10 free, exam-style Certified Clinical Documentation Specialist Outpatient (CCDS-O) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CCDS-O practice test to study every exam domain.
A 58-year-old established patient presents to her primary care office with chest pain and shortness of breath. After a thorough workup, the provider documents in the assessment: 'Chest pain, likely musculoskeletal; rule out unstable angina; will follow up after stress test.' Per ICD-10-CM Official Guidelines Section IV, the FIRST-LISTED diagnosis on this encounter is:
Correct answer: B - R07.9 - Chest pain, unspecified
Effective January 1, 2023, the E/M coding framework was updated across multiple care settings. Which statement accurately describes a 2023 change?
Correct answer: C - Observation codes were deleted; observation services are now reported using inpatient codes (99221-99223 initial, 99231-99233 subsequent)
A 64-year-old patient with Type 2 diabetes mellitus is seen in endocrinology clinic. The provider documents: 'Type 2 DM, A1c 8.2%. Patient also has Stage 3a CKD with eGFR 52. Continue metformin and lisinopril.' The provider does NOT explicitly state that the CKD is due to diabetes. According to ICD-10-CM coding conventions, the correct code assignment is:
Correct answer: B - E11.22 (Type 2 DM with diabetic chronic kidney disease) + N18.31 (Stage 3a CKD), with the relationship assumed per the 'with' convention
During an outpatient encounter, a registered dietitian documents 'BMI 42.' The patient's physician documents 'morbid obesity' in the assessment and plan, and orders nutritional counseling. For ICD-10-CM coding of this encounter, which statement is CORRECT per the Official Guidelines (Section I.B.14)?
Correct answer: B - The BMI code (Z68.41) may be assigned based on the dietitian's documentation, and the morbid obesity diagnosis (E66.01) may be assigned based on the provider's documentation
A patient is seen for a 3-month follow-up. The provider documents: 'CHF - patient stable on guideline-directed medical therapy. Recent echo shows EF 28%. Continue carvedilol, lisinopril, spironolactone, and furosemide.' Which code provides the GREATEST documentation specificity supported by this note?
Correct answer: C - I50.22 - Chronic systolic (congestive) heart failure
A CDI specialist is reviewing charts for a Medicare Advantage population during the 2026 payment year. Which of the following statements about the CMS-HCC risk adjustment model is CORRECT for charts being reviewed for PY 2026 risk adjustment?
Correct answer: B - PY 2026 uses 100% V28; V24 is fully phased out
A Medicare Advantage beneficiary's pre-adjustment RAF is calculated as 1.420 based on demographics, qualifying HCCs, and disease interactions. To determine the final RAF used for capitation, the plan applies the current normalization factor of 1.045 and the statutory minimum MA coding pattern adjustment of 5.9%. The final RAF is approximately:
Correct answer: A - 1.279
An outpatient CDI specialist is reviewing year-over-year HCC capture data for a primary care provider's panel. A patient who had Type 2 diabetes with chronic kidney disease (E11.22) documented and coded in 2024 has not had this combination documented or coded during any 2025 face-to-face encounter to date. In ACDIS terminology, this is referred to as a:
Correct answer: C - Drop
A CDI specialist reviews an outpatient note documenting: 'Patient with diabetes, A1c 8.4%, BMI 38, on metformin and lisinopril. Bilateral lower extremity edema on exam.' The CDI specialist wants to clarify the type of diabetes (which is not specified). Which query is COMPLIANT per the 2022 ACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice?
Correct answer: B - 'Please clarify the type of diabetes mellitus: a) Type 1 diabetes, b) Type 2 diabetes, c) Other specified diabetes (please specify), d) Unable to determine.'
A physician group enters into an arrangement to refer all of their imaging services to a specific imaging center owned by one of the partners. There is no documented financial relationship exception. Which federal law is most directly implicated, and what is the legal standard?
Correct answer: C - Stark Law (Physician Self-Referral Law), which is a strict liability statute prohibiting physician self-referral for designated health services
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