"AHIMA, in collaboration with ACDIS, has released the 2026 update to the Guidelines for Achieving a Compliant Query Practice, which supersedes the 2022 version ACDIS. The update introduces several substantive changes aimed at improving compliance, clarifying intent, and addressing emerging challenges like AI-generated queries.
Major changes include:
Definition of noncompliant multiple queries – The brief now explicitly defines when multiple queries are considered noncompliant, helping organizations avoid unnecessary or redundant queries ACDIS.
Role of prior encounters – Prior encounter documentation can support a query if clinically relevant to the current encounter, but it cannot be the sole basis for a query. Sufficient supporting information must be present in the current encounter Norwood Staffing.
Technology-generated queries – Compliance frameworks now address technology-generated queries (e.g., AI, CAC tools). These are now considered a compliance risk, and organizations must ensure they meet the same standards as manually created queries YouTube.
Clinical indicators – Clinical indicators (e.g., MEAT) are not used as a basis for code support. They are implicit in the requirement that queries be clinically relevant, but they cannot be the sole justification Norwood Staffing.
Query templates and policies – The update expands guidance on query templates, policies, and procedures, emphasizing that organizations should document review and any resulting policy updates as part of their compliance program ACDIS.
Yes/no and “unable to determine” responses – The option of “unable to determine” is now required in POA and all yes/no queries, ensuring transparency when documentation is insufficient Norwood Staffing.
Coding from query responses – Coding can be done from a query response alone, provided the query form is retained in the permanent medical record. If not, the provider must document the response in the medical record. A single response is sufficient, and it does not need to be repeated elsewhere Norwood Staffing.
Scope and enforcement – The brief applies to all settings (inpatient, outpatient) and stresses that everyone engaged in the query process must follow the guidelines, including outsourced or overseas CDI contractors Norwood Staffing.
Why it matters:
These changes shift the focus from simply following a checklist to ensuring queries are clinically precise, compliant, and supported by current encounter documentation. They also address modern CDI challenges like AI and automation, which can blur compliance lines if not properly managed.
If you are in CDI, coding, compliance, or revenue cycle, reviewing and updating your query policies to align with the 2026 guidelines is essential to avoid audit findings and ensure accurate, compliant documentation."
Source: https://acdis.org/system/files/resources/Guidelines%20for%20Achieving%20a%20Compliant%20Query%20Practice_2026Draft%201.pdf
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