ACDIS Updated CCDS Exam Questions and Answers by reina

The appropriate action is to query the provider regarding the patient's nutritional diagnosis. The dietitian's assessment supplies important clinical evidence, but the associated diagnosis of malnutrition generally must be documented by an appropriate provider before the diagnosis code is assigned.

The FY 2026 ICD-10-CM Official Guidelines permit selected elements to come from non-provider clinicians—such as BMI, pressure-ulcer stage, coma scale, NIH Stroke Scale, certain social determinants, and other specifically identified exceptions. Malnutrition diagnosis itself is not simply assigned solely from a dietitian's diagnostic statement under this general rule.

Ignoring the dietitian's findings would also be inappropriate. CDI review should integrate multidisciplinary documentation because such documentation can reveal valid clarification opportunities. Severe weight loss, reduced intake, and documented muscle depletion provide a clinical basis for a neutral query.

The query should not state that severe malnutrition “must” be documented because it is an MCC. Instead, it should present the relevant nutrition findings and allow the provider to determine the diagnosis, including severe malnutrition, another level of malnutrition, another cause, or inability to determine.

CCDS Reference Topics: Malnutrition; multidisciplinary documentation; provider diagnosis requirements; clinical indicators.

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CMS publishes the complete MCC and CC lists as part of the FY 2026 IPPS Final Rule supporting tables. Specifically, the FY 2026 final-rule page identifies Table 6I as the Complete MCC List and Table 6J as the Complete CC List, along with additions, deletions, and the CC exclusion list.

These files are critical reference resources when assessing MS-DRG severity logic. Nevertheless, classification as an MCC or CC does not automatically mean that the diagnosis changes a particular case's MS-DRG. Principal-diagnosis exclusions, procedure logic, DRG structure, and the presence of another MCC can affect whether a diagnosis alters final assignment.

The Hospital Consumer Assessment survey relates to patient experience rather than diagnosis severity classification. The Physician Fee Schedule governs professional reimbursement and does not contain the inpatient MS-DRG MCC/CC classification system. National Coverage Determinations address Medicare coverage for particular services rather than MS-DRG severity categories.

CDI specialists should use the current CMS version applicable to the discharge date. CMS identifies MS-DRG Version 43.1 as effective April 1 through September 30, 2026.

CCDS Reference Topics: MCC; CC; CMS Definitions Manual; IPPS; MS-DRG severity.

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Observed-to-expected mortality is calculated as:

Observed deaths ÷ Expected deaths

Therefore:

72 ÷ 90 = 0.80.

An O/E ratio of 0.80 means that observed mortality was lower than predicted by the applicable risk-adjustment model. Specifically, observed deaths were 20% below the expected number.

A ratio of 1.0 indicates observed mortality equals expected mortality. Values above 1.0 indicate more deaths than predicted, while values below 1.0 indicate fewer deaths than predicted.

CDI influences the integrity of mortality analysis because the documented disease burden contributes to clinical data used by many risk-adjustment methodologies. If significant comorbidities are incompletely documented, expected mortality may not fully reflect the patient's clinical risk.

However, mortality review must never become a mechanism for adding unsupported diagnoses. The objective is accurate clinical representation.

The CCDS candidate handbook explicitly identifies data analysis, reporting functions, medical-record review, and the impact of documentation on clinical and administrative outcomes as important CDI competencies.

CCDS Reference Topics: Mortality index; O/E ratio; risk adjustment; quality reporting; CDI analytics.

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Accurate discharge disposition is critical to application of the Post-Acute Care Transfer policy because the patient's destination after the acute inpatient stay can determine whether transfer-payment methodology applies.

Qualifying discharges to certain post-acute settings can be subject to transfer-payment rules when other criteria are met. These settings can include skilled nursing facilities and other specified post-acute arrangements, depending on applicable CMS requirements and the MS-DRG involved.

Therefore, an incorrectly documented discharge destination can affect reimbursement even when the diagnoses, procedures, and MS-DRG are otherwise accurate.

The PACT concept demonstrates why CDI and coding accuracy extend beyond diagnosis capture. The inpatient claim also relies on accurate demographic, procedural, discharge-status, and utilization information.

Dietary preference, physician experience, and the number of daily progress notes do not determine whether PACT methodology applies.

CDI specialists should recognize when conflicting documentation exists regarding whether a patient went home, to skilled nursing, rehabilitation, another acute facility, hospice, or another destination and collaborate with the appropriate departments to ensure the final record accurately reflects the actual disposition.

CCDS Reference Topics: PACT; discharge disposition; IPPS transfer rules; reimbursement; data integrity.

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