CDIP DRG Optimization and Case Mix Index 4

Question 1

A hospital's case mix index (CMI) dropped from 1.85 to 1.72 over one quarter despite stable patient volume. Which action is MOST likely to identify the root cause?

Accepted Answer

Audit high-weight DRGs for documentation completeness and CC/MCC capture rates

Answer

Auditing CC/MCC capture rates in high-weight DRGs directly identifies documentation gaps that reduce CMI.

Question 2

Which physician documentation practice most directly prevents DRG optimization in the inpatient setting?

Accepted Answer

Documenting only the chief complaint without linking complications

Answer

Failing to link complications to underlying conditions prevents coders from assigning CC/MCC codes that affect DRG weight.

Question 3

Under MS-DRG logic, a patient admitted for pneumonia with documentation of sepsis due to pneumonia would most likely be grouped to which category compared to pneumonia alone?

Accepted Answer

A higher-weighted DRG because sepsis functions as an MCC

Answer

Sepsis documented as a complication of pneumonia qualifies as an MCC, shifting the case to a higher-weighted MS-DRG.

Question 4

A CDI specialist queries a physician about a patient with a BMI of 42, hypertension, and type 2 diabetes who underwent CABG. What is the PRIMARY optimization opportunity?

Accepted Answer

Documenting morbid obesity as a secondary diagnosis to capture the CC/MCC impact

Answer

Morbid obesity (BMI ≥40) is an MCC that, when documented, can significantly increase the DRG weight for cardiac surgery cases.

Question 5

When comparing a hospital's CMI to peer institutions, which factor must be controlled to ensure a valid comparison?

Accepted Answer

Payer mix, teaching status, and service line distribution

Answer

Payer mix, teaching status, and service line distribution all directly influence CMI independently of documentation quality.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP DRG Optimization and Case Mix Index 4