Certified Documentation Improvement Practitioner (CDIP)
Exam Prep 2026 Updated Practice Questions,
Comprehensive Clinical Documentation Review, Detailed
Explanations, Verified Answers, Success Workbook
DOMAIN 1: CLINICAL CODING PRACTICE (22–26%)
1. A patient is admitted with chest pain and is subsequently diagnosed with
acute myocardial infarction (AMI) of the anterolateral wall. The physician
documents "acute myocardial infarction" without specifying the site. What is
the correct ICD-10-CM code assignment?
A) I21.09 — Acute myocardial infarction, unspecified
B) I21.3 — ST elevation (STEMI) myocardial infarction of unspecified site
C) I21.19 — Acute myocardial infarction, other
D) I21.4 — Non-ST elevation (NSTEMI) myocardial infarction
Answer: B) I21.3 — ST elevation (STEMI) myocardial infarction of
unspecified site
Rationale: When the physician documents "acute myocardial infarction" without
specifying the site, the correct code is I21.3 (ST elevation [STEMI] myocardial
infarction of unspecified site). The coder should not assume the site or type
without clear documentation. If the documentation lacks specificity, the coder must
query the physician for clarification. I21.09 is for AMI of unspecified site but is
typically used for NSTEMI when unspecified. I21.4 is for NSTEMI.
2. Which of the following is the PRIMARY purpose of assigning the principal
diagnosis in an inpatient setting?
A) To determine the patient's length of stay
B) To reflect the condition chiefly responsible for the admission
C) To identify all comorbidities present
D) To calculate the hospital's mortality rate
Answer: B) To reflect the condition chiefly responsible for the admission
,Rationale: The principal diagnosis is defined as the condition established after
study to be chiefly responsible for the admission. It is the primary factor in MS-
DRG assignment and determines Medicare reimbursement. The CDIP professional
must ensure the principal diagnosis is accurately documented and coded.
3. A patient is admitted with sepsis due to a urinary tract infection. The
physician documents "sepsis secondary to UTI." What is the correct ICD-10-
CM code assignment?
A) A41.9, N39.0
B) A41.9, N39.0 (with sequencing per guidelines)
C) N39.0 only
D) A41.9 only
Answer: B) A41.9, N39.0 (with sequencing per guidelines)
Rationale: ICD-10-CM guidelines require coding both the sepsis (A41.9) and the
underlying infection (N39.0), with sepsis sequenced first as the principal diagnosis.
The CDIP professional must ensure the physician documents the causal
relationship clearly to support correct code assignment.
4. A patient with Type 2 diabetes mellitus is admitted with diabetic
ketoacidosis. The physician documents "Type 2 diabetes with diabetic
ketoacidosis." What ICD-10-CM code should be assigned?
A) E11.9
B) E11.10
C) E11.65
D) E10.10
Answer: B) E11.10
Rationale: E11.10 (Type 2 diabetes mellitus with ketoacidosis without coma) is
the correct combination code. ICD-10-CM provides combination codes for
diabetes with its manifestations. E11.9 is for diabetes without complications.
E11.65 is for diabetes with hyperglycemia.
,5. A patient with chronic kidney disease (CKD) stage 5 due to diabetes
mellitus is admitted for hemodialysis. The physician documents "end-stage
renal disease on hemodialysis." What ICD-10-CM codes should be assigned?
A) N18.5, Z99.2
B) E11.22, N18.6, Z99.2
C) E11.9, N18.6
D) Z99.2 only
Answer: B) E11.22, N18.6, Z99.2
Rationale: ICD-10-CM guidelines require sequencing the diabetes code first as the
underlying etiology (E11.22), followed by the ESRD code (N18.6), and then the
dialysis dependence code (Z99.2). The CDIP professional must ensure the
physician documents the causal relationship between diabetes and ESRD.
6. A patient is admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). The physician documents "acute exacerbation of
COPD." What ICD-10-CM code should be assigned?
A) J44.9
B) J44.1
C) J43.9
D) J45.901
Answer: B) J44.1
Rationale: J44.1 (Chronic obstructive pulmonary disease with acute exacerbation)
is the correct code. J44.9 is for COPD without exacerbation. The CDIP
professional should ensure the physician specifies whether the exacerbation is
acute or chronic.
7. A patient is admitted with pneumonia due to Streptococcus pneumoniae.
What ICD-10-CM code should be assigned?
A) J18.9
B) J13
C) J15.9
D) J14
Answer: B) J13
, Rationale: J13 (Pneumonia due to Streptococcus pneumoniae) is the correct code
when the specific organism is documented. J18.9 is for unspecified pneumonia.
J14 is for pneumonia due to Haemophilus influenzae. The CDIP professional
should encourage providers to specify the causative organism when known.
8. A patient is admitted with a cerebrovascular accident (CVA) with left-sided
hemiplegia. The physician documents "acute ischemic stroke with left
hemiplegia." What ICD-10-CM codes should be assigned?
A) I63.9, G81.9
B) I63.9, G81.94
C) I69.354, G81.94
D) Z86.73
Answer: B) I63.9, G81.94
Rationale: I63.9 (Cerebral infarction, unspecified) is assigned for the acute
CVA. G81.94 (Hemiplegia, unspecified affecting left dominant side) is assigned
for the left-sided hemiplegia. I69 codes are for late effects of cerebrovascular
disease, not acute events.
9. A patient is admitted with congestive heart failure (CHF) with acute
pulmonary edema. The physician documents "acute on chronic systolic heart
failure with pulmonary edema." What ICD-10-CM code should be assigned?
A) I50.1
B) I50.23
C) I50.9
D) J81.0
Answer: B) I50.23
Rationale: I50.23 (Acute on chronic systolic heart failure) is the correct
combination code. This captures both the acute and chronic nature of the heart
failure. The pulmonary edema is included in the heart failure code when it is due to
heart failure.
Exam Prep 2026 Updated Practice Questions,
Comprehensive Clinical Documentation Review, Detailed
Explanations, Verified Answers, Success Workbook
DOMAIN 1: CLINICAL CODING PRACTICE (22–26%)
1. A patient is admitted with chest pain and is subsequently diagnosed with
acute myocardial infarction (AMI) of the anterolateral wall. The physician
documents "acute myocardial infarction" without specifying the site. What is
the correct ICD-10-CM code assignment?
A) I21.09 — Acute myocardial infarction, unspecified
B) I21.3 — ST elevation (STEMI) myocardial infarction of unspecified site
C) I21.19 — Acute myocardial infarction, other
D) I21.4 — Non-ST elevation (NSTEMI) myocardial infarction
Answer: B) I21.3 — ST elevation (STEMI) myocardial infarction of
unspecified site
Rationale: When the physician documents "acute myocardial infarction" without
specifying the site, the correct code is I21.3 (ST elevation [STEMI] myocardial
infarction of unspecified site). The coder should not assume the site or type
without clear documentation. If the documentation lacks specificity, the coder must
query the physician for clarification. I21.09 is for AMI of unspecified site but is
typically used for NSTEMI when unspecified. I21.4 is for NSTEMI.
2. Which of the following is the PRIMARY purpose of assigning the principal
diagnosis in an inpatient setting?
A) To determine the patient's length of stay
B) To reflect the condition chiefly responsible for the admission
C) To identify all comorbidities present
D) To calculate the hospital's mortality rate
Answer: B) To reflect the condition chiefly responsible for the admission
,Rationale: The principal diagnosis is defined as the condition established after
study to be chiefly responsible for the admission. It is the primary factor in MS-
DRG assignment and determines Medicare reimbursement. The CDIP professional
must ensure the principal diagnosis is accurately documented and coded.
3. A patient is admitted with sepsis due to a urinary tract infection. The
physician documents "sepsis secondary to UTI." What is the correct ICD-10-
CM code assignment?
A) A41.9, N39.0
B) A41.9, N39.0 (with sequencing per guidelines)
C) N39.0 only
D) A41.9 only
Answer: B) A41.9, N39.0 (with sequencing per guidelines)
Rationale: ICD-10-CM guidelines require coding both the sepsis (A41.9) and the
underlying infection (N39.0), with sepsis sequenced first as the principal diagnosis.
The CDIP professional must ensure the physician documents the causal
relationship clearly to support correct code assignment.
4. A patient with Type 2 diabetes mellitus is admitted with diabetic
ketoacidosis. The physician documents "Type 2 diabetes with diabetic
ketoacidosis." What ICD-10-CM code should be assigned?
A) E11.9
B) E11.10
C) E11.65
D) E10.10
Answer: B) E11.10
Rationale: E11.10 (Type 2 diabetes mellitus with ketoacidosis without coma) is
the correct combination code. ICD-10-CM provides combination codes for
diabetes with its manifestations. E11.9 is for diabetes without complications.
E11.65 is for diabetes with hyperglycemia.
,5. A patient with chronic kidney disease (CKD) stage 5 due to diabetes
mellitus is admitted for hemodialysis. The physician documents "end-stage
renal disease on hemodialysis." What ICD-10-CM codes should be assigned?
A) N18.5, Z99.2
B) E11.22, N18.6, Z99.2
C) E11.9, N18.6
D) Z99.2 only
Answer: B) E11.22, N18.6, Z99.2
Rationale: ICD-10-CM guidelines require sequencing the diabetes code first as the
underlying etiology (E11.22), followed by the ESRD code (N18.6), and then the
dialysis dependence code (Z99.2). The CDIP professional must ensure the
physician documents the causal relationship between diabetes and ESRD.
6. A patient is admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). The physician documents "acute exacerbation of
COPD." What ICD-10-CM code should be assigned?
A) J44.9
B) J44.1
C) J43.9
D) J45.901
Answer: B) J44.1
Rationale: J44.1 (Chronic obstructive pulmonary disease with acute exacerbation)
is the correct code. J44.9 is for COPD without exacerbation. The CDIP
professional should ensure the physician specifies whether the exacerbation is
acute or chronic.
7. A patient is admitted with pneumonia due to Streptococcus pneumoniae.
What ICD-10-CM code should be assigned?
A) J18.9
B) J13
C) J15.9
D) J14
Answer: B) J13
, Rationale: J13 (Pneumonia due to Streptococcus pneumoniae) is the correct code
when the specific organism is documented. J18.9 is for unspecified pneumonia.
J14 is for pneumonia due to Haemophilus influenzae. The CDIP professional
should encourage providers to specify the causative organism when known.
8. A patient is admitted with a cerebrovascular accident (CVA) with left-sided
hemiplegia. The physician documents "acute ischemic stroke with left
hemiplegia." What ICD-10-CM codes should be assigned?
A) I63.9, G81.9
B) I63.9, G81.94
C) I69.354, G81.94
D) Z86.73
Answer: B) I63.9, G81.94
Rationale: I63.9 (Cerebral infarction, unspecified) is assigned for the acute
CVA. G81.94 (Hemiplegia, unspecified affecting left dominant side) is assigned
for the left-sided hemiplegia. I69 codes are for late effects of cerebrovascular
disease, not acute events.
9. A patient is admitted with congestive heart failure (CHF) with acute
pulmonary edema. The physician documents "acute on chronic systolic heart
failure with pulmonary edema." What ICD-10-CM code should be assigned?
A) I50.1
B) I50.23
C) I50.9
D) J81.0
Answer: B) I50.23
Rationale: I50.23 (Acute on chronic systolic heart failure) is the correct
combination code. This captures both the acute and chronic nature of the heart
failure. The pulmonary edema is included in the heart failure code when it is due to
heart failure.
