Free Practice Questions for ACDIS CCDS Exam

Under the FY 2026 Hospital-Acquired Condition Reduction Program (HACRP), applicable subsection (d) hospitals in the worst-performing quartile based on the Total HAC Score receive a 1% payment reduction on applicable Medicare fee-for-service payments. CMS defines the worst-performing quartile as hospitals whose Total HAC Score is above the 75th percentile.

The FY 2026 program incorporates the CMS Patient Safety and Adverse Events Composite (PSI 90) plus five healthcare-associated infection measures: CLABSI, CAUTI, specified surgical-site infection, MRSA bacteremia, and C. difficile infection.

A single HAC does not automatically trigger the hospital-wide 1% HACRP reduction. Likewise, CMI is not the criterion used to determine HACRP penalties.

It is also important for CCDS candidates to distinguish the HAC Reduction Program from the separate DRA HAC/POA payment provision. CMS explicitly identifies them as distinct programs.

Accurate documentation and coding are important because quality measures rely on reliable clinical data, but CDI activity must remain focused on accurately representing the clinical record rather than manipulating quality metrics.

CCDS Reference Topics: HAC Reduction Program; PSI 90; HAI measures; quality payment; hospital performance.

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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 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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The findings strongly support clarification of acute hypercapnic respiratory failure. PaCO₂ of 74 mmHg represents marked carbon dioxide retention, while pH 7.19 demonstrates significant respiratory acidemia. The patient is also hypoxemic and requires urgent noninvasive ventilatory assistance.

Because there is no documented chronic hypercapnic baseline, the available information primarily supports an acute process rather than chronic respiratory failure.

Acute hypercapnia occurs when alveolar ventilation becomes insufficient to eliminate carbon dioxide. Potential causes include COPD or asthma exacerbation, central nervous system depression, neuromuscular weakness, obesity hypoventilation, airway obstruction, or severe fatigue.

BiPAP provides positive-pressure ventilatory support and can improve alveolar ventilation, decrease work of breathing, and lower PaCO₂.

The CDI specialist should not independently establish respiratory failure solely from an ABG. However, the combination of severe physiologic abnormality, respiratory distress, and escalation to BiPAP supplies a strong basis for provider clarification when no corresponding diagnosis is documented.

Metabolic alkalosis would ordinarily involve primary bicarbonate elevation with alkalemia rather than profound respiratory acidemia.

CCDS Reference Topics: Acute respiratory failure; hypercapnia; ABG interpretation; noninvasive ventilation; clinical indicators.

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The mortality ratio is the option most directly associated with patient outcome measurement and risk-adjusted quality reporting. Although the question uses the phrase expected/observed mortality ratio, mortality analytics are frequently expressed operationally as an observed-to-expected (O/E) mortality ratio. Documentation affects the expected component because severity-of-illness and risk-of-mortality models depend substantially on accurately reported diagnoses and comorbid conditions.

If important acute or chronic conditions are not documented or are insufficiently specified, coded data may portray a patient as less severely ill than the clinical reality. The expected mortality calculated by a risk-adjustment model may therefore be lower, potentially making actual mortality performance appear less favorable. This makes mortality analysis particularly useful when teaching physicians why documentation affects quality measures independently of reimbursement.

CC/MCC capture is useful for examining documentation and reimbursement performance but is not itself an outcome measure. Monthly review volume is a productivity metric, while CDI/coder agreement evaluates internal process performance.

The CCDS examination content specifically includes mortality reviews, interpretation of observed/expected ratios, severity of illness, risk of mortality, and documentation effects on publicly reported quality data.

CCDS Reference Topics: Impact of reportable diagnoses on quality of care; SOI/ROM; mortality index; physician education.

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The Hospital-Acquired Condition Reduction Program (HACRP) imposes a 1% reduction in applicable Medicare fee-for-service payments on subsection (d) hospitals ranking in the worst-performing quartile based on the Total HAC Score.

For the current program, CMS uses six measures: the CMS Patient Safety and Adverse Events Composite (PSI 90) and five healthcare-associated infection measures—CLABSI, CAUTI, specified surgical-site infection, MRSA bacteremia, and C. difficile infection.

HACRP must be distinguished from the separate DRA Hospital-Acquired Condition/Present-on-Admission payment provision. CMS explicitly states that these are different programs.

Hospital Value-Based Purchasing also links quality performance with hospital payment, but its structure is different: it is funded through a 2% reduction of participating hospitals' base operating DRG payments that is redistributed through value-based incentives.

For CDI professionals, accurate clinical documentation helps ensure that quality data appropriately represent the patient's condition and hospital course. CDI should not attempt to suppress valid complications or create unsupported comorbidities to change quality performance.

CCDS Reference Topics: HACRP; PSI 90; HAIs; quality reimbursement; CMS quality programs.

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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 findings strongly support clarification of acute systolic heart failure. A markedly reduced ejection fraction indicates impaired systolic ventricular function, while severe dyspnea, orthopnea, pulmonary edema, crackles, peripheral edema, and need for IV diuresis indicate acute decompensation.

If the patient's existing history establishes chronic systolic heart failure, the provider might determine that acute on chronic systolic heart failure is even more precise. The answer choices, however, make acute systolic heart failure the best-supported option.

Diastolic heart failure cannot be inferred from the findings when the documented objective evidence specifically demonstrates markedly reduced systolic function. Stable heart failure contradicts the acute symptoms, pulmonary congestion, and intravenous treatment.

Cor pulmonale refers primarily to right-sided heart dysfunction secondary to pulmonary disease and does not adequately explain the described left-sided pulmonary congestion.

As always, CDI recognizes the clarification opportunity rather than diagnosing the condition independently. The provider integrates echocardiography, history, symptoms, physical findings, imaging, biomarkers, and response to treatment.

Accurate documentation of both type and acuity is important for clinical communication, coding specificity, severity representation, and MS-DRG assignment.

CCDS Reference Topics: Heart failure; systolic dysfunction; ejection fraction; acute decompensation; clinical indicators.

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When severe sepsis is documented, coding requires the underlying systemic infection first, followed by the appropriate severe-sepsis code and additional code(s) for the acute organ dysfunction. Therefore, the sepsis code is sequenced first, followed by the severe-sepsis code and acute kidney injury.

The FY 2026 ICD-10-CM Official Guidelines state that severe sepsis requires at least two codes: one for the underlying systemic infection and another from subcategory R65.2-. Additional codes identify associated acute organ dysfunction. A code from R65.2- cannot serve as the principal diagnosis.

The UTI identifies the localized source but does not replace the systemic infection as principal diagnosis when sepsis is the condition chiefly responsible for admission. Likewise, the AKI is a manifestation of the severe systemic process and is not sequenced before the sepsis in this scenario.

For CDI specialists, the essential documentation element is the relationship between sepsis and the acute organ dysfunction. Organ dysfunction alone does not automatically permit severe-sepsis coding; provider documentation must establish the association when it is not inherent.

CCDS Reference Topics: Sepsis; severe sepsis; organ dysfunction; sequencing; principal diagnosis.

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An MS-DRG relative weight represents relative expected resource consumption, not a direct severity score or mortality probability. Therefore, a relative weight of approximately 2.0 means the MS-DRG is associated with roughly twice the resource intensity of the average case represented by the standardized reference point.

CMS calculates and recalibrates MS-DRG relative weights using national hospital data as part of IPPS rate setting. The FY 2026 final-rule materials include the MS-DRG weighting factors as well as supporting cost data used in the relative-weight methodology.

Clinically complex cases often consume more resources, so relative weight may correlate with severity. However, it is not equivalent to a patient's severity-of-illness score or risk-of-mortality score. Likewise, hospitals do not simply multiply their billed charges based on the DRG weight. IPPS payment involves the standardized amount plus various adjustments, including wage index and other applicable payment factors.

For CDI, accurate documentation matters because diagnoses and procedures drive MS-DRG assignment, and the assigned MS-DRG carries its specific relative weight.

CCDS Reference Topics: IPPS; MS-DRG relative weight; resource consumption; reimbursement methodology.

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