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AHIMA CDIP Exam Syllabus Topics:
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Leadership | 17–22% | - CDI program development and promotion - Interdisciplinary collaboration - Policy and procedure creation - Provider engagement and communication |
| Topic 2: Record Review & Document Clarification | 24–28% | - Ethical provider query development - Query tracking and follow-up - Identify documentation gaps and specificity issues - Compliance with query standards - POA, HAC, SOI, ROM clarification |
| Topic 3: Compliance | 4–8% | - Legal and ethical documentation practices - Compliance monitoring and reporting - Fraud and abuse prevention - AHIMA standards and regulatory requirements |
| Topic 4: Research & Education | 11–15% | - Documentation improvement training materials - Best practice research and implementation - Regulatory and guideline updates - Provider and staff education |
| Topic 5: CDI Metrics & Statistics | 14–18% | - DRG comparison and denial analysis - Quality audits and compliance monitoring - Benchmarking and reporting - Query response and volume tracking |
| Topic 6: Clinical Coding Practice | 22–26% | - Principal and secondary diagnosis identification - Coding software and reference resources - Payer requirements and reimbursement models - ICD-10-CM/PCS coding conventions and guidelines - DRG, CPT, and HCPCS code assignment |
AHIMA Certified Documentation Integrity Practitioner Sample Questions:
Question #1
Which of the following indicates a noncompliant multiple-choice query? One that does NOT
A. allow the provider to add their own response
B. include the option of "unable to determine"
C. list options in alphabetical order
D. include at least four options
Question #2
After one year, the clinical documentation integrity (CDI) program has become stagnant, and the manager plans to reinvigorate the program to better reflect the CDI efforts in the organization. What can the manager do to ensure program success?
A. Identify key metrics to develop program measures for coders
B. Prioritize to focus on efforts with the largest return on investment
C. Establish a CDI steering committee to build a strong foundation
D. Expand the CDI program to larger areas in outpatient clinics
Question #3
The clinical documentation integrity (CDI) manager reviewed all payer refined-diagnosis related groups (APR-DRG) benchmarking data and has identified potential opportunities for improvement. The manager hopes to develop a work plan to target severity of illness (SOI)/risk of mortality (ROM) by service line and providers. How can the manager gain more information about this situation?
A. Audit cases for missed diagnosis by the CDI practitioner to target in the education plan
B. Audit focused APR-DRGs and develop education plan for CDI team and physicians
C. Audit focused cases by physicians that have a higher SOI/ROM for education plan
D. Audit cases that have high SOI/ROM assigned by coders for education and follow-up
Question #4
Patient is admitted with oliguria, pulmonary edema, and dehydration. Labs are remarkable for an elevated creatinine of 2.4, with a baseline of 1.1. Patient was hydrated for 48 hours with drop in creatinine. What would the appropriate action be?
A. Code acute renal failure since symptoms are there and documented
B. Query the physician to see if acute renal failure is clinically supported
C. No query is needed because the patient was dehydrated
D. Query the physician to see if acute renal failure with tubular necrosis is supported
Question #5
Reviewing and analyzing physician query content on a regular basis
A. facilitates physician data collection
B. assists in identifying gaps in skills and knowledge
C. helps to calculate query response rate
D. aids in discussion between physician and reviewer
Solutions:
| Question #1 Correct Answer: D | Question #2 Correct Answer: C | Question #3 Correct Answer: B | Question #4 Correct Answer: B | Question #5 Correct Answer: B |


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