Study guide
1.1 Current Exam Facts
Certified Clinical Documentation Specialist CCDS
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1 Introduction & Exam Overview
1.1 Current Exam Facts 1.2 Eligibility Pathways and the 2,000-Hour Year 1.3 Allowed Resources and Test-Day Rules 1.4 Recertification, Fees, and How This Guide Maps the Eight Domains
2 IPPS Foundations
2.1 How IPPS Works and How CMS Updates It 2.2 MS-DRG Assignment, Relative Weights, and Grouping 2.3 Provider and Clinical Staff Documentation Duties under IPPS
3 Severity, CMI, Medical Necessity, and Oversight
3.1 CC versus MCC Recognition and CC Exclusion Lists 3.2 Case Mix Index and Why CDI Tracks It 3.3 Two-Midnight Rule, Medical Necessity of Setting, and Principal Diagnosis 3.4 MAC, RAC, CERT, OIG, and Denial-Vulnerable Practices
4 Nervous and Respiratory System CDI
4.1 Nervous System Conditions for CDI 4.2 Acute and Chronic Respiratory Failure, ABGs, and Ventilation Support 4.3 Pneumonia, COPD, PE, Pleural Effusion, and Respiratory Infections
5 Circulatory, Digestive, Hepatobiliary, Musculoskeletal, and Skin CDI
5.1 Circulatory Disorders 5.2 Digestive and Hepatobiliary Disorders 5.3 Musculoskeletal and Skin
6 Endocrine, Nutrition, Kidney, and Hematologic CDI
6.1 Diabetes, Dehydration, and Obesity 6.2 Malnutrition Criteria, Severity, and Audit Risk 6.3 AKI, CKD Staging, UTI, and Urinary Stones 6.4 Anemia, Coagulation, Sickle Cell, Lymphoma, and Leukemia
7 Infectious Disease, Other MDCs, and Clinical Indicator Tools
7.1 Sepsis, Severe Sepsis, Postoperative and Other Infections 7.2 Mental, Substance Use, Injuries/Toxicology, and HIV-Related Conditions 7.3 Medications, Diagnostic Tests, and Abbreviations as Clinical Indicators
8 Health Record Elements and Query Triggers
8.1 Which Record Elements Support Diagnosis and Procedure Codes 8.2 Attending versus Radiologist, Pathologist, and Other Providers 8.3 When a Physician Query Is Warranted 8.4 When Queries Are Not Appropriate
9 Query Timing, Verbal Queries, Formats, and Clinical Indicators
9.1 Concurrent, Retrospective, Pre-Bill, and Prospective Timing 9.2 Verbal Queries and Required Documentation 9.3 Open-Ended, Multiple-Choice, and Yes/No 9.4 Clinical Indicators and How to Source Them
10 Compliant Query Practice and Clinical Validation
10.1 Compliant versus Leading and Other Noncompliant Queries 10.2 ACDIS/AHIMA 2026 Guidelines for Achieving a Compliant Query Practice 10.3 Clinical Validation and Diagnoses without Clinical Support
11 CDI Program Metrics
11.1 Productivity, Query Volume, and Provider Response Rates 11.2 CMI, CC/MCC Capture, and High-Frequency DRGs 11.3 SOI/ROM as CDI Program Performance Metrics
12 Physician Metrics, PEPPER, Forecasting, and Public Data
12.1 Measuring Physician Documentation Performance 12.2 PEPPER, Forecasting, Hospital Financial Data, and Public Reporting
13 CDI Roles, Coder Collaboration, and Physician Education
13.1 Roles and Responsibilities of the CDI Specialist 13.2 Coder Roles Working with a CDI Department 13.3 Physician Education Tools, Forms, and Presentations
14 Provider Communication and DRG Reconciliation
14.1 Non-Confrontational Communication and When Verbal Beats Written 14.2 Working DRG versus Final DRG Reconciliation
15 Official Guidelines, Principal Diagnosis, and Secondary Diagnosis
15.1 Official Guidelines, Cooperating Parties, Updates, and AHA Coding Clinic 15.2 Principal Diagnosis Selection 15.3 Secondary Diagnosis Reporting Criteria
16 Sequencing, Coding Conventions, and POA Indicators
16.1 Sequencing When Two Diagnoses Equally Meet PD; Working DRG with Multiple Diagnoses 16.2 Integral Signs/Symptoms, the With Convention, and Uncertain Diagnoses 16.3 Present-on-Admission Indicator Assignment and Payment Impact
17 Hospital-Acquired Conditions, Disposition, and ICD-10-PCS Essentials
17.1 CMS Hospital-Acquired Condition Payment Provision 17.2 Discharge Disposition, Transfer Payment, Principal Procedure, and ICD-10-PCS Essentials
18 Ethics, Privacy, and Leading Queries as Compliance Failures
18.1 ACDIS Code of Ethics and CDI Goals beyond Reimbursement 18.2 HIPAA, Minimum Necessary, and Record Confidentiality 18.3 Leading Queries as a Compliance Failure
19 DRG Creep, OIG Oversight, PEPPER, and the False Claims Act
19.1 DRG Compliance, DRG Creep, and the OIG Work Plan 19.2 PEPPER Compliance Risks and the False Claims Act
20 Mortality Index, Observed-to-Expected Ratios, and Quality Data Sources
20.1 Documentation Impact on Mortality Index (SOI/ROM) 20.2 Mortality Reviews and Observed-to-Expected Ratios 20.3 Abstracted versus Claims-Based Quality Data
21 CMS Quality Programs, PSIs, and Infection versus Complication Codes
21.1 HVBP, HAC Reduction Program, HRRP, 30-Day Mortality, and Hospital IQR 21.2 PSI 90 Components and PSIs beyond the Composite 21.3 Healthcare-Associated Infections versus Complication Codes
1.1 Current Exam Facts
Key Takeaways Explain This Topic AI
The inpatient CCDS sitting is 140 four-option multiple-choice items in 3 hours; 120 items are scored and 20 unidentified pretest items are not
The May 2024 ACDIS CCDS/CCDS-O Candidate Handbook describes about 30% recall, 40% application, and 30% analysis; older 40/40/20 summaries are stale
Pass/fail is the raw score on the 120 scored items; ACDIS's Certifications & Certificates FAQ sets the passing score at 88 correct out of 120 scored questions (the Candidate Handbook itself gives no number)
The same handbook notes a first-time pass rate presently about 77%
After approval, candidates have 90 days from the date ACDIS sends their name to Prometric to schedule and sit at a Prometric center or via remote ProProctor
Last updated: September 2026
1.1 Current Exam Facts
Quick Answer: The inpatient Certified Clinical Documentation Specialist (CCDS) sitting from the Association of Clinical Documentation Integrity Specialists (ACDIS) is 140 four-option multiple-choice items in 3 hours . 120 items are scored and 20 unidentified pretest items are not. The May 2024 ACDIS CCDS/CCDS-O Candidate Handbook describes a cognitive mix of about 30% recall , 40% application , and 30% analysis . Pass/fail is a raw score on the 120 scored items; ACDIS's Certifications & Certificates FAQ sets the passing score at 88 correct out of 120 scored questions, though the Candidate Handbook itself states no number. The same handbook notes a first-time pass rate presently about 77% . Delivery is Prometric test centers or remote ProProctor , with a 90-day window to schedule and sit after ACDIS sends your name to Prometric.
This independent ExamFinch chapter helps learners study the inpatient CCDS. It is not an ACDIS product, and ExamFinch does not claim ACDIS approval, partnership, official review, or exact equivalence with ACDIS materials. A sibling credential, Certified Clinical Documentation Specialist–Outpatient (CCDS-O) , tests outpatient documentation integrity; this guide stays on Inpatient Prospective Payment System (IPPS) clinical documentation integrity ( CDI ).
Why these logistics belong in week one of study
CCDS is an experience credential. Most candidates already review records, write queries, and talk through working Medicare Severity Diagnosis Related Groups (MS-DRGs) every day. That background does not automatically produce a 3-hour, 140-item computer performance. The published format tells you how to spend the clock, what “pass” even means, and which internet summaries to throw out. A first-time pass rate presently about 77% also means roughly one in four first sittings does not pass. Treat that as a planning number, not a prediction about you: veteran CDI specialists fail when they study the wrong mix, hunt for pretest items, or arrive without a timing plan.
What you will see on the screen
Every item has four choices labeled A through D. You will not see constructed-response, oral stations, or a separate coding practical. Before the scored clock starts, Prometric offers an untimed computer-practice session so you can learn navigation. That practice time does not count against the 3 hours. Once the timed examination begins, you have 180 minutes for all 140 items.
Scored items versus pretest items
Your pass/fail decision uses 120 items. 20 items are pretest questions placed so ACDIS can evaluate them for later scored use. Those 20 are unidentified and scattered. You cannot tell a pretest item from a scored item by wording, difficulty, or screen flags. Any strategy that says “skip the experimental ones” is not a strategy; it is a way to leave scored points unanswered.
There is no penalty for guessing . Unanswered items cannot help you. If time is short, choose an answer on every remaining question, bookmark the ones you want to revisit, and use the on-screen grid to find blanks. The software warns you about unanswered items if time remains.
Instant result, raw score, and the 88-of-120 passing standard
When you finish, you receive an instant pass or fail notice, then a score report with raw scores by major content category . A raw score is the number of scored items you answered correctly. The handbook states that the programs apply the same passing score (it uses the phrase “cut score”) and the same answer key to every candidate on the same exam form, but the May 2024 handbook itself does not print that number. ACDIS publishes it elsewhere: the Certifications & Certificates FAQ on acdis.org states the passing score is 88 correct out of 120 scored questions. Use that FAQ figure, not a forum guess, and do not substitute ExamFinch practice-bank size for the official sitting.
You also cannot appeal an individual question, an individual answer, or a failing score on the theory that one item was unfair. Pretesting is the published reason. Appeals are limited to eligibility, credential revocation, and administration or environment problems severe enough to disrupt the sitting. Those processes have their own deadlines; they are not a second scoring method.
Cognitive mix: use the current handbook, not older FAQs
- Cognitive level Handbook meaning Approximate share
- Recall Recognize or remember a specific fact, definition, or rule ~30%
- Application Use a rule in a new or changing situation ~40%
- Analysis Break information apart, choose among solutions, or judge whether a solution works ~30%
Older public FAQs that still say 40% recall / 40% application / 20% analysis are stale relative to the May 2024 handbook. Study plans built on that older mix over-invest in flashcard definitions and under-invest in “given this record, what should the CDI specialist do next?” items. The published scored blueprint makes the same point another way: Domain II (anatomy, physiology, pathophysiology, pharmacology, and terminology) currently contributes 23 scored items with zero recall in the domain split ( 12 application, 11 analysis). You cannot pass Domain II by reciting drug names without using them as clinical indicators.
The ~30/40/30 mix describes the examination design. Combined with the domain-level recall/application/analysis counts on the 120 scored items, it is a study map: definitions still matter, but most of the sitting asks you to apply or analyze.
Exam-source baseline versus current professional practice
ACDIS's live application page currently says the current exam version was published in February 2022 and bases its questions on AHA Coding Clinic through Fourth Quarter 2021 , the FY 2021 ICD-10-CM Official Guidelines for Coding and Reporting , and the 2019 ACDIS/AHIMA query-practice brief. The newer May 2024 handbook also tells candidates to understand current professional guidance . Those statements answer different questions: use the live application page's source list when identifying the published exam-form baseline , and use current official coding, payment, and query guidance when a scenario expressly asks about current professional practice . The August 2026 query position paper, for example, governs current query practice but is not yet listed by ACDIS as a source for the February 2022 exam form. Recheck the live application page before testing because ACDIS can update the form or its source list.
Time, delivery, and the 90-day clock
One hundred forty items in 180 minutes is about 77 seconds per item if you never leave the seat. The handbook allows one unscheduled 10-minute break . The timer does not stop , and test-center candidates must pass through security again before continuing. If you take that break, you have about 73 seconds per item across the full 140. Build practice blocks at that pace instead of untimed weekend browsing.
Applications are accepted on a rolling basis. After ACDIS and HCPro approve the application, they send your name to Prometric. The eligibility period is 90 days (3 months) from the date the name is submitted to Prometric , and you must both schedule and take the examination in that window. Missing the window forfeits the application and the fee. Walk-in candidates are not seated. You sit only the examination named on the confirmation.
Delivery is a Prometric test center (the handbook notes more than 14,000 locations in North America and internationally) or Prometric’s remote ProProctor platform. Choose the channel when you schedule, then study the corresponding check-in rules in section 1.3. The content, item count, time, and scoring rules are the same either way.
Loading diagram... CCDS Path from Application to Instant Result
Exam-style scenarios
Scenario: hunting the pretest. A candidate tells colleagues, “If an item looks experimental, I will flag it and come back.” On this sitting there is no label, no separate experimental section, and no way to know. The safer habit is to treat every item as scored, answer it, bookmark only for genuine review, and never leave a blank because you hoped it was one of the 20.
Scenario: studying like a 40/40/20 recall test. Another candidate builds 400 flashcards on IPPS acronyms and barely works through record vignettes. The current handbook mix is about 30/40/30, and Domain II’s 23 scored items are application and analysis only. That candidate is practicing the smaller share of the exam. Flip the plan: use recall drills to unlock application sets, then spend the largest block of hours on “what would you query, sequence, or measure?” problems.
Scenario: treating 77% as a personal forecast. A manager says, “Most people pass, so two weekends of review is enough.” About 77% first-time pass is a published snapshot, not a guarantee, and the handbook itself warns that experienced specialists are among those who do not pass on the first attempt. Use the number as a reason to respect the sitting, not as permission to under-prepare.
Scenario: confusing practice-bank size with the real exam. ExamFinch’s practice inventory is a study tool. The ACDIS sitting itself is 140 items with 120 scored. Never quote a local bank count as if it were the examination.
How to use these facts while you study
Plan review in 140-item, 3-hour blocks once content knowledge is in place. Practice bookmarking, guessing without penalty, and returning via the grid. When a blog or old slide deck quotes a percent-to-pass, a 1,000-hour year, seven “core competencies,” or a 40/40/20 mix, compare the date with the May 2024 handbook and the live ACDIS requirements page. Those two sources win.
Fees, books, identification, and recertification have their own published rules; the next three sections of this chapter cover them. For the sitting itself, remember the five numbers that structure every later chapter: 140 , 120 , 20 , 3 hours , and 30/40/30 .