; diagnostic clarification.

=========

The most clinically supported clarification is acute cerebral infarction. A transient ischemic attack is characterized by transient neurologic dysfunction without acute infarction. In this scenario, the patient's slurred speech has resolved, but the right-sided weakness persists, and CT demonstrates a new hypodense cerebral area. Together, those findings raise substantial concern for an established ischemic infarction rather than a completely transient event.

The CDI specialist should not independently convert the diagnosis of TIA to cerebral infarction. Instead, the persistent focal deficit and imaging findings establish an appropriate clinical basis for a provider query asking whether the final diagnosis is acute cerebral infarction, TIA, another neurologic condition, or clinically undetermined.

Acute encephalopathy generally produces global cerebral dysfunction rather than the focal unilateral weakness described here. Transient global amnesia predominantly affects memory formation and would not explain persistent unilateral motor deficits. Transient cerebral ischemia/TIA becomes less consistent once objective evidence of acute infarction and persistent neurologic impairment is present.

Accurate clarification is important because cerebral infarction and TIA differ substantially in coding, severity representation, quality reporting, and secondary-prevention planning.

CCDS Reference Topics: Neurologic clinical indicators; cerebral infarction versus TIA; diagnostic clarification; medical record specificity.

=========

The CDI specialist should clarify the clinical significance and relationship to the procedure. Not every condition occurring after surgery constitutes a complication of care, and mechanical ventilation itself does not establish postoperative respiratory failure.

Major operations often require planned postoperative ventilatory support because of anesthesia, surgical duration, hemodynamic status, or other expected recovery needs. Conversely, unexpected inability to extubate, severe hypoxemia or hypercapnia, escalating ventilatory support, or other clinical deterioration may support a genuine postoperative respiratory complication.

ICD-10-CM complication reporting requires careful attention to provider documentation of the relationship between the condition and the procedure. The FY 2026 Official Guidelines emphasize that the fact a condition occurs after a procedure is not, by itself, sufficient to classify it as a complication.

Option A therefore assumes a complication that may not exist. Option C improperly alters provider documentation without clarification. Option D mistakes treatment for diagnosis.

A compliant query should objectively present respiratory findings, duration of ventilation, reintubation or escalation when present, and the operative/anesthesia documentation, then allow the provider to characterize the condition.

CCDS Reference Topics: Postoperative respiratory failure; complications of care; mechanical ventilation; clinical validation.

=========

A neutral multiple-choice query is appropriate when significant clinical indicators exist but no corresponding diagnosis has been documented. The query should present the relevant patient-specific facts and allow the provider to exercise independent clinical judgment among reasonable alternatives.

For example, depending on the complete record, options could include sepsis, localized infection without sepsis, bacteremia, another condition, or unable to determine. Each offered diagnosis must be clinically supported.

A yes/no query is generally inappropriate when it introduces a completely new diagnosis that has never appeared in the health record. Option B is overtly leading because it directs the provider to document sepsis rather than requesting clarification.

The 2026 ACDIS/AHIMA compliant-query guidance, published August 20, 2026, supersedes all previous versions and serves as the current foundational standard for CDI and coding query practice. It applies across inpatient, outpatient, ambulatory, and professional-fee settings.

The purpose of the query is documentation integrity—not obtaining an MCC, changing the MS-DRG, or achieving a particular quality result.

CCDS Reference Topics: Multiple-choice queries; missing diagnosis; nonleading queries; clinical indicators; compliance.

=========

POA indicator U means that the documentation is insufficient to determine whether the condition was present on admission.

This is different from Y, which indicates that the condition was present when inpatient admission occurred, and N, which indicates that the condition was not present at admission. Indicator W is used when the provider is unable to clinically determine whether the condition was present at the time of inpatient admission.

The distinction between U and W is especially important. U reflects inadequacy of the documentation, whereas W reflects a clinical determination that the timing cannot be established despite appropriate evaluation.

CDI specialists should generally attempt to resolve unclear timing when clinically feasible before a case reaches final coding. Accurate POA assignment can influence CMS Hospital-Acquired Condition payment logic and quality measurement.

CMS publishes an annual list of diagnoses exempt from POA reporting and maintains the FY 2026 POA resources separately from the HAC code lists.

POA reporting focuses on the condition's status at inpatient admission, not merely when it was first documented or when diagnostic confirmation became available.

CCDS Reference Topics: POA indicators; U versus W; HACs; admission timing; inpatient reporting.

=========