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AHIMA Certified Documentation Integrity Practitioner Sample Questions:

1. Which of the following can be evidence of physician-hospital alignment?

A) A low physician agreement rate
B) A high physician agreement rate
C) A high physician response rate
D) A high clinical documentation integrity practitioner (CDIP) query rate

2. 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

3. Combination codes are used to classify two diagnoses, a diagnosis with a manifestation, or a diagnosis

A) that is an integral part of a disease process
B) with an associated procedure
C) with an associated complication
D) with a sequelae or late effect

4. An 88-year-old male is admitted with a fever, cough, and leukocytosis. The physician documents admit for probable sepsis due to urinary tract infection (UTI). Antibiotics are started. Three days later, the blood and urine cultures are negative, the patient has been afebrile since admission, and the white blood count is returning to normal. What documentation clarification is needed to support accurate coding of the record?

A) Send a clinical validation query for only the diagnosis of sepsis.
B) A clinical validation query is not required for either diagnosis.
C) Send a clinical validation query for both the diagnoses of sepsis and UTI.
D) Send a clinical validation query for only the diagnosis of UTI.

5. A patient is admitted due to pneumonia. On day 1, a sputum culture is positive for psuedomonas bacteria. If the physician is queried and agrees that the patient has pseudomonas pneumonia, this specificity would

A) increase relative weight
B) not increase relative weight
C) not meet medical necessity
D) meet medical necessity

Solutions: