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ACDIS Certified Clinical Documentation Specialist – Outpatient (CCDS-O)

Practice Questions

Sample ACDIS CCDS Practice Questions

Try these sample questions to review concepts for the ACDIS CCDS exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 147+ question experience with AI tutoring.

1According to UHDDS, the principal diagnosis is defined as the condition established after study to be chiefly responsible for what?
A.Generating the highest reimbursement on the claim
B.Occasioning the patient's admission for care
C.Accounting for the longest length of stay
D.Requiring the most resource-intensive treatment
Explanation: The Uniform Hospital Discharge Data Set (UHDDS) defines the principal diagnosis as the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care. 'After study' allows the diagnosis to be determined once workup is complete, not necessarily the admitting diagnosis.
2A secondary diagnosis classified as a major complication or comorbidity (MCC) generally has what effect on MS-DRG assignment compared with a CC?
A.It lowers the DRG weight below the no-CC tier
B.It maps the case to a higher-weighted MS-DRG tier
C.It has no impact; the principal diagnosis sets the DRG
D.It affects outpatient APCs but not inpatient DRGs
Explanation: An MCC reflects a more severe condition requiring more resources than a CC, so it typically moves a case into a higher-weighted MS-DRG tier and yields greater reimbursement. Many MS-DRG families have three tiers: with MCC, with CC, and without CC/MCC.
3Which POA indicator means the provider is unable to clinically determine whether the condition was present at the time of inpatient admission?
A.Y
B.N
C.U
D.W
Explanation: The POA indicator 'W' means clinically undetermined — the provider is unable to clinically determine whether the condition was present on admission. This reflects clinical ambiguity rather than a documentation gap. For HAC payment purposes, 'W' is treated like 'Y' (paid).
4Per the ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice, a query is considered leading when it does what?
A.Directs the provider toward an unsupported diagnosis
B.Includes relevant clinical indicators from the record
C.Offers answer options including 'unable to determine'
D.Documents the clinical rationale prompting the query
Explanation: A leading query is one that is not supported by the clinical elements in the record and/or directs a provider to a specific diagnosis or procedure. Compliant queries present clinical indicators and allow the provider to reach an independent conclusion without being steered to a desired answer.
5In the 3M APR-DRG methodology, the subclasses for Severity of Illness (SOI) and Risk of Mortality (ROM) each range across how many levels?
A.Two levels: low and high severity
B.Three levels: minor, moderate, and major only
C.Four levels: minor, moderate, major, extreme
D.Five levels numbered 1 through 5
Explanation: APR-DRGs assign each case to one of four SOI and four ROM subclasses: 1 (minor), 2 (moderate), 3 (major), and 4 (extreme). SOI reflects physiologic decompensation/organ loss of function while ROM reflects likelihood of dying; the two are scored independently.
6Acute respiratory failure is generally supported when arterial blood gas shows which of the following?
A.pO2 greater than 90 and pCO2 less than 35
B.pO2 less than 60 or pCO2 greater than 50
C.pH greater than 7.45 with normal pO2
D.Bicarbonate greater than 28 only
Explanation: Commonly cited diagnostic thresholds for acute respiratory failure include a pO2 less than 60 mmHg (hypoxemic) and/or a pCO2 greater than 50 mmHg with pH below 7.35 (hypercapnic). The diagnosis should also be symptomatic and supported by the clinical picture, not ABG values alone.
7Under the Sepsis-3 consensus definition, sepsis is defined as suspected or confirmed infection plus what?
A.Two or more SIRS criteria on presentation
B.Acute organ dysfunction shown by a SOFA rise of 2 or more
C.A positive blood culture identifying the causative organism
D.Fever above 38.3 degrees Celsius with tachycardia
Explanation: Sepsis-3 defines sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, operationalized as an acute increase of 2 or more points in the SOFA score in the setting of suspected or confirmed infection. SIRS criteria are no longer part of the Sepsis-3 definition.
8A CDI specialist reviews a chart before the patient is discharged and queries the physician while care is ongoing. This type of query is best described as:
A.Retrospective
B.Concurrent
C.Post-bill
D.Pre-admission
Explanation: A concurrent query is generated during the patient's stay, while the record is still open and care is ongoing. Concurrent queries are preferred because the provider has the patient in front of them and can document clarifications in real time, improving accuracy before coding and billing.
9Which document is the authoritative coding rulebook that coders and CDI staff must follow for ICD-10-CM code assignment and sequencing?
A.The AMA's CPT Assistant coding newsletter
B.The CMS Inpatient Prospective Payment System Final Rule alone
C.The ICD-10-CM Official Guidelines for Coding and Reporting
D.The Merck Manual of Diagnosis and Therapy
Explanation: The ICD-10-CM Official Guidelines for Coding and Reporting, approved by the four Cooperating Parties (AHA, AHIMA, CMS, NCHS), are the authoritative rules for diagnosis code assignment and sequencing. They accompany and complement the conventions and instructions in the classification itself.
10For Medicare's Hospital-Acquired Condition (HAC) payment provision, a selected condition coded with a POA indicator of 'N' will generally:
A.Increase the DRG payment by acting as an MCC
B.Be excluded from acting as a CC or MCC
C.Have no effect on the payment for the stay
D.Trigger automatic denial of the entire claim
Explanation: Under the HAC payment provision, certain conditions that are NOT present on admission (POA = N or U) will not be counted as a CC or MCC when grouping the case, removing the higher payment that condition would otherwise generate. This discourages payment for preventable conditions acquired in the hospital.

About the ACDIS CCDS Exam

The ACDIS Certified Clinical Documentation Specialist (CCDS) validates inpatient clinical documentation integrity expertise — clinical and coding knowledge, the query process, and compliance.

Exam sponsor: Association of Clinical Documentation Integrity Specialists (ACDIS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

140 questions

Time Limit

3 hours

Passing Score

Pass/fail by raw score on 120 scored items; no published cut score

Exam / Certification Fees

USD 280 ACDIS members / USD 380 non-members; first retake USD 150 after a 90-day wait

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

12.5% (15 of 120 scored items)

Domain I: Inpatient Prospective Payment System and Regulations

MS-DRG assignment, CC/MCC capture, POA indicators, HACs, the Two-Midnight rule and CMS payment rules

19.2% (23 of 120 scored items)

Domain II: Anatomy, Physiology, Pathophysiology and Pharmacology

Clinical indicators for sepsis, respiratory failure, AKI, malnutrition, encephalopathy, heart failure and the drugs that support them

19.2% (23 of 120 scored items)

Domain III: Medical Record Documentation

Provider documentation requirements, conflicting and incomplete documentation, specificity and linkage

8.3% (10 of 120 scored items)

Domain IV: CDI Program Analysis

Review prioritisation, workflow, productivity, program metrics and reconciliation

9.2% (11 of 120 scored items)

Domain V: Communication

Compliant written and verbal queries, physician education and escalation

14.2% (17 of 120 scored items)

Domain VI: Official Coding Guidelines

ICD-10-CM/PCS Official Guidelines, coding conventions and sequencing rules

9.2% (11 of 120 scored items)

Domain VII: Professionalism, Ethics and Compliance

ACDIS Code of Ethics, compliant query practice, audit and denial defence

8.3% (10 of 120 scored items)

Domain VIII: Quality Impact

PSI/HAC quality measures, risk adjustment, SOI/ROM, mortality and readmission indices

Preparing for the ACDIS CCDS Exam

What You Need to Know

  • Passing score: Pass/fail by raw score on 120 scored items; no published cut score
  • Exam length: 140 questions
  • Time limit: 3 hours
  • Exam / certification fees: USD 280 ACDIS members / USD 380 non-members; first retake USD 150 after a 90-day wait Official sources

Using Our Practice Resources

  • Work through all 147 available questions
  • Review every answer and explanation
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Frequently Asked Questions

What does the CCDS exam cover?

Clinical knowledge, coding concepts (ICD-10, MS-DRG, CCs/MCCs), the compliant query process, CDI process, regulatory and compliance, and quality and reimbursement.

Who offers the CCDS?

The Association of Clinical Documentation Integrity Specialists (ACDIS) offers the Certified Clinical Documentation Specialist (CCDS) for inpatient CDI.