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

Case mix index is calculated by dividing the sum of MS-DRG relative weights by the number of inpatient discharges:

2,640 ÷ 1,600 = 1.65

Therefore, the CMI is 1.65.

CMI represents the average relative resource intensity of the hospital's inpatient cases. It is affected by the types of patients treated, surgical versus medical mix, tertiary services, transplant or trauma volume, documentation specificity, coding accuracy, and annual changes to MS-DRG relative weights and grouper logic.

CMS publishes hospital case-mix information and FY 2026 relative weighting factors through the IPPS Final Rule supporting data. Table 5 contains MS-DRGs and relative weighting factors, while Table 2 contains hospital-specific case-mix information.

A decline in CMI should not automatically be interpreted as a CDI failure. A shift toward lower-complexity cases or changes in service lines can legitimately reduce CMI even with excellent documentation.

CDI managers should therefore trend CMI alongside diagnosis capture, surgical volume, service lines, payer population, coding reconciliation, and quality indicators.

CCDS Reference Topics: Case mix index; MS-DRG relative weight; CDI analytics; hospital performance.

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The clinical picture presents an appropriate opportunity to clarify whether the patient has NSTEMI, unstable angina, or another acute coronary diagnosis.

A significant rise and/or fall in cardiac troponin consistent with acute myocardial injury, together with ischemic symptoms and ECG abnormalities, strongly raises concern for acute myocardial infarction. In contrast, unstable angina generally refers to ischemia without the biomarker evidence required for myocardial infarction.

Nevertheless, CDI should not make the diagnosis independently. Troponin elevations can occur in multiple conditions, including myocarditis, pulmonary embolism, sepsis, tachyarrhythmia, renal disease, and other forms of myocardial injury.

Therefore, the cardiologist should be asked to clarify the final diagnosis based on the complete clinical evaluation.

GERD, chronic stable angina, and old MI do not adequately reflect the acute findings described.

For CCDS preparation, cardiovascular questions frequently require distinguishing symptoms from established diagnoses and understanding the clinical indicators associated with NSTEMI, STEMI, type 2 MI, and other myocardial injury categories.

The ACDIS candidate handbook identifies anatomy, physiology, pharmacology, pathophysiology, and clinical record analysis as essential examination competencies.

CCDS Reference Topics: NSTEMI; acute coronary syndrome; troponin; myocardial ischemia; diagnostic clarification.

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The wound care nurse's documentation may be used to establish the stage of a pressure ulcer, making option D correct. ICD-10-CM provides specific exceptions to the general rule that diagnosis code assignment is based on documentation by a provider legally accountable for establishing diagnoses. Pressure-ulcer staging is one of the clinical details that may be derived from documentation by qualified non-provider clinicians involved in the patient's care.

Wound care nurses possess specialized expertise in pressure-injury assessment and commonly document staging based on tissue involvement. Current ICD-10-CM guidance directs assignment of the pressure-ulcer stage according to clinical documentation and provides specific rules for unstageable ulcers, healing ulcers, and ulcers that progress during hospitalization.

This exception does not mean that a wound-care nurse independently establishes every element of the medical diagnosis for coding purposes. The provider documentation remains central to identifying the pressure-ulcer diagnosis and relevant clinical condition, while the stage may come from qualified clinician documentation.

POA assignment follows separate reporting rules and is based on whether the condition was present at the time inpatient admission occurred.

CCDS Reference Topics: Pressure ulcers; non-provider documentation; staging; coding conventions.

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The strongest educational approach is targeted specialty-specific education using the surgeons' own documentation trends and realistic clinical examples. This addresses the recurring documentation problem while remaining clinically relevant to the audience.

Orthopedic surgeons do not need to become coding specialists. Education should instead explain which clinical distinctions matter—for example, whether anemia represents expected postoperative change, acute blood loss anemia, chronic anemia, or another diagnosis—and why accurate terminology improves the medical record.

Providing a long code list is unlikely to improve physician documentation behavior. Instructing surgeons to document acute blood loss anemia whenever hemoglobin decreases would be clinically inappropriate and could produce unsupported diagnoses. A postoperative hemoglobin decline may reflect hemodilution, expected surgical blood loss, chronic anemia, or other factors.

Stopping queries would leave meaningful ambiguities unresolved.

ACDIS/AHIMA query guidance emphasizes documentation accuracy and provider independence rather than reimbursement-focused diagnosis selection.

Successful physician education should be concise, clinically oriented, supported by service-line data, and reinforced when subsequent query trends demonstrate persistent problems.

CCDS Reference Topics: Physician education; communication; postoperative anemia; query trends; provider engagement.

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The attending physician is the correct answer and this scenario is adapted from an official ACDIS CCDS sample item addressing conflicting medical-record documentation.

ICD-10-CM coding depends on provider documentation, but when clinically significant documentation conflicts within the record, the discrepancy must be clarified rather than resolved independently by the coder or CDI specialist. The FY 2026 Official Guidelines specifically state that when medical-record documentation conflicts, the patient's provider should be queried for clarification.

In the inpatient environment, the attending provider is generally responsible for synthesizing the patient's diagnoses and final clinical picture. A consultant's documentation may supply essential clinical information and may support code assignment when there is no conflict, but conflicting descriptions of heart-failure type or acuity should not simply be selected based on which diagnosis produces the higher-severity code.

The query should identify the conflicting statements objectively and request clarification of the clinically appropriate diagnosis. It should not suggest which diagnosis should be selected or mention reimbursement consequences.

This concept is central to CDI because unresolved contradictions can affect MS-DRG assignment, risk adjustment, severity measurement, quality reporting, and the clinical integrity of the record.

CCDS Reference Topics: Conflicting documentation; provider clarification; heart-failure specificity; medical-record integrity.

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CMS PSI 90, the Patient Safety and Adverse Events Composite, is one of the six measures used in the FY 2026 HAC Reduction Program.

CMS states that the program uses one claims-based patient-safety composite—PSI 90—plus five healthcare-associated infection measures: CLABSI, CAUTI, colon and abdominal hysterectomy surgical-site infection, MRSA bacteremia, and C. difficile infection.

Case mix index is an MS-DRG resource-intensity statistic and is not a HACRP quality measure. Query-response rate is an internal CDI performance metric. Patient-experience measures belong to other CMS quality frameworks, including Hospital VBP, rather than constituting a HACRP measure.

For FY 2026, hospitals with Total HAC Scores above the 75th percentile—effectively the worst-performing quartile—are subject to a 1% payment reduction under the program.

A CDI specialist should also distinguish HACRP from the separate HAC/POA payment provision. CMS explicitly identifies them as distinct programs, even though both involve hospital-acquired conditions.

CCDS Reference Topics: HACRP; PSI 90; healthcare-associated infections; patient safety; quality reimbursement.

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The query should be rewritten as a neutral, clinically supported clarification request. The original wording is noncompliant because it directs the physician toward a particular diagnosis and explicitly identifies its reimbursement consequence.

The current ACDIS/AHIMA 2026 Guidelines for Achieving a Compliant Query Practice, released in August 2026, supersede prior versions and emphasize that the query process exists to ensure the health record accurately reflects the patient's clinical status.

A compliant query could present relevant findings such as oxygen saturation, respiratory rate, blood-gas values, oxygen requirements, work of breathing, escalation to noninvasive or invasive ventilation, and treatment. It should then request clarification using clinically reasonable choices or another compliant format without highlighting which answer produces an MCC.

An oxygen saturation of 84% may be an important indicator, but a CDI specialist may not convert that finding independently into respiratory failure. The provider must evaluate the complete clinical picture.

Approval from a coding manager does not cure biased wording. Substituting “CC” for “MCC” likewise leaves the fundamental compliance problem intact.

CCDS Reference Topics: Query compliance; leading queries; respiratory failure; ethical CDI practice.

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The clinical presentation most strongly supports clarification of hypovolemic shock, specifically hemorrhagic shock in the context of traumatic splenic bleeding. Profound hypotension at 80/60 mmHg, extreme tachycardia at 160 beats/min, substantial crystalloid resuscitation, transfusion of three units of packed red blood cells, and vasopressor support demonstrate severe circulatory compromise.

Acute blood loss anemia may also be present and should be documented when clinically supported, but it does not fully represent the patient's hemodynamic instability. Shock describes failure of effective tissue perfusion and therefore more accurately captures the immediate physiologic severity.

SIRS due to trauma is less specific than the evident volume-loss state and would not adequately describe the hemorrhagic circulatory collapse. The record already identifies splenic laceration; “ruptured spleen” should not be substituted without provider confirmation and appropriate operative/imaging evidence.

For CDI purposes, this is a classic situation in which documentation of only the anatomical injury understates the patient's physiologic acuity. A neutral query can present the documented hypotension, tachycardia, transfusion, fluids, and vasoactive treatment and request clarification of the associated condition.

CCDS Reference Topics: Shock; trauma; hemorrhage; acute blood loss; severity-of-illness documentation.

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BMI is one of the explicit ICD-10-CM exceptions permitting code assignment from documentation by a clinician other than the provider responsible for establishing the diagnosis. Therefore, the BMI of 43.6 may be taken from the dietitian's documentation, while the associated diagnosis of morbid obesity is supported by the attending physician's documentation.

The FY 2026 Official Guidelines specifically identify BMI, pressure-ulcer stage, non-pressure ulcer depth, coma scale, NIH Stroke Scale, certain social determinants, laterality, blood alcohol level, and several other elements as information that may be documented by other qualified clinicians. However, the associated diagnosis, such as obesity, must be documented by the patient's provider.

Option C incorrectly gives the dietitian's BMI documentation authority to establish the obesity diagnosis itself. Option D imposes an unnecessary discharge-summary requirement; valid diagnoses may be supported by appropriate provider documentation elsewhere in the health record according to applicable coding rules.

For CDI specialists, the key distinction is between a diagnosis and a permissible clinical detail used to further characterize that diagnosis.

CCDS Reference Topics: BMI; non-provider documentation; obesity; medical-record review; coding documentation exceptions.

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The CDI specialist should respect the provider's independent clinical judgment, provided the response clearly addresses the query and the resulting documentation is clinically coherent.

A query is a request for clarification—not a mechanism for compelling the provider to select CDI's preferred diagnosis. Physician disagreement is therefore not inherently a failed query. The provider may appropriately document another condition, rule out a suspected condition, or explain why the indicators have another clinical interpretation.

Repeatedly querying until a desired diagnosis appears creates serious compliance risk and can undermine the integrity of the documentation process. Escalation may be appropriate in defined circumstances—for example, unresolved contradictions, unanswered high-priority queries, or persistent clinical-validation issues—but should follow organizational policy and should not occur merely because CDI dislikes the provider's answer.

The 2026 ACDIS/AHIMA guidance is the current foundational query-practice standard and emphasizes compliant clarification across healthcare settings.

Effective CDI communication requires clinical knowledge, professional dialogue, and recognition that final diagnostic determinations belong to the responsible provider.

CCDS Reference Topics: Physician communication; query responses; provider independence; escalation; professional conduct.

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