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AHIMA Certified Documentation Integrity Practitioner Sample Questions:

1. Which of the following is an appropriate first step to address physicians with low query response rates?

A) A meeting between the physician advisor/champion and the noncompliant physician
B) An educational session between the clinical documentation integrity practitioner (CDIP) and physician
C) The medical staff review the physician's noncompliance to consider sanctions
D) The physician receives a suspension until query responses are improved

2. A 70-year-old severely malnourished nursing home patient is admitted for a pressure ulcer covered by eschar on the right hip. The provider is queried to clarify the stage of the pressure ulcer. Because the wound has not been debrided, the provider responds "unable to determine".
How will the stage of this pressure ulcer be coded?

A) Unstageable pressure ulcer
B) Undetermined stage pressure ulcer
C) Stage IV pressure ulcer
D) Stage III pressure ulcer

3. A 94-year-old female patient is admitted with altered mental status and inability to move the left side of her body. She is diagnosed with a cerebral vascular accident with left sided weakness. The patient is ambidextrous, but the physician does not specify the predominance of the affected side. The default code is

A) dominant
B) ambidextrous
C) non-dominant
D) preferred

4. A clinical documentation integrity practitioner (CDIP) hired by an internal medicine clinic is creating policies governing written queries. What is an AHIMA best practice for these policies?

A) Primary care physicians must answer written queries
B) Queries are limited to non-leading questions
C) Queries for illegible chart notes are unnecessary
D) Non-responses to written queries are grounds for discipline

5. When there is a discrepancy between the clinical documentation integrity practitioner's (CDIP's) working DRG and the coder's final DRG, which of the following is considered a fundamental element that must be in place for a successful resolution?

A) Physician and CDIP interaction
B) Physician advisor/champion involvement
C) Coder and CDIP interaction
D) Executive oversight

Solutions: