Certified Clinical Documentation Specialist-Outpatient

Question 1

The primary purpose of the RADV program is to

A. support accuracy of Evaluation and Management billing.

B. identify over-payments rendered to individual physicians.

C. ensure risk-adjusted payment integrity and accuracy.

D. verify medical necessity of care provided.

Correct Answer: C

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Question 2

A patient presents to the PCP's office with LLE edema and pain for 3 days. The problem list indicates morbid obesity and a history of DVT. Vital signs are T 37.9, P 76, R 12, BP 142/88, BMI 46. Documentation states: "Patient presents with LLE edema, increased pain, and hx of DVT. Sedentary lifestyle and contraindications to anticoagulation therapy. LLE warm to touch, 3+ edema from ankle to knee. Pedal pulses 2+ on L and 3+ on R." Doppler exam indicates DVT. The PCP should be queried for which of the following diagnoses?

A. Morbid obesity and status of the DVT

B. Hypertensive urgency and status of the DVT

C. Hypercoagulability and morbid obesity

D. Hypercoagulability and hypertensive urgency

Correct Answer: A

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Question 3

Upon review of payer data, a decrease in RAF scores for the organization is noted. After reviewing internal metrics, a CDI specialist notes an increase in the volume of HCC queries across the organization, with accurate coding confirmed. Which of the following is the MOST plausible explanation for these findings?

A. CPT codes are not reflected in the reporting

B. The payer is not receiving all diagnosis codes

C. The HCC model has not been updated within the organization

D. CDI specialist queries are validated and compliant

Correct Answer: B

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Question 4

Which of the following acronyms is often used in considering reportability of conditions?

A. RADV

B. OPPS

C. MACRA

D. MEAT

Correct Answer: D

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Question 5

Which of the following conditions or findings supports a diagnosis of diabetes?

A. 2-hour blood sugar level of 90 during oral glucose tolerance test

B. Hemoglobin A1c (HbA1c) level of 7.0%

C. Hypoglycemia

D. Fasting glucose of 100

Correct Answer: B

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Question 6

A CDI specialist receives a call from a disgruntled provider regarding recent documentation queries. The provider claims to only have 15 minutes to see patients and does not have time for interruptions like this if it does not increase reimbursement. Which of the following is the BEST course of action to effectively facilitate communication?

A. Call the provider's superior and report him as being non-compliant with organizational processes.

B. Explain to the provider that queries may affect reimbursement, however not directly, and he should comply.

C. Listen to the provider, agree this does not affect reimbursement, and explain that the CDI team will stop querying.

D. Request a time at the provider's convenience to review the query process and collaborate to facilitate the best workflow.

Correct Answer: D

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Question 7

Which of the following contributes to the risk adjustment score under the CMS-HCC model?

A. Cost of care provided and hospital readmissions

B. Income status and disability status

C. Enrollment eligibility status and reported conditions

D. Health status and previous risk score

Correct Answer: C

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Question 8

A female patient who underwent total hip replacement 2 weeks ago is in for a follow-up visit with her PCP. The visit note states: "Patient complains of fatigue and lethargy. Hgb on discharge was 10.4gm/dL - now is 8.6 gm/dL. Will start FeSO4 325mg po daily with food. Repeat H/H in 2 weeks. She has return visit with Ortho then." Which of the following is the BEST course of action for the CDI specialist?

A. Query the provider for a diagnosis related to fatigue, decreased Hgb, and FeSO4.

B. Add acute blood loss anemia to the diagnoses reported on the claim.

C. Instruct the provider to add iron deficiency anemia to the problem list.

D. Review the lab work referenced by the provider in the progress note for congruence.

Correct Answer: A

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ACDIS Certified Clinical Documentation Specialist-Outpatient - CCDS-O Exam Practice Test

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