CDIP LATEST 2026 TEST PAPER QUESTIONS AND
SOLUTIONS GRADED A+
✔✔The assigning of codes based on abnormal lab test without physician documentation
is known as? - ✔✔Assumption
✔✔Can the coder use the anesthesia documentation to assign codes? - ✔✔Yes
✔✔The cooperating parties include: - ✔✔AHIMA, NCHS, CMS, AHA
✔✔Coders should code initial MI specified as acute or with a stated duration of four
weeks (28 days) or less from onset in category I21 in ICD-10. T/F? - ✔✔True.
✔✔What are the 3 severity-based DRG systems? - ✔✔o Medicare Severity DRGs (MS-
DRGs)
o All Patient DRGs (AP-DRGs)
o All Patient Refined DRGs (APR-DRGs)
✔✔What components are DRGs based on? - ✔✔The DRGs are based on several
components including:
o Principal diagnosis
o Medical versus surgical patient
o Comorbidities and complications (CCs) and major CCs (MCCs)
o Age and discharge status (sex and discharge status on our question from AHIMA)
✔✔What type of group are most DRG's put into? - ✔✔Triplets
ex.
637 Diabetes with MCC (weight 1.3944)
638 Diabetes with CC (weight 0.8261)
639 Diabetes without CC/MCC (weight 0.6068)
✔✔Which number within the triplet has the highest rate? - ✔✔The lowest number
✔✔What is the calculation for the payment from a DRG? - ✔✔The weight of the DRG
times a hospital specific base rate = roughly the payment
✔✔How are APR-DRGs assigned? - ✔✔SOI/ROM
✔✔Essentially, diagnoses that are not POA are considered a quality concern and are
not included in the calculation for payment by CMS. T/F? - ✔✔True
, ✔✔What are CPT (Current Procedural Terminology) codes used for? - ✔✔Coding
professionals used CPT codes to assign a code to any procedures or physician office
visits
✔✔Who publishes the manuals and coding guidelines for CPT codes? - ✔✔The
American Medical Association
✔✔Who created ICD-10-CM/PCS for use in the United States? - ✔✔CMS (Center for
Medicare and Medicaid Services)
✔✔Reviewing actual documentation and data prior to investing in a CDI program
prevents the CDI review team from acting on assumptions. T/F? - ✔✔True
✔✔Which service line has less severely ill patient's than others? - ✔✔Orthopedic
✔✔What is healthgrades? - ✔✔An organization that grades physicians
✔✔3 sources of comparative data for an analysis of a hospitals for assessing clinical
documentation - ✔✔- normative data from a broad representative population
- regulatory guidance such as CMS
- the organization's own benchmarks or trends over time
✔✔What is the best way to benchmark a hospital's CMI? - ✔✔it is much more relevant
to use data from hospitals that are similar in size, teaching status, and geographic
status.
✔✔What can be a red-flag when looking at hospitals DRGs? - ✔✔A vague or
symptomatic principal diagnosis
✔✔One-day stays might want to be removed from data since they can skew overall
averages? T/F? - ✔✔True
✔✔What is the capture rate? - ✔✔The percentage of cases where an MCC or CC is
present within those MS-DRGs that include them
✔✔Peer benchmarking reports are useful at the start of a new CDI program to
determine the potential opportunity for improving reimbursement. T/F? - ✔✔True
✔✔Retrospective Review - ✔✔The reviewer assesses the documentation after
discharge and usually after the coding professional codes the record
✔✔________ is optimal since it is generally representative of the overall patient
population - ✔✔Random Sampling
SOLUTIONS GRADED A+
✔✔The assigning of codes based on abnormal lab test without physician documentation
is known as? - ✔✔Assumption
✔✔Can the coder use the anesthesia documentation to assign codes? - ✔✔Yes
✔✔The cooperating parties include: - ✔✔AHIMA, NCHS, CMS, AHA
✔✔Coders should code initial MI specified as acute or with a stated duration of four
weeks (28 days) or less from onset in category I21 in ICD-10. T/F? - ✔✔True.
✔✔What are the 3 severity-based DRG systems? - ✔✔o Medicare Severity DRGs (MS-
DRGs)
o All Patient DRGs (AP-DRGs)
o All Patient Refined DRGs (APR-DRGs)
✔✔What components are DRGs based on? - ✔✔The DRGs are based on several
components including:
o Principal diagnosis
o Medical versus surgical patient
o Comorbidities and complications (CCs) and major CCs (MCCs)
o Age and discharge status (sex and discharge status on our question from AHIMA)
✔✔What type of group are most DRG's put into? - ✔✔Triplets
ex.
637 Diabetes with MCC (weight 1.3944)
638 Diabetes with CC (weight 0.8261)
639 Diabetes without CC/MCC (weight 0.6068)
✔✔Which number within the triplet has the highest rate? - ✔✔The lowest number
✔✔What is the calculation for the payment from a DRG? - ✔✔The weight of the DRG
times a hospital specific base rate = roughly the payment
✔✔How are APR-DRGs assigned? - ✔✔SOI/ROM
✔✔Essentially, diagnoses that are not POA are considered a quality concern and are
not included in the calculation for payment by CMS. T/F? - ✔✔True
, ✔✔What are CPT (Current Procedural Terminology) codes used for? - ✔✔Coding
professionals used CPT codes to assign a code to any procedures or physician office
visits
✔✔Who publishes the manuals and coding guidelines for CPT codes? - ✔✔The
American Medical Association
✔✔Who created ICD-10-CM/PCS for use in the United States? - ✔✔CMS (Center for
Medicare and Medicaid Services)
✔✔Reviewing actual documentation and data prior to investing in a CDI program
prevents the CDI review team from acting on assumptions. T/F? - ✔✔True
✔✔Which service line has less severely ill patient's than others? - ✔✔Orthopedic
✔✔What is healthgrades? - ✔✔An organization that grades physicians
✔✔3 sources of comparative data for an analysis of a hospitals for assessing clinical
documentation - ✔✔- normative data from a broad representative population
- regulatory guidance such as CMS
- the organization's own benchmarks or trends over time
✔✔What is the best way to benchmark a hospital's CMI? - ✔✔it is much more relevant
to use data from hospitals that are similar in size, teaching status, and geographic
status.
✔✔What can be a red-flag when looking at hospitals DRGs? - ✔✔A vague or
symptomatic principal diagnosis
✔✔One-day stays might want to be removed from data since they can skew overall
averages? T/F? - ✔✔True
✔✔What is the capture rate? - ✔✔The percentage of cases where an MCC or CC is
present within those MS-DRGs that include them
✔✔Peer benchmarking reports are useful at the start of a new CDI program to
determine the potential opportunity for improving reimbursement. T/F? - ✔✔True
✔✔Retrospective Review - ✔✔The reviewer assesses the documentation after
discharge and usually after the coding professional codes the record
✔✔________ is optimal since it is generally representative of the overall patient
population - ✔✔Random Sampling
