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ACDIS CCDS-O Exam - Topic 5 Question 8 Discussion

Documentation states: ''Patient with history of STEMI five weeks ago. Returning to office for follow-up. Problem list includes CAD, hypertension, heart failure, leukemia, malnutrition, and atrial fibrillation, all were relevant to the encounter. CBC and WBC reviewed and referred to oncologist. Follow-up with dietitian to further evaluate nutritional status.'' Which of the following is the MOST impactful risk adjusted query opportunity?
A) Status (remission, or relapse) and acuity of leukemia
B) Type (diastolic, systolic, combined) and acuity of heart failure
C) Differentiation of atrial fibrillation (paroxysmal, persistent, permanent)
D) Severity of the malnutrition (mild, moderate, severe)

ACDIS CCDS-O Exam - Topic 5 Question 8 Discussion

Actual exam question for ACDIS's CCDS-O exam
Question #: 8
Topic #: 5
[All CCDS-O Questions]

Documentation states: ''Patient with history of STEMI five weeks ago. Returning to office for follow-up. Problem list includes CAD, hypertension, heart failure, leukemia, malnutrition, and atrial fibrillation, all were relevant to the encounter. CBC and WBC reviewed and referred to oncologist. Follow-up with dietitian to further evaluate nutritional status.'' Which of the following is the MOST impactful risk adjusted query opportunity?

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Suggested Answer: A

In outpatient risk adjustment, the highest-impact clarification is often the one that determines whether a condition is currently active (and therefore risk-adjustable) versus historical/resolved. ''Leukemia'' listed on the problem list, plus active review of CBC/WBC and referral to oncology, strongly suggests ongoing disease evaluation/management. ACDIS outpatient CDI principles emphasize querying to confirm whether the leukemia is active, in relapse, or in remission because that distinction can change code selection from an active malignancy to a history code, and history codes typically do not carry the same risk adjustment impact as an active HCC-bearing diagnosis. While heart failure type/acuity and malnutrition severity are also important for specificity and may affect risk capture, they generally represent refinement of already-established chronic conditions rather than a potential ''on/off'' determination of a major disease category. Likewise, atrial fibrillation subtype differentiation is clinically useful but usually does not materially change risk adjustment compared with confirming an active hematologic malignancy. Therefore, clarifying leukemia status/acuity is the most impactful risk-adjusted query opportunity.


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Nenita
25 days ago
Totally agree, A seems crucial!
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Nettie
30 days ago
I think A is the most important since leukemia can really impact treatment.
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Cecil
1 month ago
I’m leaning towards the atrial fibrillation differentiation, but I’m not entirely confident. It seems like it could change the approach to treatment.
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Jonelle
2 months ago
I feel like the severity of malnutrition could be really important, especially since they mentioned a follow-up with a dietitian.
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Rusty
2 months ago
I think we practiced a similar question about leukemia and its status affecting overall patient management. That might be crucial in this case too.
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Dan
2 months ago
I remember we discussed how the acuity of heart failure can significantly impact treatment plans, but I'm not sure if it's the most impactful here.
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