The updated guidelines, developed jointly by AHIMA and ACDIS, are expected to be announced today.
The American Health Information Management Association (AHIMA) is expected to release today the highly anticipated and long-awaited preliminary update to guidelines for achieving a compliant query. Earlier today, the Association of Clinical Documentation Integrity Specialists (ACDIS), released the guidelines which had been a collaboration between the two associations.
As one of the four ICD-10-CM/PCS Cooperating Parties, along with American Hospital Association (AHA), the Centers for Medicare & Medicaid Services (CMS), and the National Center for Health Statistics, the 2001 AHIMA’s brief and its subsequent updates in 2008, 2013, 2016, and 2019 have been deemed “industry standards” quoted by government attorneys addressing allegations of fraudulent “upcoding.”
As an example, in the case of the United States of America ex rel., Ronda Osinek, versus Kaiser Permanente, the government alleges that “Kaiser regularly brought these mined diagnoses to the physician’s attention for addition to the patient’s medical record using a tool called a “query”—which in the healthcare industry is a communication tool used to clarify documentation in the health record. Queries present significant risks for improper diagnosis coding, and national standards guide and limit queries’ use. The standards include that a query cannot be leading (i.e., cannot direct a provider to a specific diagnosis) and cannot discuss financial impact. But Kaiser routinely violated the national query standards and used queries not to clarify medical records, but instead to press physicians to retrospectively add new diagnoses via addenda that had nothing to do with the visit, so that Kaiser could then seek payment from CMS for these diagnoses.” The full text of the government’s allegations is available at https://www.justice.gov/opa/press-release/file/1444936/download.
Ronald Hirsch, MD, said in an email, “leading queries are at the foundation of the Kaiser Health qui tam suit that alleges that ‘Kaiser regularly brought these minded diagnoses to the physician’s attention for addition to the patient’s medical record.’”
The 2022 proposed version released today (Oct. 10) will not take effect until all feedback has been received and a final version is published later. Comments are due on Oct. 25, 2022, and may be submitted through mechanisms announced by AHIMA and ACDIS.
Programming note: Listen to Talk Ten Tuesdays tomorrow, Oct. 11, at 10 Eastern when Melissa Potts, an AHIMA representative, will report on the new guidelines.
With Thanksgiving later this week, now is a good time to revisit some codes and coding guidance for which we are thankful for. Perhaps the
For decades, clinical documentation integrity (CDI) programs have been synonymous with inpatient care. They evolved from early efforts to improve Diagnosis-Related Group (DRG) accuracy into
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
