AHIMA AHIMA Clinical Documentation Improvement 2 — Questions and Answers
Question 1: Which organization jointly developed the Official Guidelines for Coding and Reporting used with ICD-10-CM in the US?
- AMA and AHA only
- CMS, NCHS, AHA, and AHIMA (Correct answer)
- CMS and AMA only
- WHO and CMS
Correct answer: CMS, NCHS, AHA, and AHIMA
The Official Guidelines are a cooperative effort of four organizations: CMS, NCHS, AHA, and AHIMA.
Question 2: What is the purpose of a 'physician advisor' in a CDI program?
- To replace CDI specialists for all queries
- To review complex clinical documentation issues and support query escalations (Correct answer)
- To assign final MS-DRGs after discharge
- To perform utilization management reviews only
Correct answer: To review complex clinical documentation issues and support query escalations
A physician advisor supports CDI programs by reviewing clinically complex cases, educating physicians, and resolving disputes between CDI specialists and attending physicians.
Question 3: Which MS-DRG complication or comorbidity (CC) level carries the highest relative weight and reimbursement impact?
- CC (Complication or Comorbidity)
- MCC (Major Complication or Comorbidity) (Correct answer)
- No CC/MCC
- Secondary CC
Correct answer: MCC (Major Complication or Comorbidity)
MCCs (Major Complications or Comorbidities) carry the highest relative weight in MS-DRG grouping, reflecting greater resource utilization.
Question 4: What does 'specificity' mean in the context of ICD-10-CM coding for CDI purposes?
- Using the fewest possible codes
- Selecting the most detailed code that accurately reflects the documented condition (Correct answer)
- Coding only confirmed diagnoses
- Assigning codes based on lab values
Correct answer: Selecting the most detailed code that accurately reflects the documented condition
ICD-10-CM requires coding to the highest level of specificity, using the most detailed code available that accurately represents the condition.
Question 5: In CDI, what is the 'case mix index' (CMI)?
- The average length of stay for all patients
- The average relative weight of all MS-DRGs for a given period (Correct answer)
- The ratio of surgical to medical cases
- The percentage of cases with MCCs
Correct answer: The average relative weight of all MS-DRGs for a given period
The case mix index is the average relative weight of MS-DRGs for a hospital's patient population, reflecting the complexity and resource intensity of cases treated.
Question 6: Which document serves as the foundation for CDI query standards in the US?
- CMS Conditions of Participation
- AHIMA/ACDIS CDI Query Practice Brief (Correct answer)
- Joint Commission Accreditation Standards
- OIG Work Plan
Correct answer: AHIMA/ACDIS CDI Query Practice Brief
The AHIMA/ACDIS CDI Query Practice Brief provides industry-standard guidelines for compliant, ethical, and clinically appropriate physician queries.
AHIMA AHIMA Clinical Documentation Improvement 2
Which organization jointly developed the Official Guidelines for Coding and Reporting used with ICD-10-CM in the US?