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AHIMA Certified Documentation Integrity Practitioner Sample Questions:

1. Which of the following sources provide external benchmarks to examine the effectiveness of a facility's clinical documentation program?

A) Health Care Financing Administration
B) American Health Information Management Association
C) Medicare Provider Analysis and Review
D) Agency for Healthcare Research and Quality

2. Which physician would best benefit from additional education for unanswered queries?

A) Dr. C
B) Dr. A
C) Dr. B
D) Dr. D

3. A patient presents to the emergency room with acute shortness of breath. The patient has a history of lung cancer that has been treated previously with radiation and chemotherapy. The patient is intubated and placed on mechanical ventilation. A chest x-ray is remarkable for a pleural effusion. A thoracentesis is performed, and the cytology results show malignant cells. Diagnoses on discharge: Acute respiratory failure due to recurrence of small cell carcinoma and malignant pleural effusion. Which coding reference takes precedence for assigning the ICD-10-CM/PCS codes?

A) AHA Coding Clinic for ICD-10-CM/PCS
B) AMA CPT Assistant
C) Conventions and instructions of the classification for ICD-10-CM/PCS
D) ICD-10-CM Official Guidelines for Coding and Reporting

4. A patient was admitted with complaints of confusion, weakness, and slurred speech. A CT of the head and MRI were performed and resulted in normal findings. Daily aspirin was administered and a speech therapy evaluation was conducted. The final diagnosis on discharge was transient ischemic attack, and cerebrovascular disease was ruled out. What is the correct diagnostic related group assignment?

A) 948 Signs and Symptoms without MCC
B) 066 Intracranial Hemorrhage or Cerebral Infarction without CC/MCC
C) 069 Transient Ischemia
D) 093 Other Disorders of Nervous System without CC/MCC

5. A patient falls off a ladder and undergoes a right femur procedure. Three weeks later, the patient returns to the hospital for removal of the external fixation device. The ICD-10-CM 7th character code value should indicate

A) subsequent
B) sequela
C) initial
D) aftercare

Solutions: