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AHIMA CDIP Exam Syllabus Topics:

AHIMA Certified Documentation Integrity Practitioner Sample Questions:

1. A 50-year-old with a history of stage II lung cancer is brought to the emergency department with severe dyspnea. The patient underwent the last round of chemotherapy
3 days ago. Vital signs reveal a temperature of 98.4, a heart rate of 98, a respiratory rate of 28, and a blood pressure of 124/82. O2 saturation on room air is 92%. The patient is 5'5"and weighs 98 lbs. The registered dietitian notes the patient is malnourished with BMI of 19.
Chest x-ray reveals a large pleural effusion in the right lung.
Thoracentesis is performed and 1000 cc serosanguinous fluid is removed. The admitting diagnosis is large right lung pleural effusion related to lung cancer stage II, documented multiple times. What post discharge query opportunity should be sent to the physician that will affect severity of illness (SOI)/risk of mortality (ROM)?

A) Query if the malignant pleural effusion is the reason for admission
B) Query for a diagnosis associated with the dietician's finding of malnutrition
C) Query for malignant pleural effusion
D) Query for protein calorie malnutrition

2. Which of the following organizations should a clinical documentation integrity practitioner (CDIP) monitor?

A) Recovery Auditors (RAs), Program for Evaluating Payment Patterns Electronic Report (PEPPER), Office of Inspector General (OIG)
B) Office of Inspector General (OIG), Accreditation Commission for Healthcare (ACHC), Recovery Auditors (RAs)
C) Program for Evaluating Payment Patterns Electronic Report (PEPPER), Recovery Auditors (RAs), Center for Improvement in Healthcare (CIHQ)
D) Center for Improvement in Healthcare (CIHQ), Accreditation Commission for Healthcare (ACHC), Recovery Auditors (RAs)

3. The physician advisor/champion needs to provide ongoing education regarding coding and reimbursement regulations to the

A) organization senior administration staff
B) Health Information Management coding staff
C) organization's medical and surgical staff
D) clinical documentation integrity staff

4. The clinical documentation integrity practitioner (CDIP) performed a verbal query and then later neglected following up with the provider. How should the CDIP avoid a compliance risk for this follow up failure according to AHIMA's Guidelines for Achieving a Compliant Query Practice?

A) Complete the documentation immediately after the provider's response
B) Complete the documentation at the time of discussion or immediately following
C) Complete the documentation when there is a provider agreement
D) Complete the documentation at the end of the day when entering cases reviewed

5. Which of the following is considered a hospital-acquired condition if not present on admission?

A) Stage I and II pressure ulcers
B) Air leak
C) Diabetes with hypoglycemia
D) Blood incompatibility

Solutions: