CDIP Quality Improvement and Compliance 4

Question 1

A CDI specialist reviews a record where the attending documents 'respiratory failure' but the pulmonologist documents 'acute hypoxic respiratory failure.' Which coding guideline applies?

Accepted Answer

Query the attending to clarify and reconcile the conflicting documentation

Answer

When provider documentation conflicts, a query is required to reconcile the discrepancy before a final diagnosis can be coded.

Question 2

Which element is NOT required for a compliant CDI query according to ACDIS/AHIMA guidelines?

Accepted Answer

A statement of the financial impact of the query

Answer

Queries must never include financial impact information, as this constitutes a leading query designed to influence diagnosis selection for reimbursement.

Question 3

A hospital's compliance audit reveals that 40% of HAC (Hospital-Acquired Condition) cases lack required 'present on admission' (POA) indicators. What is the primary risk?

Accepted Answer

Loss of Medicare payment for those HAC-related conditions

Answer

CMS does not pay the higher DRG rate for cases where a HAC occurs that was not present on admission, resulting in payment reduction.

Question 4

Which of the following best describes the concept of 'clinical validation' in the CDI context?

Accepted Answer

Determining whether the clinical evidence supports the documented diagnosis

Answer

Clinical validation involves reviewing clinical evidence in the record to confirm that a documented diagnosis is clinically supported.

Question 5

When a payer denies a claim for 'lack of medical necessity,' what documentation should the CDI specialist prioritize in the appeal?

Accepted Answer

Clinical documentation demonstrating the patient met criteria for the level of care

Answer

Medical necessity appeals require clinical documentation showing the patient's condition warranted the level of care that was provided.

(CDIP) Certified Documentation Improvement Practitioner Practice Test

(CDIP) Certified Documentation Improvement Practitioner Practice Test

CDIP Quality Improvement and Compliance 4