1.4 Recertification, Fees, and How This Guide Maps the Eight Domains

Certified Clinical Documentation Specialist CCDS

Track your progress as you read

Finished sections get a check mark.

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

1.4 Recertification, Fees, and How This Guide Maps the Eight Domains

Key Takeaways Explain This Topic AI

CCDS application fees are $280 ACDIS members / $380 non-members and are non-refundable; the first retake is $150 after a 90-day wait, and later attempts are full price

Recertify every 2 years with 30 CDI-relevant CEUs; recertification fees are $125 members / $225 non-members

A 45-day grace period exists; after that the credential is inactive with a $150 late fee, and after one year from expiration the holder must reapply and retest

Holders of both CCDS and CCDS-O submit 40 CEUs and pay $200 members / $300 non-members on a single recertification date

The 120 scored items split across eight domains; Domain II and Domain III are the largest at 23 items (19.2%) each

Last updated: September 2026

1.4 Recertification, Fees, and How This Guide Maps the Eight Domains

Quick Answer: The May 2024 handbook lists CCDS application fees of $280 ACDIS members / $380 non-members , non-refundable . The first retake is $150 after a mandatory 90-day wait; later attempts are full price . Recertify every 2 years with 30 continuing education units ( CEUs ) relevant to CDI; recertification fees are $125 members / $225 non-members . After a 45-day grace period the credential becomes inactive and a $150 late fee applies; after one year from expiration you must reapply and retest . The examination’s 120 scored items fall in eight domains ; this guide’s later chapters take those domains in order.

This independent ExamFinch section connects published money rules to the eight-domain map you will study. ExamFinch does not set ACDIS fees, award CEUs, or recertify anyone.

Why fees and recertification belong beside the blueprint

A candidate who only memos “140 questions” still needs a two-year CEU plan and a retake budget. Non-refundable application fees mean an incomplete eligibility file is an expensive mistake. The 90-day wait between attempts is not study advice; it is a calendar lock: you may not apply or pay to retake until the wait has passed. Recertification is how the credential stays current with IPPS, coding guideline, and query-practice changes. If you let it lapse past one year, the handbook’s remedy is the examination again—not a late packet.

Application, retake, and reschedule money

Event Member Non-member Notes
Initial CCDS application and exam $280 $380 Credit card at submission; non-refundable
First retake $150 $150 One discounted retake; 90-day wait; do not apply or pay until the wait ends
Later attempts $280 $380 Full price after the first discounted retake

Prometric reschedule/cancel, exam 30+ days away $0 Prometric fee $0 Prometric fee Still contact ACDIS/HCPro Customer Care

Prometric reschedule/cancel, 7–29 days away $35 Prometric fee $35 Prometric fee Exam date itself is not counted in the 7–29 window

7 days or less before the exam Fees not refundable Fees not refundable Future sitting requires reapplication and repayment

Rolling applications have no published seasonal deadline. The 90-day Prometric window from name submission is still the hard clock for the first sitting. Missing that window forfeits the fee just as a late cancellation inside seven days does.

If you do not pass, you receive the instant fail notice and a category raw-score report. Use that report to aim the 90-day study block at weak domains instead of rereading every chapter equally. The discounted $150 retake is once . A second failure returns you to $280 / $380 .

Recertification, CEUs, grace, and lapse

Certification is valid two years from the exam date . Holders apply for recertification every two years and submit evidence of 30 CEUs relevant to CDI through ACDIS’s credentialing site. Retaking the examination is not required if you recertify on time. ACDIS emails reminders but is not responsible for undelivered mail; keep your address current. A percentage of recertification files are audited —keep activity records.

If you also hold CCDS-O , submit a combined 40 CEUs and pay the joint recertification fee: $200 members / $300 non-members . ACDIS sets one recertification date: every two years from the date you passed the second exam. Example from the handbook’s logic: pass CCDS on January 1, 2024, pass CCDS-O on October 1, 2024, and the joint 40-CEU date is October 1, 2026. This inpatient guide does not teach CCDS-O content; it only notes the dual-credential CEU math so dual holders do not under-count.

Timing if you are late:

Submit by the two-year date when you can.

A 45-day grace period still allows CEU submission.

Missing the grace period makes the certification inactive and adds a $150 late fee . You must recertify, paying recertification plus the late fee, within one year of expiration to keep using the credential.

After one year , you are no longer certified. You may not use CCDS on signatures, cards, or directories. You must reapply and pass the exam again.

Replacement certificates are listed at $25 if you need a copy; that is stationery, not recertification.

The eight scored domains and this guide’s chapter map

The sitting is eight content areas totaling 120 scored items (the 20 pretest items are extra and unidentified). Weights below use 120 as the denominator.

Domain Scored items Weight Cognitive split (R / A / An) This guide
I IPPS, reimbursement, and documentation requirements 15 12.5% 10 / 3 / 2 Chapters 2–3

II Anatomy, physiology, pathophysiology, pharmacology, and medical terminology 23 19.2% 0 / 12 / 11 Chapters 4–7

III Medical record documentation 23 19.2% 6 / 11 / 6 Chapters 8–10
IV Healthcare facility CDI program analysis 10 8.3% 3 / 4 / 3 Chapters 11–12
V Communication skills 11 9.2% 3 / 6 / 2 Chapters 13–14
VI Official Guidelines for Coding and Reporting 17 14.2% 6 / 8 / 3 Chapters 15–17
VII Professionalism, ethics, and compliance 11 9.2% 4 / 4 / 3 Chapters 18–19
VIII Impact of reportable diagnoses on quality 10 8.3% 3 / 3 / 4 Chapters 20–21

Domain II and Domain III are tied for the largest shares ( 23 items, 19.2% each). Together they are 46 of 120 scored items—more than one-third of the decision. Domain VI (coding guidelines) is the next largest at 17 . Domain I is only 15 items but is almost all recall (10 of 15), so IPPS definitions still deserve a dedicated early block. Domain II has no recall in the published split: those 23 items are application and analysis, which is why later clinical chapters spend time on indicators, not on vocabulary lists alone.

Introduction Chapter 1 is not a scored domain. It exists so you do not misread the clock, the year definition, the book list, or the CEU cycle before you reach IPPS.

Loading diagram... CCDS Recertification Clock

Exam-style scenarios

Scenario: budgeting only the first sitting. A non-member pays $380, does not pass, and assumes every retake is $150 forever. Only the first retake is $150, and only after 90 days. A later attempt is full $380 (or $280 with membership). Build the study plan to make the first or second sitting count; do not treat unlimited discount retakes as unpublished policy.

Scenario: CEUs in month 25. A CCDS holder finishes 30 CEUs 50 days after the two-year mark and pays only the $125 member recertification fee. The 45-day grace has already ended, so the credential is inactive and the $150 late fee is due on top of recertification. Paying the base fee alone does not close an inactive file.

Scenario: dual credential, 30 CEUs. A specialist who passed CCDS, then CCDS-O, submits 30 CEUs at the first credential’s anniversary. Dual holders need 40 CEUs and use the date two years after the second exam. Thirty CEUs on the wrong anniversary under-shoots both count and date.

Scenario: studying only queries because “that is the job.” Queries live mainly in Domain III (23 items) and Domain V (11 items). Ignoring Domain II (23 clinical items) and Domain VI (17 guideline items) leaves 40 scored items under-prepared. Job-description study is not domain-weight study. Use the table above as the hour budget: largest blocks to II and III, then VI, then I, then the 10–11 item domains.

Scenario: quoting a cut score. A colleague says “you need 86 of 120.” The number is close but wrong: ACDIS's Certifications & Certificates FAQ sets the passing score at 88 correct out of 120 scored questions (the Candidate Handbook itself does not print that number). The score report gives raw category counts and pass/fail; do not repeat a half-remembered figure when the FAQ states the exact one.

How to use this guide from here

Chapter 2 begins Domain I: how IPPS is updated, how MS-DRGs group, and what documentation must support payment. Subsequent chapters stay inside one domain cluster so you can match weak score-report categories to a named file. When you recertify, prefer CEU activities that refresh the same eight areas—IPPS changes, clinical indicator updates, the current ACDIS/AHIMA query practice brief (this guide uses the 2026 update in Domain III), Official Guidelines, ethics, and quality programs—because those are the bodies of knowledge the sitting keeps testing. This chapter’s job is narrower: know the published fees, the two-year/30-CEU clock, and which domains carry 23 items versus 10 before you spend a study weekend on the wrong slice.