The attending physician documents morbid obesity. A registered dietitian documents a body mass index of 43.6 kg/m² in the nutritional assessment. Which of the following is the MOST accurate statement?

Which statement BEST describes the basic funding mechanism of the Hospital Value-Based Purchasing Program?

Two MS-DRGs have relative weights of 0.85 and 2.10. Which statement is MOST accurate?

A patient is admitted with TIA, right-sided weakness, and slurred speech. The physician's physical examination notes that the patient's right-sided weakness continues, but the slurred speech has resolved. A CT scan of the brain reveals a new hypodense area. The most specific diagnosis to query is acute:

A patient with sepsis has acute confusion, impaired attention, fluctuating mental status, and no focal neurologic findings. CT of the head is negative. The provider documents only “AMS secondary to infection.” Which clarification would be MOST clinically appropriate?

A patient is admitted with confusion and a history of alcoholic cirrhosis. Ammonia level is 100 µ/L and the blood alcohol level is 2.9. Based on these clinical indicators, the CDI specialist should query the physician for which of the following conditions?

Which pressure-ulcer category is specifically included in the traditional CMS HAC payment policy when the condition is not present on admission?

A patient's past medical history lists remote peptic ulcer disease. During the current admission, the condition receives no evaluation, treatment, diagnostic workup, extended length of stay, or increased nursing monitoring. Which statement is MOST accurate?

A CDI program reports the following monthly results:

- Provider response rate: 97%

- Provider agreement rate: 84%

- Queries issued after discharge: 38%

- CDI/coder agreement: 96%

Which metric presents the clearest opportunity to improve concurrent CDI workflow?

What type of query is needed to compliantly address a scenario in which clinical indicators of a diagnosis exist, but for which no diagnosis has been documented in the medical record?

A CDI specialist identifies fever, leukocytosis, tachycardia, positive blood cultures, and IV antibiotic treatment. No infectious diagnosis has been documented. Which query approach is MOST compliant?

A patient with cirrhosis presents with confusion and asterixis. Ammonia is elevated and the patient improves after lactulose administration. The physician documents “altered mental status due to liver disease.” Which clarification would provide the MOST clinically specific documentation?

When a physician documents the abbreviation “HCAP” in the health record, the BEST action for a CDI specialist to take is to:

A neurologist documents acute cerebral infarction. A qualified stroke nurse records the NIH Stroke Scale score in the medical record. Which statement is MOST accurate?

Documentation indicates an excisional debridement was performed without further specification. The CDI specialist should query to clarify which of the following?

A patient with a history of heart failure is admitted with severe dyspnea and bilateral lower-extremity edema. BNP is 1,000 pg/mL and echocardiography shows an ejection fraction of 25% with left ventricular systolic dysfunction. Which diagnosis should the CDI specialist consider when constructing a clinically supported clarification query?

A patient with known heart failure presents with severe dyspnea, orthopnea, bilateral crackles, pulmonary edema, and lower-extremity edema. Echocardiography shows an ejection fraction of 28%. IV loop diuretics are administered. Which clarification is MOST clinically supported?

A patient with chronic heart failure presents with confusion, nausea, and seizures. Serum sodium is 116 mEq/L. The patient is treated with hypertonic saline and intensive electrolyte monitoring. Which diagnosis is MOST strongly supported for clarification?

A patient is admitted with a stage 2 sacral pressure ulcer. During the hospitalization, the ulcer progresses and is documented as stage 3 at the same site. How should the pressure ulcer be reported?

A CDI program plans to develop a policy for addressing diagnoses that require clinical validation. According to the Guidelines for Achieving a Compliant Query Practice, which of the following should be addressed in the policy?

A CDI specialist reviews a prior hospitalization and finds that the patient previously had chronic systolic heart failure. During the current admission, the provider documents only “history of CHF,” although the patient remains on long-term heart-failure therapy. What is the BEST approach?

A patient is admitted with sepsis due to an E. coli urinary tract infection. The provider also documents acute kidney injury due to the sepsis and “severe sepsis without septic shock.” Which sequencing is most appropriate?

A patient's baseline creatinine is 1.0 mg/dL. Following prolonged hypotension, creatinine rises to 3.8 mg/dL. Urinalysis demonstrates granular casts, and the nephrologist documents “acute renal failure” but does not specify the underlying renal lesion. Which condition would be MOST appropriate to consider in a clinically supported clarification query?

Which of the following diagnoses is classified as a major complication/comorbidity (MCC) under the FY 2026 MS-DRG system?

A physician is completing rounds when a CDI specialist identifies conflicting documentation that can be clarified immediately. Which approach is MOST appropriate?

A patient is admitted with right-sided weakness and aphasia. MRI confirms an acute left cerebral infarction. Two days later, aphasia resolves but right-sided weakness remains. The physician's documentation continues to state “TIA.” What should the CDI specialist do?

A patient with abdominal pain and melena is found to have a duodenal ulcer with hemorrhage. The CDI specialist would look for clinical indicators to support which of the following conditions?

A patient is admitted with nausea, confusion, and generalized weakness. Laboratory testing shows a serum sodium level of 119 mEq/L. The patient receives hypertonic saline and frequent serum sodium monitoring. The physician documents “electrolyte disturbance.” Which condition is the MOST appropriate clarification opportunity?

A patient's baseline serum creatinine is 0.9 mg/dL. Forty-eight hours after admission, the creatinine is 1.5 mg/dL. Urine output has also decreased. Which condition is most appropriate for the CDI specialist to consider as a clarification opportunity?

A patient with an indwelling central venous catheter develops fever and positive blood cultures for Staphylococcus aureus. The physician documents “bacteremia” but does not establish whether the catheter caused the infection. Which action is MOST appropriate?

A CDI specialist submits a neutral query regarding possible acute blood loss anemia. The physician answers “clinically unable to determine.” The CDI specialist believes documenting the diagnosis would increase reimbursement substantially. What is the MOST appropriate next action?

During a quarter, a CDI department issued 800 provider queries. Providers answered 720 queries, and 540 of those responses agreed with the clarification proposed by the clinical evidence. What was the provider query response rate?

The amount of the IPPS Indirect Medical Education Adjustment is determined by teaching intensity as measured by the hospital's number of residents compared to:

A patient is admitted with a documented diagnosis of acute hypoxic respiratory failure. Which of the following clinical data BEST supports the diagnosis?

Which of the following is included among the FY 2026 Hospital-Acquired Condition Reduction Program measures?

A patient is admitted with fever, productive cough, and hypotension. The attending physician documents sepsis due to pneumonia. Acute kidney injury develops and is documented as due to sepsis. Which of the following is the MOST appropriate sequencing concept?

A CDI manager notes that the physician query response rate is 98%, but only 55% of queries are answered before discharge. Which metric should receive the MOST immediate workflow analysis?

A wound care nurse documents an assessment and care of a pressure ulcer. For coding purposes, the wound care nurse's documentation can be used to assign which of the following?

An operative report states that the surgeon performed an excisional debridement of a heel wound. The report documents removal of necrotic tissue but does not identify the deepest tissue level removed. What should the CDI specialist clarify?

A patient without chronic hypercapnia develops severe respiratory distress. ABG results are pH 7.19, PaCO₂ 74 mmHg, and PaO₂ 60 mmHg. The patient requires emergent BiPAP. Which condition is MOST strongly supported for clarification?

Respiratory failure is documented in a patient's initial progress notes. There are no clinical indicators in the record to support this diagnosis. According to the AHIMA/ACDIS Practice Brief Guidelines for Achieving a Compliant Query Practice, the MOST appropriate action by the CDI specialist is which of the following?

A hospital's query policy states that all answered queries will be retained, but all unanswered queries that might delay billing will be permanently destroyed. What is the PRIMARY compliance concern?

A patient accidentally takes twice the prescribed dose of warfarin and develops gastrointestinal bleeding. Which coding concept applies?

A patient was admitted with weakness, loss of appetite, hemoglobin 7.8, WBC 2,700, and platelet count 58. The admitting diagnoses on the history and physical were anemia, leukopenia, decreased platelets, and rule out myelodysplastic syndrome. Based on these clinical indicators a CDI specialist should query for which of the following conditions?

A patient's record contains fever, tachycardia, hypotension, positive blood cultures, and treatment with IV antibiotics and fluids. No corresponding diagnosis has been documented. Which query format is MOST appropriate?