CCDS CDI Strategies 2

Question 1

Which CDI review method involves a CDI specialist examining charts while the patient is still hospitalized?

Accepted Answer

Concurrent review

Answer

Retrospective review

Answer

Prospective review

Answer

Post-discharge review

Question 2

A CDI specialist uses a 'working DRG' during concurrent review. What is the PRIMARY purpose of the working DRG?

Accepted Answer

To predict the expected MS-DRG assignment based on current documentation

Answer

To bill the payer before the patient is discharged

Answer

To calculate the patient's out-of-pocket cost estimate

Answer

To replace the final coded DRG submitted on the claim

Question 3

Which of the following is the MOST important criterion when deciding whether to send a physician query?

Accepted Answer

There is a genuine clinical indicator in the record supporting a more specific diagnosis

Answer

The query will likely result in a higher-weighted DRG

Answer

The payer has requested additional documentation

Answer

The patient's length of stay exceeds the GMLOS for the current working DRG

Question 4

A CDI specialist identifies that a patient with an open wound has documentation of 'possible osteomyelitis.' Under inpatient coding guidelines, how should this be coded?

Accepted Answer

It should be coded as osteomyelitis per the uncertain diagnosis guideline

Answer

It cannot be coded; only confirmed diagnoses are coded

Answer

It should be coded as a wound infection instead

Answer

It should be flagged as a query but left uncoded pending confirmation

Question 5

When a CDI specialist conducts a 'triggered review,' what typically initiates the review?

Accepted Answer

Clinical criteria such as specific diagnoses, procedures, or LOS thresholds

Answer

A random selection of charts for quality auditing purposes

Answer

A physician's request for documentation assistance

Answer

A denial letter from a payer

Question 6

Which CDI metric measures how often physicians respond to queries compared to total queries sent?

Accepted Answer

Query response rate

Answer

Query rate

Answer

Query agreement rate

Answer

Physician compliance rate