AHIMA CCA Exam Guide 2026: Pass Entry-Level Coding (FREE)

The CCA Is Your Entry Ticket Into Medical Coding — Here's How to Pass It in 2026

The AHIMA Certified Coding Associate (CCA) is the nationally recognized entry-level credential for new medical coders. Unlike the CCS (which demands 2+ years of inpatient experience) or the CPC (which is owned by a different certifying body, AAPC), the CCA is specifically designed for career changers, HIM graduates, and coding students who want to prove foundational competency across ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II without requiring prior work experience.

That's why CCA is the credential AHIMA itself markets as the "starting line" of a coding career — and why hospitals, physician groups, and remote coding vendors (Ciox, Optum, Aviacode, UASI) list it as an acceptable minimum on entry-level job postings when they also want a path to CCS within 2–3 years.

This 2026 guide covers the verified cost, structure, six content domains, eligibility paths, 10-week study plan, career outlook, and the specific ICD-10-CM and CPT traps that cause most candidates to fail. Everything is free.

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CCA Exam At a Glance (2026)

All figures verified against AHIMA's official CCA page and 2026 Candidate Guide.

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What the CCA Is — and Why It Matters in 2026

The CCA is AHIMA's entry-level coding certification. It validates that you can:

1. Assign accurate codes from four code sets — ICD-10-CM (diagnoses), ICD-10-PCS (inpatient procedures), CPT (physician and outpatient procedures), and HCPCS Level II (drugs, supplies, DME)
2. Apply the ICD-10-CM Official Guidelines to routine diagnostic scenarios
3. Understand foundational reimbursement methodologies — MS-DRG, APC, RBRVS, IPPS, OPPS, claims processing
4. Recognize HIPAA privacy/security rules, the HITECH Act, and the AHIMA Code of Ethics
5. Navigate an electronic health record, use an encoder, and understand CAC (computer-assisted coding) at a conceptual level

The CCA is intentionally broader and shallower than the CCS. The CCS drills deep into ICD-10-PCS table construction and full-chart inpatient coding; the CCA tests whether you understand how all four code sets fit together well enough to work under supervision in a revenue-cycle role, coding specialty clinic, or remote outpatient coding team.

Why CCA Beats "Just Go Straight to CPC"

• No membership lock-in. AHIMA membership is optional to earn and keep the CCA. AAPC's CPC requires continuous $222/year AAPC membership to keep the credential active. Over a 20-year career, that's ~$4,400 in ongoing dues.
• Open-book exam with real code books. Both CCA and CPC are open book, but the CCA's broader ICD-10-PCS inclusion makes it the better preparation for advancing to CCS (hospital inpatient) — which is where the highest-paying coding jobs live.
• Hospital-friendly branding. AHIMA is the credentialing body most closely associated with hospital HIM departments. If your goal is acute care, start inside the AHIMA ecosystem.
• Lower barrier. $199 member fee vs. $425+ for CPC. That's a $200+ savings before you even factor in AAPC membership.

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Who Should Take the CCA (and Who Shouldn't)

Ideal Candidates

1. Recent graduates of coding certificate programs or associate's degrees in HIM
2. Career changers (medical assistants, billers, nurses re-entering the workforce) who want a credible credential without 2+ years of experience
3. Coding students finishing their AHIMA-approved or CAHIIM-accredited program
4. Billers or claims specialists who already know revenue cycle and want to add coding competency
5. Anyone planning to advance to CCS within 2–3 years (CCA → experience → CCS is the canonical AHIMA career path)

Skip the CCA If You Are

• An experienced inpatient coder with 2+ years of hospital chart work — go straight to CCS
• A physician-office coder with CPT mastery and no interest in hospital work — CPC (AAPC) aligns better
• Someone who cannot yet code basic ICD-10-CM diagnoses accurately — complete a coding course first

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Eligibility Paths (AHIMA Recommendations)

AHIMA does not strictly gate the CCA — anyone can apply. However, AHIMA officially recommends that you meet one of the following three paths before sitting for the exam:

Candidates without any of these still register and sit for the exam, but historical pass rates are materially lower for self-taught candidates without at least 100 hours of structured coursework.

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Exam Format: 2 Hours of Multiple Choice (2026)

The CCA is a computer-based, multiple-choice exam administered at Pearson VUE test centers.

Target pace: ~1 minute per question. Flag anything taking more than 90 seconds and return at the end.

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The Six CCA Content Domains (2026)

AHIMA's official CCA Exam Content Outline organizes the exam into six domains. Percentages reflect question weighting.

Domain 1 Deep Dive — Clinical Classification Systems (30–34%)

The single largest domain. This is where you win or lose the exam. Expect heavy testing on:

ICD-10-PCS: What CCA Tests (vs. CCS)

The CCA tests ICD-10-PCS at a foundational level. You need to know:

• The 7-character structure and what each character represents
• How to look up a procedure in the Index and navigate to a Table
• The 31 Medical and Surgical root operations grouped into 9 functional families
• Common approach values (0=Open, 3=Percutaneous, 4=Percutaneous Endoscopic, 8=Via Natural/Artificial Opening Endoscopic, X=External)

You will not be asked to build complex multi-table inpatient codes or assign MS-DRGs by hand the way CCS candidates are. CCA expects you to correctly assign codes for routine, single-procedure scenarios (e.g., appendectomy, cholecystectomy, hernia repair, total knee replacement).

Memorize these PCS character positions:

Worked ICD-10-CM Example — Diabetes with CKD and Neuropathy

Scenario: 72-year-old female seen in clinic for routine follow-up. Chart documents Type 2 diabetes with diabetic chronic kidney disease (stage 3) and diabetic peripheral neuropathy. On metformin and lisinopril.

Coding:

Teaching points:

• ICD-10-CM assumes a cause-and-effect relationship between diabetes and CKD/neuropathy — you code the "with" combination code without needing the provider to explicitly document "diabetic" each time (I.C.4.a.2).
• Always add the N18.xx code for CKD stage specificity (use additional code note at E11.22).
• Long-term drug use Z-codes are frequently missed by CCA candidates.

Domain 2 — Reimbursement Methodologies (21–25%)

This is the second-largest domain and a common weakness for coders coming from clinical backgrounds.

Know these payment systems and their acronyms cold:

Also expect questions on:

• Chargemaster (CDM) — the master price list that drives hospital billing
• Claims processing (UB-04 for facility, CMS-1500 for professional)
• Denial management (medical necessity, bundling, duplicate, timely filing)
• Revenue integrity fundamentals

Domain 3 — Health Records & Data Content (13–17%)

Tests your ability to recognize:

• Components of a health record (H&P, progress notes, orders, discharge summary, operative report, pathology)
• Data standards — LOINC (labs), SNOMED CT (clinical terms), RxNorm (drugs)
• Master Patient Index (MPI) — duplicate resolution, overlays, overlaps
• Record retention requirements (state-specific but generally 10 years for adults, age 21 or 25 for pediatrics)
• Abstracting — pulling structured data from unstructured notes
• Discharge planning documentation

Domain 4 — Compliance (12–16%)

Know the statutes:

• HIPAA (1996) — Privacy Rule, Security Rule, Breach Notification, minimum necessary
• HITECH (2009) — electronic breach notification thresholds, business associate direct liability
• Stark Law — physician self-referral prohibition
• Anti-Kickback Statute (AKS) — criminal statute, requires intent, safe harbors
• False Claims Act (FCA) — civil liability for knowingly submitting false claims, qui tam whistleblower provisions
• OIG Work Plan — annual audit focus areas (sepsis, malnutrition, mechanical ventilation)
• AHIMA Code of Ethics — 11 principles, professional conduct standards
• Clinical Documentation Improvement (CDI) — compliant query format per AHIMA/ACDIS 2022 Practice Brief

Domain 5 — Information Technologies (6–10%)

• EHR (Electronic Health Record) types — hospital, ambulatory, hybrid
• Encoder vs. grouper software (3M, Optum, TruCode)
• Computer-Assisted Coding (CAC) — NLP-suggested codes requiring human validation
• HIE (Health Information Exchange) and interoperability (HL7, FHIR)
• CPOE, CDS, telemedicine, mHealth basics
• Audit logs, access controls, user provisioning

Domain 6 — Confidentiality & Privacy (6–10%)

• Minimum necessary standard — disclose only what's needed for the purpose
• Authorization vs. consent — when each is required
• TPO (Treatment, Payment, Operations) — PHI use permitted without authorization
• Breach notification — 60 days to individuals, annual HHS report for <500, immediate HHS + media for 500+
• Business Associate Agreements (BAAs) — required for all BAs handling PHI
• De-identification — Safe Harbor method (18 identifiers removed) vs. Expert Determination method
• Psychotherapy notes — heightened protection, separate authorization required
• Marketing, fundraising, research — when authorization is/isn't required
• Release of Information (ROI) workflow, disclosure accounting

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Pass Rate and Difficulty: The Honest Picture

AHIMA publishes CCA first-time pass rates on the official certification page. The historical range has been roughly 62–70% for first-time testers — meaningfully higher than the CCS (50–70%) because the CCA doesn't require ICD-10-PCS code construction or full-chart inpatient case coding.

Candidates who fail most often do so because:

1. They underestimate Reimbursement Methodologies. The 21–25% weighting surprises career changers who assumed this was pure "coding."
2. They don't memorize ICD-10-CM conventions. Excludes1 vs. Excludes2 questions recur. Placeholder X and 7th-character rules trap candidates.
3. They run out of time. ~1 minute per question requires discipline; open-book lookups must be fast.
4. They bring wrong-year code books. Exams on/after 5/1/2026 require 2026 editions only.

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10-Week CCA Study Plan (Entry-Level)

Realistic plan for someone with basic medical terminology and anatomy background.

Total: ~104 study hours over 10 weeks. Working professionals should extend to 12 weeks.

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Recommended Resources

The CCA prep market is mature. These are the resources practicing CCA instructors actually recommend:

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Code Set Mastery: What You Must Know for Each

ICD-10-CM (Diagnoses) — Used in All Settings

• Chapter structure (22 chapters) and what each covers
• Conventions — Excludes1 (never code together), Excludes2 (not included here, may code together if both present), "code first," "use additional code," "code also"
• Placeholder X — must fill empty character positions with X (e.g., T50.901A)
• 7th-character extensions — A (initial encounter), D (subsequent), S (sequela); Q/P for fracture healing
• Combination codes — single code for two conditions (I25.110, E11.22)
• Laterality — left, right, bilateral, unspecified (unspecified should be avoided when laterality is documented)
• Sequencing — principal (inpatient) vs. first-listed (outpatient); reason for encounter is usually first-listed in outpatient

ICD-10-PCS (Inpatient Procedures) — Foundational Level for CCA

• 7-character structure (Section, Body System, Root Operation, Body Part, Approach, Device, Qualifier)
• 31 Medical & Surgical root operations — memorize all definitions, especially Excision vs. Resection, Release vs. Division
• Approach values — 0 Open, 3 Percutaneous, 4 Percutaneous Endoscopic, 7 Via Natural/Artificial Opening, 8 Via Natural/Artificial Opening Endoscopic, X External
• Device vs. no device — Z = no device
• How to navigate Index → Table

CPT (Procedures — Outpatient, Physician, Facility)

• Six sections — E/M, Anesthesia, Surgery, Radiology, Pathology/Lab, Medicine
• E/M 2021/2023 changes — office/outpatient selection by MDM or total time; inpatient/observation levels revised 2023
• Modifiers — 25 (significant separately identifiable E/M on same day), 51 (multiple procedures), 59 (distinct procedural service), XE/XP/XS/XU (subsets of 59), 26 (professional component), TC (technical component), 50 (bilateral)
• Global surgical package — includes preoperative visit, intraoperative services, and typical postoperative follow-up
• Separate procedure designation — procedures considered bundled unless performed independently
• Add-on codes — never reported alone; denoted by "+" symbol
• Category I vs. Category III — permanent vs. emerging technology (4-year life)

HCPCS Level II (Drugs, Supplies, DME)

• J-codes — drugs administered by injection/infusion
• A-codes — medical/surgical supplies, ambulance
• E-codes — durable medical equipment
• G-codes — CMS temporary codes for procedures/professional services
• Q-codes — temporary codes for supplies
• V-codes — vision and hearing
• Modifiers — LT/RT, anatomic modifiers, KX (documentation on file), GA (ABN on file)

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Common Pitfalls That Cost CCA Candidates Points

1. Skipping reimbursement study. 21–25% weighting catches career changers off guard. Memorize IPPS/OPPS/RBRVS cold.
2. Not practicing open-book lookups. The exam is open book but the clock keeps running. Bookmark your code books strategically (Official Guidelines, Table of Drugs, modifier list, E/M level tables).
3. Confusing Excludes1 vs. Excludes2. Excludes1 = "NEVER code together." Excludes2 = "not included here, but may be coded together if both documented."
4. Forgetting placeholder X. T and S codes especially require X placeholder when a position is empty before a 7th character.
5. Using wrong-year code books. Exams on/after 5/1/2026 require 2026 editions of ICD-10-CM, ICD-10-PCS, and CPT. Test center will refuse entry with wrong-year books.
6. Over-reading into scenarios. CCA scenarios are intentionally less complex than CCS. Code what's documented — don't infer.
7. Panicking on time. 2 hours for ~105 questions = 68 seconds per question. Flag anything over 90 seconds and return.
8. Ignoring AHIMA Code of Ethics. Small domain but easy points — read all 11 principles.

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Test-Day Tips

Before the Exam

• Confirm your Pearson VUE appointment 48 hours before
• Print your AHIMA admission letter and bring it
• Bring two forms of ID (primary government photo + signature)
• Bring the correct-year code books (2026 editions for exams on/after 5/1/2026)
• Eat a normal breakfast; avoid excess caffeine
• Arrive 30 minutes early (late = automatic forfeit)

During the Exam

• Use the on-screen calculator for reimbursement calculations
• Flag anything taking >90 seconds and return at end
• For open-book lookups, go to the Index first (not the Tabular List)
• Apply elimination workflow — remove violating-convention options first
• For multiple correct-sounding answers, pick the most specific supported by documentation
• Never leave a question blank — unanswered = wrong

What You Can and Cannot Bring

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Salary and Career Outlook (2026)

The BLS groups medical coders under Medical Records Specialists (OCC 29-2072). May 2023 BLS data:

CCA Salary Ranges (2026)

CCA is an entry-level credential, so expected pay reflects early-career coding:

Important: CCA is designed as a stepping stone. Earning the CCS within 2–3 years typically pushes compensation into $55,000–$95,000. That's why AHIMA explicitly positions the CCA → CCS pipeline as the flagship coding career track.

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Recertification: Keeping Your CCA Active

Every 2 years you must earn 20 CEUs to recertify. Key 2025–2026 rules:

• 40% of CEUs must come from AHIMA, Component Associations, or AHIMA ACEP-approved providers (new rule effective January 2025)
• 60% may come from other approved continuing education sources
• Annual Coding Self-Review: required — counts 5 CEUs per year
• Recertification fee: $100 for AHIMA members / $249 for non-members (per AHIMA's official Recertify page)
• Additional credentials: first credential fee is the same; each additional is free for members / $50 for non-members
• Holding multiple AHIMA credentials: +10 CEUs per extra credential, up to 50 CEUs total

Free CEU sources:

• AHIMA webinars and Journal articles (with quizzes)
• CDC coding roundtables
• ICD-10 Coordination and Maintenance Committee meetings
• HIMSS and state HIM association events

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CCA vs. CCS vs. CPC — The Decision Matrix

This is the single most important decision in your medical coding career. Here's the honest comparison.

Which to Pick (Decision Tree)

• Brand new, no experience → CCA first. Build foundation, then advance.
• Goal is hospital inpatient work → CCA → CCS. AHIMA is the hospital standard.
• Goal is physician office work → CCA → CPC or straight to CPC if you already have CPT fluency.
• Already have 2+ years inpatient experience → Skip CCA, go straight to CCS.
• Budget-conscious → CCA. $199 AHIMA member vs. $425+ for CPC + $222/yr AAPC dues.
• Want broadest credential recognition → CCS eventually. It outpays CPC in most surveys.

The Three Most-Confused Facts

1. CPC is owned by AAPC, not AHIMA. Different certifying body, different membership dues, different exam format. AHIMA does not offer the CPC.
2. CCA is not just "easier CCS." It's broader (all care settings) and shallower. CCS is narrower (inpatient hospital) and deeper.
3. CCA does not require ICD-10-PCS mastery at CCS level. You need to understand the 7-character structure and navigate tables — you do not need to build complex inpatient procedure codes from scratch.

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Worked CPT Coding Example — Office E/M with Minor Procedure

Scenario: A 48-year-old established patient presents to her primary care physician for a follow-up visit for poorly controlled hypertension and Type 2 diabetes. The physician performs a detailed history and exam, adjusts medications, orders labs, and counsels on diet. During the visit, the patient points out a skin tag on her neck that has been catching on her jewelry. The physician excises the benign 0.4 cm skin tag from the neck using sterile technique.

Coding walkthrough:

Teaching points:

• Modifier 25 is required when an E/M and a minor procedure occur on the same day and the E/M addresses a separately identifiable problem. Without 25, the E/M would be bundled into the procedure's global package and denied.
• 2021/2023 office/outpatient E/M rules eliminated history and exam as selection criteria — use either total time spent on the date of encounter or medical decision making (MDM).
• Skin tag removal (11200) is a single code for multiple tags up to 15; add 11201 in units of up to 10 additional lesions beyond 15. Don't double-bill.
• Diagnosis codes must support each service — hypertension and diabetes support the E/M, skin tag diagnosis (L91.8) supports the procedure.

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Reimbursement Deep Dive — IPPS and OPPS

The 21-25% reimbursement domain is heavily conceptual. You won't calculate DRG weights by hand, but you must understand how each payment system works.

IPPS (Inpatient Prospective Payment System)

CMS pays acute care hospitals a predetermined amount per discharge based on the assigned MS-DRG. Key facts:

• Payment = base rate × MS-DRG relative weight × hospital-specific adjustments (wage index, IME, DSH, outlier, etc.)
• MS-DRG (Medicare Severity-Diagnosis Related Group) — assigned from ICD-10-CM diagnoses, ICD-10-PCS procedures, and POA indicators
• Base DRG can split into 1, 2, or 3 severity tiers depending on whether secondary diagnoses include CC (Complication/Comorbidity), MCC (Major CC), or neither
• Principal diagnosis and principal procedure drive the initial DRG assignment; CC/MCC secondaries drive the severity tier
• POA = N on a HAC diagnosis means CMS does not pay the CC/MCC weight premium for that condition

OPPS (Outpatient Prospective Payment System)

CMS pays hospitals for outpatient services under a per-service payment model:

• Services are grouped into APCs (Ambulatory Payment Classifications)
• Each APC has a relative weight and conversion factor determining payment
• Status indicators (T, S, V, etc.) tell you how each service is paid
• Comprehensive APCs (C-APCs) pay a single amount for a primary service plus all adjunctive services
• Packaging bundles services (like drugs, supplies) into the payment for a parent service

RBRVS (Physician Fee Schedule)

Medicare pays physicians using the Resource-Based Relative Value Scale:

• Payment = (work RVU + practice expense RVU + malpractice RVU) × geographic adjustment × conversion factor
• Work RVU reflects physician time, skill, and intensity
• Practice expense RVU reflects staff, supplies, overhead
• Malpractice RVU reflects liability insurance cost
• The Conversion Factor (CF) is set annually by CMS and converts RVUs to dollars

Claims Formats You Must Recognize

Denial Reasons You Must Know

• Medical necessity — service not covered for the diagnosis billed (NCD/LCD mismatch)
• Bundling/NCCI — service bundled into another code billed same day
• Timely filing — claim submitted after payer deadline (typically 90-365 days)
• Duplicate — same service billed twice
• Authorization — prior auth not obtained
• Coordination of benefits — wrong primary payer

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Compliance Deep Dive — What CCA Actually Tests

The 12-16% compliance domain is "easy points" if you memorize the statutes.

HIPAA Privacy Rule (45 CFR Part 164, Subpart E)

• Applies to Covered Entities (providers, health plans, clearinghouses) and Business Associates
• Permits PHI use/disclosure for Treatment, Payment, Operations (TPO) without authorization
• Requires authorization for marketing, sale of PHI, psychotherapy notes, and uses beyond TPO
• Minimum necessary standard applies to all non-TPO disclosures
• Individuals have rights to access, amend, account for disclosures, restrict, confidential communications

HIPAA Security Rule (45 CFR Part 164, Subpart C)

• Applies to electronic PHI (ePHI)
• Three safeguard categories: Administrative, Physical, Technical
• Required implementation specifications vs. Addressable (risk-assessment driven)
• Risk analysis, sanction policy, contingency planning, access controls, audit logs, encryption

HITECH Act (2009)

• Extended HIPAA direct liability to Business Associates
• Created Breach Notification Rule federal standard (prior to HITECH, only state laws)
• Established Meaningful Use (now Promoting Interoperability) incentives
• Increased penalties — up to $1.5M per violation category per year

Fraud and Abuse Statutes

AHIMA Code of Ethics (11 Principles)

CCA candidates should read the full AHIMA Code of Ethics at least once. The 11 principles cover:

1. Advocate for patient privacy, protect health information
2. Professional conduct, integrity
3. Preserve, protect, secure PHI
4. Refuse to participate in or conceal unethical practices
5. Advance professional knowledge
6. Accurate, honest representation of credentials
7. Facilitate interdisciplinary collaboration
8. Report violations
9. Avoid conflicts of interest
10. Serve the public interest
11. Maintain competency through continuing education

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Related AHIMA Credentials

Passing CCA opens the door to AHIMA's full certification ladder:

Most CCA holders add CCS within 3 years and either RHIT (associate) or CDIP (CDI track). That stack is what hospital systems pay $85K–$110K+ for.

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Ready to Pass the CCA in 2026?

Start Your FREE CCA Practice →Practice questions with detailed explanations

Domain-by-domain practice, ICD-10-CM guideline drills, CPT/HCPCS case sets, reimbursement quizzes, and HIPAA compliance challenge sets. 100% free, no credit card.

Pair it with AHIMA's official Self-Assessment and at least one full-length mock exam, and you'll walk into Pearson VUE prepared.

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Official Sources

• AHIMA — Certified Coding Associate (CCA) official certification page
• AHIMA CCA Exam Content Outline (official domains and weights)
• AHIMA 2026 Required Code Books list (approved ICD-10-CM, ICD-10-PCS, CPT editions)
• AHIMA Candidate Guide (eligibility recommendations and policies)
• AHIMA Recertification Guide (CEU requirements and maintenance fees)
• Pearson VUE — AHIMA Exam Delivery (test center scheduling)
• BLS Medical Records Specialists OES 29-2072 (salary and employment)
• CMS ICD-10-CM Official Guidelines (primary source)
• AHIMA/ACDIS Guidelines for Achieving a Compliant Query Practice (query compliance standard)