CDIP MAIN EXAMINATION 2026 SET QUESTIONS AND
SOLUTIONS GRADED A+
✔✔This catheter is inserted into larger, deeper veins such as the subclavian, jugular, or
femoral veins. The catheter is then advanced into the superior vena cava leading
directly to the heart.
a.Peripherally inserted central catheter (PICC)
b.Vascular access device (VAD)
c.Central venous catheter
d.None of the above - ✔✔c Central venous catheters are inserted into larger, deeper
veins such as the subclavian, jugular, or femoral veins. The catheter is then advanced
into the superior vena cava leading directly to the heart. Central venous catheters may
be inserted by physicians, but are often inserted by other specially trained personnel
such as physician assistants, nurse practitioners, or critical care nurses. Central venous
catheterization is usually performed in the subclavian vein by a subclavicular approach.
Another site is the internal jugular vein. The femoral vein is used infrequently because
of concern over deep vein thrombosis (DVT) (AHA First Quarter 1996, 3-4).
✔✔Within 2 hours following surgery, a 68 year-old female began to develop noisy
breathing, fever, tachypnea, chest discomfort, and cough. Chest x-ray was performed
which showed increased interstitial markings, lobar consolidation, and atelectasis. The
physician documented pneumonia; concern for aspiration. The patient was started on
Cefepime. The CDS would most likely query for:
a.Postoperative aspiration pneumonia
b.Respiratory failure
c.Bacterial pneumonia
d.No query needed - ✔✔a Postprocedural aspiration pneumonia was developed to
uniquely capture this condition and distinguish it from other respiratory complications
Query as appropriate utilizing appropriate query format. (AHIMA 2013b).
✔✔Patient is admitted with acute congestive heart failure treated with diuretics and
education. The patient also had atrial fibrillation which the physician stated as the cause
of the heart failure. Which condition should be assigned as principal?
a.Coding rules state query should be performed
b.The condition documented as causing the admission
c.Either diagnosis
d.Neither - ✔✔b If both conditions are present on admission and meet the definition of
principal diagnosis, either condition may be sequenced as principal diagnosis. The
Official Guidelines for Coding and Reporting, Section II, B., state "When there are two or
more interrelated conditions (such as diseases in the same ICD-9-CM chapter or
manifestations characteristically associated with a certain disease) potentially meeting
the definition of principal diagnosis, either condition may be sequenced first, unless the
circumstances of the admission, the therapy provided, the Tabular List, or the
Alphabetic Index indicate otherwise." If, however, one of the conditions is clearly
documented as causing the admission, then that condition should be designated as the
,principal diagnosis. See also Coding Clinic, Second Quarter 1990, page 4, for additional
examples (AHA First Quarter 2012, 7).
✔✔If a patient has a chronic conditions with ongoing or long-term therapy but has
presented to the hospital for another acute condition. These chronic conditions:
a.Should be reported when they present to their office visit
b.Cannot be reported
c.Can be reported
d.Are irrelevant diagnoses - ✔✔c Based on Official Coding Guidelines for Coding and
Reporting: For reporting purposes the definition for 'Other diagnoses" is interpreted as
additional conditions that affect patient care in terms of requiring: Clinical evaluation; or
Therapeutic treatment; or Diagnostic procedures; or Extended length of hospital stay; or
Increased nursing care and/or monitoring (AHA Second Quarter 2000, 20-21; CMS
2016b, Section III).
✔✔In outpatient CDI reviews, it would be appropriate to report all the following
diagnosis except:
a.Chest pain
b.Dizziness
c.Evidence of pneumonia
d.Appears to be bronchitis - ✔✔d The phrase "appears to be," listed in the diagnostic
statement fit the definition of a probable or suspected condition and would not be coded
in the outpatient setting. The Official Guidelines for Coding and Reporting, Section IV.I.
state, "Do not code diagnoses documented as 'probable,' 'suspected,' 'questionable,'
'rule out,' or 'working diagnosis' or other similar terms indicating uncertainty. Rather,
code the condition(s) to the highest degree of certainty for that encounter/visit, such as
symptoms, signs, abnormal test results, or other reason for the visit." In terms of coding
and reporting for hospital inpatients, according to the Official Guidelines for Coding and
Reporting, Section III.B., it would not be appropriate to code abnormal findings from
radiology reports.
However, when the provider documents "evidence of a particular condition, it is not
considered an uncertain diagnosis and should be appropriately coded and reported in
the outpatient setting (AHA Third Quarter 2009, 7 and CMS 2016b, Section IV.I).
✔✔A review contractor sends a denial for the following: Attending physician states on
history and physical likely pneumonitis and or bronchitis with failed outpatient treatment.
The patient had a cough, green sputum, and fever of 101.3 on admission. The patient
was started on IV antibiotics in broad coverage, Levaquin, Zosyn, and Vancomycin with
02 and IV steroids. Patient had a history of lung cancer with metastasis to the brain in
remission, status post treatment. Discharge summary restates findings on chest
angiogram that pneumonia could not be excluded. The principal diagnosis was changed
to bronchitis.
Based on the above information, which diagnosis should most likely be principal?
a.Pneumonia
b.Bronchitis
, c.Secondary neoplasm of the brain
d.Lung cancer - ✔✔a Based on the clinical findings of cough, green sputum, and fever
with IV antibiotic coverage, pneumonia should be the principal diagnosis. Section II.
Selection of Principal Diagnosis - The circumstances of inpatient admission always
govern the selection of principal diagnosis. The principal diagnosis is defined in the
Uniform Hospital Discharge Data Set (UHDDS) as "that condition established after
study to be chiefly responsible for occasioning the admission of the patient to the
hospital for care."
Two or more diagnoses that equally meet the definition for principal diagnosis In the
unusual instance when two or more diagnoses equally meet the criteria for principal
diagnosis as determined by the circumstances of admission, diagnostic workup and/or
therapy provided, and the Alphabetic Index, Tabular List, or another coding guidelines
does not provide sequencing direction, any one of the diagnoses may be sequenced
first (CMS 2016b; Section II).
✔✔A review contractor sends a denial for the following: Attending physician states on
history and physical likely pneumonitis and or bronchitis with failed outpatient treatment.
The patient had a cough, green sputum, and fever of 101.3 on admission. The patient
was started on IV antibiotics in broad coverage, Levaquin, Zosyn, and Vancomycin with
02 and IV steroids. Patient had a history of lung cancer with metastasis to the brain in
remission, status post treatment. Discharge summary restates findings on chest
angiogram that pneumonia could not be excluded. The principal diagnosis was changed
to bronchitis.
What type of denial is this?
a.DRG
b.DRG with clinical validation
c.Medical necessity
d.Level of care - ✔✔b CMS has approved DRG reviews with clinical validation. This
type of review involves ensuring that the diagnosis is documented by the physician and
clinically supported. Contractors often utilize this review method for DRG denials
(AHIMA 2014b)
✔✔Patient is diagnosed with congestive heart failure. The physician states this is CHF
with diastolic dysfunction due to hypertension. That diagnosis should be listed as
principal:
a.Hypertension
b.Hypertensive heart disease with heart failure
c.Congestive heart failure
d.Either - ✔✔b Hypertensive heart disease with heart failure. If a patient has
hypertensive heart disease with congestive heart failure due to hypertension, it is
appropriate to assign a code for the hypertensive heart disease with heart failure as the
principal diagnosis (AHA Fourth Quarter 2002, 49-52).
✔✔These notes have been expanded at the beginning of each chapter to clarify the
hierarchy of the chapters:
SOLUTIONS GRADED A+
✔✔This catheter is inserted into larger, deeper veins such as the subclavian, jugular, or
femoral veins. The catheter is then advanced into the superior vena cava leading
directly to the heart.
a.Peripherally inserted central catheter (PICC)
b.Vascular access device (VAD)
c.Central venous catheter
d.None of the above - ✔✔c Central venous catheters are inserted into larger, deeper
veins such as the subclavian, jugular, or femoral veins. The catheter is then advanced
into the superior vena cava leading directly to the heart. Central venous catheters may
be inserted by physicians, but are often inserted by other specially trained personnel
such as physician assistants, nurse practitioners, or critical care nurses. Central venous
catheterization is usually performed in the subclavian vein by a subclavicular approach.
Another site is the internal jugular vein. The femoral vein is used infrequently because
of concern over deep vein thrombosis (DVT) (AHA First Quarter 1996, 3-4).
✔✔Within 2 hours following surgery, a 68 year-old female began to develop noisy
breathing, fever, tachypnea, chest discomfort, and cough. Chest x-ray was performed
which showed increased interstitial markings, lobar consolidation, and atelectasis. The
physician documented pneumonia; concern for aspiration. The patient was started on
Cefepime. The CDS would most likely query for:
a.Postoperative aspiration pneumonia
b.Respiratory failure
c.Bacterial pneumonia
d.No query needed - ✔✔a Postprocedural aspiration pneumonia was developed to
uniquely capture this condition and distinguish it from other respiratory complications
Query as appropriate utilizing appropriate query format. (AHIMA 2013b).
✔✔Patient is admitted with acute congestive heart failure treated with diuretics and
education. The patient also had atrial fibrillation which the physician stated as the cause
of the heart failure. Which condition should be assigned as principal?
a.Coding rules state query should be performed
b.The condition documented as causing the admission
c.Either diagnosis
d.Neither - ✔✔b If both conditions are present on admission and meet the definition of
principal diagnosis, either condition may be sequenced as principal diagnosis. The
Official Guidelines for Coding and Reporting, Section II, B., state "When there are two or
more interrelated conditions (such as diseases in the same ICD-9-CM chapter or
manifestations characteristically associated with a certain disease) potentially meeting
the definition of principal diagnosis, either condition may be sequenced first, unless the
circumstances of the admission, the therapy provided, the Tabular List, or the
Alphabetic Index indicate otherwise." If, however, one of the conditions is clearly
documented as causing the admission, then that condition should be designated as the
,principal diagnosis. See also Coding Clinic, Second Quarter 1990, page 4, for additional
examples (AHA First Quarter 2012, 7).
✔✔If a patient has a chronic conditions with ongoing or long-term therapy but has
presented to the hospital for another acute condition. These chronic conditions:
a.Should be reported when they present to their office visit
b.Cannot be reported
c.Can be reported
d.Are irrelevant diagnoses - ✔✔c Based on Official Coding Guidelines for Coding and
Reporting: For reporting purposes the definition for 'Other diagnoses" is interpreted as
additional conditions that affect patient care in terms of requiring: Clinical evaluation; or
Therapeutic treatment; or Diagnostic procedures; or Extended length of hospital stay; or
Increased nursing care and/or monitoring (AHA Second Quarter 2000, 20-21; CMS
2016b, Section III).
✔✔In outpatient CDI reviews, it would be appropriate to report all the following
diagnosis except:
a.Chest pain
b.Dizziness
c.Evidence of pneumonia
d.Appears to be bronchitis - ✔✔d The phrase "appears to be," listed in the diagnostic
statement fit the definition of a probable or suspected condition and would not be coded
in the outpatient setting. The Official Guidelines for Coding and Reporting, Section IV.I.
state, "Do not code diagnoses documented as 'probable,' 'suspected,' 'questionable,'
'rule out,' or 'working diagnosis' or other similar terms indicating uncertainty. Rather,
code the condition(s) to the highest degree of certainty for that encounter/visit, such as
symptoms, signs, abnormal test results, or other reason for the visit." In terms of coding
and reporting for hospital inpatients, according to the Official Guidelines for Coding and
Reporting, Section III.B., it would not be appropriate to code abnormal findings from
radiology reports.
However, when the provider documents "evidence of a particular condition, it is not
considered an uncertain diagnosis and should be appropriately coded and reported in
the outpatient setting (AHA Third Quarter 2009, 7 and CMS 2016b, Section IV.I).
✔✔A review contractor sends a denial for the following: Attending physician states on
history and physical likely pneumonitis and or bronchitis with failed outpatient treatment.
The patient had a cough, green sputum, and fever of 101.3 on admission. The patient
was started on IV antibiotics in broad coverage, Levaquin, Zosyn, and Vancomycin with
02 and IV steroids. Patient had a history of lung cancer with metastasis to the brain in
remission, status post treatment. Discharge summary restates findings on chest
angiogram that pneumonia could not be excluded. The principal diagnosis was changed
to bronchitis.
Based on the above information, which diagnosis should most likely be principal?
a.Pneumonia
b.Bronchitis
, c.Secondary neoplasm of the brain
d.Lung cancer - ✔✔a Based on the clinical findings of cough, green sputum, and fever
with IV antibiotic coverage, pneumonia should be the principal diagnosis. Section II.
Selection of Principal Diagnosis - The circumstances of inpatient admission always
govern the selection of principal diagnosis. The principal diagnosis is defined in the
Uniform Hospital Discharge Data Set (UHDDS) as "that condition established after
study to be chiefly responsible for occasioning the admission of the patient to the
hospital for care."
Two or more diagnoses that equally meet the definition for principal diagnosis In the
unusual instance when two or more diagnoses equally meet the criteria for principal
diagnosis as determined by the circumstances of admission, diagnostic workup and/or
therapy provided, and the Alphabetic Index, Tabular List, or another coding guidelines
does not provide sequencing direction, any one of the diagnoses may be sequenced
first (CMS 2016b; Section II).
✔✔A review contractor sends a denial for the following: Attending physician states on
history and physical likely pneumonitis and or bronchitis with failed outpatient treatment.
The patient had a cough, green sputum, and fever of 101.3 on admission. The patient
was started on IV antibiotics in broad coverage, Levaquin, Zosyn, and Vancomycin with
02 and IV steroids. Patient had a history of lung cancer with metastasis to the brain in
remission, status post treatment. Discharge summary restates findings on chest
angiogram that pneumonia could not be excluded. The principal diagnosis was changed
to bronchitis.
What type of denial is this?
a.DRG
b.DRG with clinical validation
c.Medical necessity
d.Level of care - ✔✔b CMS has approved DRG reviews with clinical validation. This
type of review involves ensuring that the diagnosis is documented by the physician and
clinically supported. Contractors often utilize this review method for DRG denials
(AHIMA 2014b)
✔✔Patient is diagnosed with congestive heart failure. The physician states this is CHF
with diastolic dysfunction due to hypertension. That diagnosis should be listed as
principal:
a.Hypertension
b.Hypertensive heart disease with heart failure
c.Congestive heart failure
d.Either - ✔✔b Hypertensive heart disease with heart failure. If a patient has
hypertensive heart disease with congestive heart failure due to hypertension, it is
appropriate to assign a code for the hypertensive heart disease with heart failure as the
principal diagnosis (AHA Fourth Quarter 2002, 49-52).
✔✔These notes have been expanded at the beginning of each chapter to clarify the
hierarchy of the chapters:
