Key details for this exam, checked against the published exam outline
Each question shows the correct answer and an explanation of why it is right
Which of the following is designed to reduce claims denials and appeals by providing one-on-one feedback to the provider to increase accuracy in specific areas?
Targeted Probe and Educate (TPE) is an education-focused review initiative intended to improve billing accuracy and reduce future denials by combining targeted claim review with direct provider/supplier feedback. In outpatient CDI terms, TPE aligns with a ''fix-forward'' approach: auditors identify specific error patterns (often documentation, medical necessity, coding, or coverage rule issues), then provide one-on-one education so the provider can correct processes and documentation habits. This is distinct from Recovery Audit Contractors (RACs), which primarily identify and recoup improper payments, often after the fact, and are not structured as an individualized education cycle. The OIG Work Plan identifies oversight priorities and areas of potential fraud/waste/abuse; it does not deliver provider-level coaching to reduce denials. CERT measures Medicare improper payment rates through sampling and can drive policy/education broadly, but it is not designed as individualized, iterative provider education. Because TPE is specifically built around targeted review plus direct education to prevent repeat errors and reduce appeals, it is the best answer.
review]
Which of the following diabetic complications requires the assignment of a combination code plus the code for the specific complication?
In ICD-10-CM diabetes coding (as reinforced in outpatient CDI education), some diabetes manifestations are fully captured by a single diabetes ''combination'' code, while others require a diabetes complication code plus an additional code to identify the specific manifestation. Diabetic nephropathy and many forms of diabetic retinopathy are commonly represented by diabetes combination codes that already describe the manifestation with built-in specificity options (e.g., diabetes with nephropathy; diabetes with retinopathy with/without macular edema and severity). Osteomyelitis, however, is typically captured using a diabetes code such as ''diabetes with other specified complication'' (e.g., E11.69) to establish the linkage to diabetes and an additional code from the osteomyelitis category (e.g., M86.-) to specify the site, acuity, and type of osteomyelitis. From a chart review standpoint, CDI often queries to confirm the causal relationship (''due to diabetes'') and to ensure the osteomyelitis details (site, acute vs chronic) are documented so both codes can be assigned accurately and compliantly.
review]
A patient with stage 3 CKD presents to the clinic for evaluation. Upon review of labs, an elevated iPTH and a normal phosphorus level are noted. Which of the following diagnoses may be appropriately queried based upon these lab values?
In stage 3 chronic kidney disease, impaired vitamin D activation and early disturbances in calcium-phosphate regulation commonly drive a compensatory rise in parathyroid hormone (PTH), known as secondary hyperparathyroidism of renal origin. Outpatient CDI chart review looks for clinical indicators that suggest a condition being evaluated or requiring management, and an elevated iPTH in a CKD patient is a classic indicator that supports querying the provider for CKD-related mineral and bone disorder, specifically renal secondary hyperparathyroidism, if it is clinically being assessed/treated (e.g., monitoring trends, prescribing vitamin D analogs, calcimimetics, dietary counseling, nephrology follow-up). Primary hyperparathyroidism is less supported here because it typically requires a different biochemical pattern and clinical context (often hypercalcemia) rather than being driven by CKD physiology. Hypoparathyroidism is the opposite process (low PTH), making option C inconsistent with the lab finding. Option D is not supported because phosphorus is normal, not low, and hypophosphatemia is not documented as a driver. Therefore, querying for renal secondary hyperparathyroidism is most appropriate.
review]
Which of the following conditions or findings supports a diagnosis of diabetes?
In outpatient clinical documentation and chart review, diabetes can be supported by recognized diagnostic thresholds. An HbA1c value reflects average blood glucose over approximately the prior 2--3 months and is commonly used to diagnose and monitor diabetes. An HbA1c 6.5% (when confirmed per clinical practice standards and interpreted in the appropriate clinical context) supports a diagnosis of diabetes; therefore an HbA1c of 7.0% clearly meets the threshold and supports diabetes. By comparison, a 2-hour OGTT value of 90 mg/dL is normal and does not support diabetes (diabetes is typically supported when the 2-hour value is 200 mg/dL). Hypoglycemia is low blood glucose and is not diagnostic of diabetes; it may occur in diabetics due to treatment but can also occur in non-diabetics for many reasons. A fasting glucose of 100 mg/dL is at most borderline/prediabetes range and does not meet diagnostic criteria for diabetes (diabetes is supported at 126 mg/dL).
Which statement is MOST accurate about the problem list?
A well-maintained problem list supports continuity of care by giving the care team an accurate, up-to-date clinical ''snapshot'' of active and relevant historical conditions that affect ongoing management, decision-making, and risk assessment. Outpatient CDI education emphasizes that the problem list should be curated---conditions should be current, clinically meaningful, and appropriately resolved or clarified (e.g., active vs history, controlled vs uncontrolled). Option A is incorrect because diagnoses are not removed based on an arbitrary time threshold; they are updated based on clinical status (resolved, inactive, erroneous, or no longer relevant). Option C is inaccurate because simply adding more diagnoses can introduce noise and increase the risk of outdated or incorrect conditions being propagated (''problem list bloat''), which can harm patient safety and lead to inaccurate coding. Option D is inaccurate because CDI professionals typically do not independently update the problem list; rather, they support providers through compliant queries, education, and process improvements so the treating provider validates and maintains the record. Therefore, B best reflects outpatient documentation best practice.
140 questions covering all exam domains, starting from $20
Exam domains verified against: Official ACDIS CCDS-O exam guide, last checked September 2026.
Master the Official Guidelines for Coding and Reporting including first-listed and secondary diagnoses, reportable diagnosis criteria, and documentation from non-providers. Understand OPPS code sets, ambulatory payment classifications, and the distinction between inpatient and observation status. Apply CPT and ICD-10-CM concepts to medical necessity, claims submission, and Medicare Physician Fee Schedule reimbursement.
Identify clinical indicators and query opportunities across all disease categories from the ICD-10-CM Tabular List, including infectious diseases, neoplasms, endocrine disorders, circulatory and respiratory diseases, and injury/poisoning codes. Recognize pharmaceutical treatments, diagnostic tests without corresponding diagnoses, and standard medical abbreviations as documentation clarification triggers. Perform prospective and retrospective case reviews with awareness of common primary care documentation gaps.
Sample question from this domain above: Q3
Demonstrate expertise in CMS-HCC risk adjustment including hierarchies, disease interactions, beneficiary demographics, and RAF scoring calculations. Identify diagnoses that qualify as HCCs and understand how documentation impacts risk scores. Track HCC reporting performance, RAF progression, and ACO/MSSP metrics. Apply knowledge of Medicare Advantage capitated payments and compliant CMS-HCC reporting requirements.
Sample question from this domain above: Q1
Develop effective provider education tools and presentations tailored to departments and services while communicating in a nonconfrontational manner. Track key performance indicators including chart review productivity, query rates, and provider engagement metrics. Analyze outpatient CDI department performance through HCC reporting, RAF scoring, denial rates, and unspecified code usage. Measure impact on physician performance including E/M billing accuracy and risk-adjusted diagnosis capture rates.
Understand population health concepts and CDI collaboration with utilization review and care coordination teams. Explain MSSP and ACO operations, MACRA including MIPS and APMs, and CMS Quality Payment Program measures. Develop compliant outpatient queries adhering to ACDIS guidelines, distinguish between leading and acceptable query formats, and identify when queries are inappropriate. Apply HIPAA confidentiality standards and address OIG and RADV compliance requirements.
Common questions about the exam itself
