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 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 Option C is inaccurate because simply adding more diagnoses can introduce noise and increase the risk of outdated or incorrect conditions being propagated (''problem list bloat''), which can harm patient safety and lead to inaccurate coding.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.
When compliantly querying providers, CDI specialists or HIM/coding professionals may
Compliant querying principles taught in outpatient CDI allow the CDI/coding professional to present a multiple-choice query that includes reasonable diagnostic options supported by the current encounter's clinical indicators. Including a ''new'' diagnosis as an option is acceptable when it is clinically supported by documented findings (signs/symptoms, test results, treatments, clinical course) and the query is written in a non-leading manner---typically with balanced options and an ''other'' and/or ''unable to determine'' choice. This approach helps the provider clarify the most accurate condition being evaluated or treated without steering toward a particular response. Option A is not compliant because relying solely on prior encounter documentation (without current relevance) risks coding historical conditions that are not addressed today. Option B is generally discouraged because calling out HCC status can be perceived as prompting for payment impact rather than clinical accuracy. Option D is incorrect because including relevant clinical indicators is essential; omitting them weakens the clinical basis and does not make a query less leading---rather, it makes it less defensible.
A patient presents to the clinic for follow up of type 2 diabetes. The patient is also noted to have peripheral neuropathy. The patient has COPD and is found to have no recent exacerbations. The patient also has a history of depression, reported as stable. Which of the following CMS-HCCs will be captured for this visit?
HCC 17: Diabetes with Acute Complications
HCC 18: Diabetes with Chronic Complications
HCC 19: Diabetes without Complications
HCC 58: Major Depressive, Bipolar and Paranoid Disorders
HCC 111: Chronic Obstructive Pulmonary Disease
In the CMS-HCC model, diabetes categories are hierarchical, meaning you capture the highest supported diabetes HCC for the year, not multiple diabetes HCCs simultaneously. Type 2 diabetes with peripheral neuropathy represents a chronic diabetic complication, so it maps to HCC 18 (Diabetes with Chronic Complications) rather than HCC 19 (without complications) or HCC 17 (acute complications). COPD is documented as present and clinically relevant (even without an exacerbation) and therefore maps to HCC 111 (Chronic Obstructive Pulmonary Disease) when it is assessed/managed as part of the visit. ''History of depression, stable'' does not necessarily meet the threshold for HCC 58, which is reserved for specific serious psychiatric diagnoses (e.g., major depressive disorder, bipolar disorder, paranoid disorders). A general ''depression'' history, especially if not specified as major depressive disorder and not actively addressed, often will not support HCC 58 capture. Therefore, the visit captures HCC 18 and HCC 111 only.
Which of the following is a provider benefit of a prospective query?
A prospective query is initiated early enough (before or during the visit workflow) so the provider can evaluate, assess, and document the condition in real time while the patient is present. This is a major provider benefit because it supports better clinical accuracy and completeness: the clinician can ask targeted questions, perform relevant exam elements, review results, and determine whether the condition is present, active, being monitored, or ruled out---then document the final clinical impression and plan. From an ACDIS outpatient CDI perspective, prospective querying improves efficiency and reduces retrospective ''chart-chasing,'' late addenda, and documentation gaps that occur when clarification is requested after the encounter is closed. Importantly, prospective queries must remain non-leading and cannot direct the provider to a particular diagnosis (eliminating option A). They also cannot ''guarantee'' risk-adjusted capture because the diagnosis must be clinically supported and addressed (eliminating option B). Defining the purpose of the encounter is driven by the clinical reason for visit, not by CDI (eliminating option D).
review]
A patient is scheduled to see his PCP in 3 days. A CDI specialist notes that during the patient's last visit earlier this year, the problem list shows both DM 2 associated erectile dysfunction and DM 2 without complications. The last clinic note states that DM 2 with autonomic neuropathy was addressed. The CDI specialist should do which of the following FIRST?
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 is with complications (and which complications are active/being addressed) versus truly without 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
Which of the following tools or processes is MOST appropriate to share with providers and administrators during a department meeting when demonstrating documentation and coding patterns?
When the goal is to demonstrate documentation and coding patterns to a mixed audience of providers and administrators, the most effective tool is one that clearly displays comparisons and trends in an easily interpretable way. A bar graph is ideal because it can quickly show differences in rates or volumes---such as unspecified diagnosis utilization, HCC capture rates, query response/agree rates, denial categories, or condition specificity---across providers, clinics, or time periods. This supports outpatient CDI education by making variation visible and actionable while keeping the discussion focused on documentation behaviors and opportunities for improvement. A spaghetti diagram is used for mapping physical workflow movement and inefficiencies, not coding patterns. The PDSA cycle is a structured improvement method for testing changes, but it is not primarily a visualization tool for presenting pattern data. The Donabedian model (structure--process--outcome) is a quality framework that helps organize improvement thinking, but it doesn't display coding/documentation pattern performance as directly as a bar graph.
Exam domains verified against: Official ACDIS CCDS-O exam guide, last checked October 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: Q6
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.
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.
Sample question from this domain above: Q2
Common questions about the exam itself
