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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Clinical Coding Practice | 15–18% | - DRG assignment and reimbursement concepts - Coding fundamentals and guidelines application - Diagnosis and procedure code assignment and sequencing |
| Topic 2: CDI Metrics and Statistics | - Performance metrics and reporting - Quality and outcome measurement (SOI/ROM) | |
| Topic 3: Education and Leadership Development | 21–26% | - CDI project development and physician engagement - CDI program leadership and organizational collaboration - Provider education and interdisciplinary communication |
| Topic 4: Compliance | - Regulatory compliance and ethical documentation practices - Audit readiness and documentation integrity standards | |
| Topic 5: Record Review and Document Clarification | 24–28% | - Post-discharge review and documentation validation - Clinical documentation review and gap identification - Provider query development and compliance |
1. The best approach in resolving unanswered queries is to
A) notify the physician advisor/champion that the physician has not responded to the query
B) notify the coding team of the physician's unanswered query
C) review the facility's query policies and procedures
D) contact the physician repeatedly until he/she responds to the query
2. The physician advisor/champion needs to provide ongoing education regarding coding and reimbursement regulations to the
A) organization's medical and surgical staff
B) Health Information Management coding staff
C) organization senior administration staff
D) clinical documentation integrity staff
3. AHIMA suggests which of the following for an organization to consider as physician response rate and agreement rate?
A) 70%/50%
B) 80%/80%
C) 80%/40%
D) 75%/75%
4. A patient is admitted due to pneumonia. On day 1, a sputum culture is positive for psuedomonas bacteria. If the physician is queried and agrees that the patient has pseudomonas pneumonia, this specificity would
A) increase relative weight
B) meet medical necessity
C) not meet medical necessity
D) not increase relative weight
5. An organization dealing with staffing shortages has adopted a policy requiring clinical documentation integrity practitioner (CDIP) to stop reviewing any record after a major complication or co-morbidity is found. What is the unintended consequence of this?
A) Increase in case mix index
B) Decrease in severity of illness and risk of mortality
C) Increased number of records reviewed by each CDIP
D) Reduced risk of clinical denials
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: A | Question # 3 Answer: B | Question # 4 Answer: A | Question # 5 Answer: B |
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