Online Access Free CDIP Practice Test

What type of query may NOT be used in circumstances where only clinical indicators of a condition are present, and the condition/diagnosis has not been documented in the health record?

• A.Open-ended
• B.Yes/No
• C.Multiple-choice
• D.Verbal

A patient receives a blood transfusion after a 400 ml blood loss during surgery. The clinical documentation integrity practitioner (CDIP) queries the physician for an associated diagnosis. The facility does not maintain queries as part of the permanent health record. What does the physician need to document for the CDIP to record the query as answered and agreed?

• A.A cause-and-effect relationship between anemia and the underlying cause
• B.The associated diagnosis and the clinical rationale in the progress notes
• C.That the blood loss was not clinically significant
• D.The associated diagnosis directly on the query form

Identify the error in the following query:
This patient's echocardiogram showed an ejection fraction of 25%. The chest x-ray showed congestive heart failure (CHF). The patient was prescribed Lasix and an angiotensin-converting enzyme inhibitor (ACEI). Is this patient's CHF systolic?

• A.The query is unclear.
• B.The query is leading.
• C.The query contains irrelevant information.
• D.The query does not contain clinical indicators.

Which of the following criteria for clinical documentation means the content of the record is trustworthy, safe, and yielding the same result when repeated?

• A.Precise
• B.Legible
• C.Reliable
• D.Complete

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.not meet medical necessity
• B.not increase relative weight
• C.meet medical necessity
• D.increase relative weight