Study guide
1.3 Allowed Resources and Test-Day Rules
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
1.3 Allowed Resources and Test-Day Rules
Key Takeaways Explain This Topic AI
Optional CCDS books are Optum DRG Expert (any year) plus one listed drug handbook; they are not required
Tabs and pre-existing handwritten margin notes are allowed; inserted pages, loose notes, and writing in books during the exam are not
Bring one valid government-issued photo ID with signature in Latin characters; name must match registration or the appointment is missed without refund
Test centers issue an analog whiteboard with eraser and up to three dry-erase markers; remote candidates use an online scratch pad
One unscheduled 10-minute break is allowed; the 3-hour timer does not stop, and test-center candidates must re-screen
Last updated: September 2026
1.3 Allowed Resources and Test-Day Rules
Quick Answer: For the inpatient CCDS sitting you may bring two optional paper resources: DRG Expert published by Optum ( any year ) plus one drug handbook from the published list (Lippincott Nursing Drug Handbook, Mosby’s Nursing Drug Reference, Physicians’ Desk Reference or PDR Nurse’s Drug Handbook, Pearson’s Nurse’s Drug Guide, Saunders Nursing Drug Handbook, or Davis’s Drug Guide). Tabs and pre-existing handwritten margin notes are allowed. Inserted pages and loose notes are not, and you may not write in the books during the exam . Arrive with a valid government-issued photo ID with signature. Test centers give an analog whiteboard ; remote ProProctor candidates get an online scratch pad . You may take one unscheduled 10-minute break ; the timer does not stop .
This independent ExamFinch section teaches published test-day mechanics so learners do not lose a non-refundable sitting to a book, ID, or break mistake. CCDS-O uses different optional resources; do not pack outpatient-only materials for this inpatient exam.
Why resource rules are scoring rules
The CCDS sitting is not an open-library test and not a closed-book trivia contest. Two named references are permitted if you want them. They will not answer analysis items for you. They will help you confirm an MS-DRG family, a CC/MCC listing as printed in that DRG Expert year, or a drug class that supports a clinical indicator. Candidates fail the logistics, not the medicine, when they bring a second drug book, a printed query brief, encoder screenshots, or a DRG Expert stuffed with sticky packets. Prometric will inspect the books. Extra pages stay out; in some cases the sitting is refused.
The resources are optional . The handbook states they are not required. If you have never used DRG Expert at work, test day is a poor first encounter. If you use it daily, practice with the same copy you will carry, including your tabs, under timed conditions.
Allowed optional books (CCDS only)
Resource Rule Common fail
DRG Expert (Optum) Any year ; optional Assuming only the newest year is legal, or bringing a different publisher’s DRG book
One listed drug handbook Lippincott, Mosby’s, PDR or PDR Nurse’s, Pearson’s, Saunders, or Davis’s Bringing two drug books, or a hospital formulary printout
Markings Tabs allowed; pre-existing handwritten margin notes allowed Inserted pages, loose notes, glued packets
Writing No writing in books during the exam Adding DRG notes or query outlines once the clock starts
An older public FAQ that says DRG Expert “must be an ICD-10 edition” and that both volumes of a two-volume set are permitted is describing edition mechanics. The May 2024 handbook’s controlling phrase for year is any year . Do not discard a marked ICD-10 DRG Expert you already own just to buy a newer unused copy on the way to Prometric. Do not bring an ICD-9 relic and hope; the examination content is current IPPS/ICD-10 practice, and an unusable book still occupies your optional slot.
Practice a lookup path before test day: how you find an MS-DRG in DRG Expert, how you check a CC/MCC list in that edition, and how you confirm a drug indication in your chosen handbook. Speed comes from tabs you placed weeks earlier, not from a first-time index search at item 90.
Identification, arrival, and remote versus center
Arrive 30 minutes before the appointment. Bring the confirmation email with your confirmation number and Prometric ID. You must present one valid, government-issued photo ID with a signature (examples: driver’s license, passport). The name on the ID must match the name used to register. The document must be in Latin characters and contain your photograph and signature. If you test outside your country of citizenship and are not a permanent legal resident there, you must present a valid passport . If you test within your country of citizenship or permanent legal residence, a valid passport, driver’s license, national ID, or military ID is acceptable. If the ID is missing, expired, or the name does not match, Prometric treats the visit as a missed appointment and the fee stays paid.
Test-center candidates are assigned a locker for belongings. Eating, drinking, and smoking are not permitted in the testing room. You may not ask the administrator questions about examination content . Personal electronics are misconduct, not a convenience.
Remote ProProctor candidates install the ProProctor application and complete a system check from the appointment email. The workspace must be clean and clutter-free: no extra papers, extra books beyond the allowed CCDS resources, second monitors, or wall notes. The proctor will inspect the room by camera, including desk, chair, sleeves, pockets, and behind the ears for devices. Allowed paper resources still have to survive the same page-insert rules as at a center. Read Prometric’s ProProctor user guide before you pick remote just because it is geographically convenient; a cluttered kitchen table is a failed environment check.
Scratch tools, the untimed tutorial, and the break
Test-center candidates receive a physical, analog hand-held whiteboard , one eraser/cloth/tissue, and up to three dry-erase markers of any color. That board is the scratch paper. Remote candidates receive an online scratch pad . No documents or notes of any kind leave a test center. Do not copy items onto the board with the idea of photographing them later; recording questions is misconduct and can void the sitting without a refund.
Before the timed examination, you may run an untimed practice session on the computer. When you are comfortable with navigation, quit the practice session and start the 3-hour clock. During the timed exam you can bookmark items, view a progress bar and time remaining, open a grid of unanswered or bookmarked questions, and leave a comment on an item. Comments are reviewed later; you will not receive an individual reply, and comments are not a scoring protest.
Break rule: you may take one unscheduled 10-minute break . The timer does not stop . Test-center candidates must go back through security screening before continuing. Use the break only if you need it; the 10 minutes come out of the same 180. Eating is still not a test-room activity when you return.
Appointment changes that affect test day
Reschedule or cancel through ACDIS/HCPro Customer Care, not by ignoring the appointment. If the exam is 30 or more days away (not counting the exam date), Prometric does not charge a reschedule/cancellation fee. If it is 7–29 days away, Prometric charges $35 . If it is 7 days or less away, examination fees are not refundable ; sitting later means reapplying and repaying . Center closures for weather or power are handled by Prometric rescheduling; keep the contact data on the file accurate. Unscheduled walk-ins are not seated.
Loading diagram... Test-Day Flow for Inpatient CCDS
Exam-style scenarios
Scenario: two drug books and a query packet. A candidate brings Davis’s Drug Guide, Lippincott’s Nursing Drug Handbook, and a stapled hospital query policy inside DRG Expert. The published allowance is DRG Expert plus one listed drug handbook. Inserted pages are not allowed. At inspection, the extra book and the packet are unauthorized aids. Pack the pair you practiced with; leave policies at home.
Scenario: writing the working DRG in the book. Mid-exam, a candidate starts listing MS-DRG numbers in the DRG Expert margin because the whiteboard feels small. Pre-existing margin notes are allowed; writing in books during the exam is not . Use the issued whiteboard or online scratch pad for working notes. The book is a reference, not a worksheet.
Scenario: remote desk with a second monitor. A ProProctor candidate leaves a dual-monitor coding setup in place because “that is how I work.” Remote rules require a clutter-free station without second monitors and extra papers. The environment inspection happens before the items appear. Rehearse the room the night before: one screen, allowed books only, camera able to pan the room.
Scenario: 8-minute identification failure. A recently married candidate’s driver’s license still shows a prior surname that does not match the ACDIS/Prometric registration. That is a missed appointment without refund under the identification rule. Check name match when you apply, not at minute minus five.
Scenario: a long hall-walk break. A test-center candidate takes 18 minutes because restroom plus re-screening ran long. Only 10 unscheduled minutes are described, and the clock never stopped. Budget break time as scored time. If you do not need the break, stay in the item grid and use leftover minutes to clear bookmarks.
How to practice the logistics
Do at least one full 140-item, 3-hour sitting with the actual DRG Expert year and the actual drug handbook you will carry, tabs already placed, writing only on a small whiteboard or a blank on-screen pad. Practice a 10-minute stand-up that costs clock time. Practice opening the grid and answering every item. Books do not replace Domain II analysis or Domain VII ethics judgment; they support lookups. Unauthorized paper turns a prepared specialist into a candidate who never sees item 1.