CRC Clinical Documentation Improvement 2

Question 1

A CDI specialist reviews a chart where the physician documents 'CHF' without further specification. Which query would be most effective for risk adjustment?

Accepted Answer

What is the heart failure type, acuity, and current severity class?

Answer

An effective CDI query should address all specificity elements: type, acuity, and severity. This avoids multiple follow-ups.

Question 2

A CDI specialist notices lab values showing eGFR of 22 mL/min but the physician only documents 'renal insufficiency.' What is the appropriate CDI action?

Accepted Answer

Query the provider to document CKD stage consistent with the eGFR findings

Answer

CDI specialists cannot diagnose based on lab values alone. The appropriate action is to query the provider to document the CKD stage.

Question 3

A physician documents 'patient is malnourished.' The dietitian's assessment documents 'severe protein-calorie malnutrition with BMI 15.2.' For CDI purposes, which source can be used?

Accepted Answer

A CDI query should be generated for the physician to confirm the severity

Answer

Best practice for risk adjustment is to have the physician document or confirm the severity, creating the strongest documentation for RADV audit defense.

Question 4

A CDI team finds query response rate dropped from 85% to 60%. Which strategy is most likely to improve physician engagement?

Accepted Answer

Redesign queries to be more specific with clinical indicators and response checkboxes

Answer

Improving query design with specific clinical indicators and easy response formats is the most effective strategy.

Question 5

Which documentation improvement scenario would have the greatest positive impact on risk adjustment accuracy?

Accepted Answer

Changing 'diabetes' to 'diabetes mellitus type 2 with diabetic nephropathy' when supported by evidence

Answer

Specifying diabetes type and capturing complications directly affects HCC mapping. Diabetes with nephropathy maps to HCC 18, nearly tripling the RAF contribution vs diabetes alone.

(CRC) Certified Risk Adjustment Coder Practice Test

(CRC) Certified Risk Adjustment Coder Practice Test

CRC Clinical Documentation Improvement 2