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Every release and every piece of in-flight work for Medical Auto Coding. Filter by status, kind, or tag, then read the full notes below.
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First public release of the unified platform.
A labor epidural line (01967) bills the directed or teaching modifiers only when the record shows that an anesthesiologist was there for the epidural. The autocoder compares the time of the 01967 line with the documented time of each anesthesiologist on the case. This applies when a CRNA, an anesthesiologist assistant (AA), or a resident placed the epidural.
For example: a CRNA places a labor epidural early in the morning, and the anesthesiologist's documented time starts at the cesarean delivery hours later. The 01967 line bills QZ, and the coder confirms whether the anesthesiologist directed the placement.
ob_labor_epidural_direction_unverified). Reviewer: a coder. Type: Compliance, severity 8. It names the placer, the epidural time and the time of each anesthesiologist on the case, and asks whether an anesthesiologist medically directed the placement. In HANK Claim Maker, this Compliance alert pulls a coder by default. It is the one alert for the line: the CRNA-alone audit alert does not appear beside it.hardstop CRNA-alone setting), the CRNA line bills no payment modifier while the question is open. The question then follows that setting: it is a Hardstop, severity 10, for your charge entry team.In a sample of 2,336 recent fully automated anesthesia cases, 1.4% had a 01967 line, so this question can apply to at most 1.4% of such cases.
When no anesthesiologist has documented time at all, the existing missing-times alert asks instead, so the case gets one question, not two.
See Obstetric Anesthesia and the Anesthesia Alert Reference.
Diagnosis pairs the classification says cannot be coded together are now resolved by the book, and you see a note instead of a question.
An Excludes1 note in the ICD-10-CM Tabular List says that two conditions are not coded together. For example, the note at K83.1 (obstruction of bile duct) excludes "obstruction of bile duct with cholelithiasis (K80.-)". The autocoder now reads these notes for the fiscal year of the date of service. It gives the diagnosis check each conflicting pair, the note, and any combination code that the classification offers. Then it verifies the result on the finished claim. This applies to anesthesia, surgery, E/M and radiology claims.
Each pair ends in one of these outcomes:
Automated claim validation (ClaimCleaner) now runs two times on an anesthesia claim. The second run checks the finished claim, after the diagnosis check and the Excludes1 resolution. So a combination code that the autocoder applies is checked before the claim reaches you. ClaimCleaner questions come from the second run only, so a question never names a diagnosis that has already left the claim. If the first run fails, the claim carries one failure alert, not two.
See the Anesthesia Alert Reference and Diagnosis Coding for the triggers and what to verify.
Some anesthesia claims bill one anesthesia code on two lines on purpose, one line for each provider:
Automated claim validation (ClaimCleaner) can read these two lines as a duplicate. The second validation check on an anesthesia claim now keeps both lines. Every provider line stays billed, and the claim records the removal that the autocoder did not apply. The kept line also receives the diagnosis and modifier corrections that validation made on the other line of the same anesthesia code. The payment modifiers stay as they are, because the two lines differ there on purpose.
For example: an anesthesiologist supervises five concurrent rooms, and a CRNA gives the anesthetic in one of them. The CRNA line with QX stays on the claim beside the anesthesiologist line with AD.
Automated claim validation (ClaimCleaner) checks an anesthesia claim two times. The second check runs on the finished claim, after the claim-wide diagnosis check. The second check now keeps every diagnosis that the diagnosis check decided from the record.
For example: the record documents a left knee replacement, and the diagnosis check keeps Z96.652 (presence of left artificial knee joint). The second check no longer swaps that code for the right side.
Your facility processing rules can create an alert. When a rule creates an alert and does not set an alert type, the autocoder now picks the type from what the rule does to the claim.
A rule that sets its own alert type always keeps it. The autocoder's shipped rules already set their type, so their alerts do not change.
Every finished claim runs through automated claim validation before it reaches you. Validation checks NCCI procedure pairs, add-on code rules, Medicare payment rules, coverage articles, code validity for the date of service, and diagnosis conventions. This release changes what you see from it in two ways.
Validation alerts now name the rule. Before this release, an alert read "Modifier 59 added by ClaimCleaner" and stopped there. You could see the change but not the rule behind it, so confirming the change meant looking the rule up yourself. Each of these alerts now ends with the rule, in the form "Reason: [the rule's own explanation] [the rule id]". Read that sentence first. It names the payment rule or coding convention that produced the change. The alerts themselves are unchanged: same names, same types, same severities.
The alerts that gained the reason are Anesthesia Code Changed, Diagnosis Added, Modifier Added To An Anesthesia Code, Modifier Added To A Surgical Code, Line Left With No Code, and Line Removed By Validation.
Ten new alerts carry the questions validation could not answer. Validation also reports problems it will not correct on its own, because the answer needs the record, not a rule. Until now none of those reports reached a coder. Ten new alerts carry the ones worth your time:
Each alert reads "ClaimCleaner:" then the rule's explanation and its rule id. The type and the severity come from the rule. Every rule in this set classifies as Compliance today. The alert carries the rule's own classification, so a future validation rule could arrive as Financial. One exception: the units alert for a single line over an absolute limit is Compliance, severity 5, set by the autocoder, because validation marks that finding Informational after reducing the units in its own copy of the claim.
What to look out for. Expect a small number of new alerts, not a flood. An alert appears only when five conditions are true.
The rule is on the autocoder's review list. The rule's own classification is not Informational. Validation did not fix the problem itself. The line is still billable on the finished claim. The diagnosis problem that the finding names is still on the finished claim.
For an Excludes1 pair, the alert stays while the diagnosis that carries the Excludes1 note, or another code under the same note, is still billed together with a diagnosis from the note's family. When the autocoder cannot read the note from the finding, it checks the two named diagnoses instead.
The autocoder removes an alert again when it later moves the line out of billing, or when the diagnosis problem that the finding names is no longer on the finished claim. If the claim-wide diagnosis check replaces the diagnosis that carries the note with another code under the same note, or replaces the other diagnosis with another code from the note's family, the alert stays, because the conflict is still on the claim. The alert then also names the pair that the claim bills now. When the diagnosis check leaves two findings on the same pair of billed diagnoses, or two conflicts land on one line, you get one alert that names each pair. Conflicts on different lines raise one alert each. For the other diagnosis findings, and for an Excludes1 finding whose note the autocoder cannot read, a replacement or removal of a named diagnosis removes the alert. A finding about a diagnosis that is missing, for example no diagnosis for the side billed or no diagnosis that a coverage article covers, stays, because the autocoder cannot tell whether a diagnosis added later qualifies.
Start with the rule text in the alert, then check the record for the fact the rule needs: the side of service, the patient demographics, the covered diagnosis, the distinct service, or the units of service.
If a family of these questions does not fit your workflow, your organization can silence it or route it to a different reviewer role. Ask your Hank representative. A silenced alert still appears as an informational note.
See the Anesthesia Alert Reference for the full list, the trigger for each alert, and what to verify.
A routine extreme-age add-on no longer raises an alert. Before this release, every claim that billed 99100 carried a review alert asking a coder to confirm the patient's age. The autocoder had already verified that age against the date of service. That alert is gone, and so is the alert for a 99100 the autocoder withheld. The decision is on the claim instead:
No alert when a payer class bundles the add-ons. Medicare bundles 99100, 99116, 99135, and 99140 into the base anesthesia code, and your configuration can list other payer classes that do the same. Those claims no longer carry an informational alert. The codes move to the bundled procedures, and the reason on each entry names the payer class that bundles it.
One new alert, for demographics that cannot both be right. If the patient's date of birth is later than the date of service, the claim now carries the Date of Birth Is After the Date of Service alert (HARDSTOP, severity 8), and the extreme-age add-on is withheld. Every date-anchored rule reads those two dates, so this is a demographics question, not an add-on question. The alert fires on every specialty.
A new option to review a 99140 that rests on weak evidence. The autocoder trusts a documented emergency and raises no alert for it. Your organization can now ask for a review of the weak cases only. With the Emergency Add-On 99140 Billed On Weak Documentation rule turned on (FINANCIAL, severity 5), a coder is asked when a billed 99140 cites documentation that shows neither a physical status with the E suffix nor a statement that a delay in treatment would significantly increase the threat to life or body part. The rule is off unless you ask for it. A record that reaches you only as handwriting still raises the handwritten emergency-status alert.
The 99116 and 99135 review alert reads more precisely. It now asks you to confirm the record documents deliberate total body hypothermia (99116) or deliberate controlled hypotension (99135) as an anesthetic technique. The cooling and the low blood pressure that come with cardiopulmonary bypass are not the same thing, and they do not support these codes.
Why: a review alert is a question for a human. When the autocoder has no question, it should record what it did and stay quiet. The extreme-age alert asked a coder to re-check arithmetic the autocoder had already verified against the ASA rule, on a large share of anesthesia cases. The payer-class alert reported a decision your own configuration had made.
Physical status modifiers (P1 to P6) now follow your facility setting exactly. If your facility turns physical status modifiers off, no P1 to P6 value reaches a claim line, no matter where it came from. Before this fix, a physical status value that the coding step placed on a code by itself could stay on the claim after the setting said no. When the autocoder removes such a value, it records the removal with the Physical Status Modifier Removed Per Facility Configuration alert (INFORMATIONAL, severity 2). The documented ASA status still shows on the claim when the record has one.
Two new checks protect facilities that do bill physical status. A P1 to P6 value can be on a claim when the record documents no ASA physical status. The Physical Status Modifier Without a Documented ASA Status alert (FINANCIAL, severity 5) then asks a coder to confirm the status. If the setting is off and a value still slips through, the Physical Status Modifier Present Although the Facility Disables Them alert (FINANCIAL, severity 5) reports it.
The extreme-age add-on 99100 is never reported with 00326, 00561, 00834, or 00836. These anesthesia codes already describe a patient younger than 1 year, and CPT does not allow 99100 with them. The autocoder now moves such a 99100 to the bundled procedures, with a reason that names the anesthesia code. No bypass modifier is added.
99100 is re-decided when the demographics arrive late. When the date of birth is missing at coding time and the automatic gap fill recovers it from the record, the autocoder runs the age test again. A patient who qualifies gets 99100 back on the billable lines. A patient the recovered date of birth disproves loses a 99100 that was billing: it moves to the bundled procedures with the reason. The code also stays bundled when the anesthesia code excludes it, when a facility rule withholds it, or when the payer class does not pay it. Before this fix the code stayed off the claim with no trace.
Configuration problems are now visible on the claim. A qualifying circumstance setting that cannot be read as written raises the Qualifying Circumstance Configuration Is Malformed alert (FINANCIAL, severity 5) and names the fault and the posture the autocoder applied. A processing rules setting that cannot be read raises the Processing Rules Could Not Be Read alert (HARDSTOP, severity 9). Every claim now records which facility configuration built it and which qualifying circumstance posture applied to its payer class.
Facility instructions now follow GI and OB cases. An additional coding instruction configured for the anesthesia lane now also applies when the autocoder handles the case as a GI or obstetric case. Before this fix the instruction was dropped on those cases.
What to look out for:
Teams that used the extreme-age alert as a prompt to review patient demographics will not see it any more. If you want a reviewer on every 99100, ask your Hank representative to turn the alert on for the rule that adds the code:
"processingRules": {
"special_circumstances_99100": {
"action": {
"setBillable": true,
"createHRE": true,
"hreTag": "FINANCIAL",
"hreSeverity": 4,
"hreReviewerRole": "CODER",
"hreTemplate": "99100 billed for an extreme-age patient - confirm the date of birth."
}
}
}The same shape works on the 99140 rule. Give every key: the switch turns the alert on, and the other keys set the type, the severity, the suggested reviewer, and the text the reviewer reads.
Two more points. The "enabled" switch on the physical status rule is now ignored; only its value decides. If you set the value to false and also switched the rule off, the modifiers used to appear anyway. They now stop, which lowers the base units billed on P3 and higher. If you switched the rule off but left the value true, nothing changes. And if your reports counted the informational payer-class alert to find bundled add-ons, count the bundled procedures on the claim instead.
Some billing groups prefer CPT codes only as the surgical code on anesthesia claims, and do not want HCPCS screening codes such as G0121, G0105, or G0104 to appear there. A new facility election supports this.
What it does. When enabled, the autocoder replaces those HCPCS codes with their CPT equivalents on the anesthesia claim: G0121 and G0105 become 45378, and G0104 becomes 45330. The billed anesthesia code (00811, 00812) is never affected. Each replacement is noted with a low-severity informational alert so your audit trail shows what changed.
Three settings. Keep the codes as coded (the default), replace them on every payer, or replace them only when the payer is not Medicare. Medicare Advantage counts as Medicare.
What is not affected. Surgeon claims keep the G-codes. Medicare requires G0121 or G0105 on the claim that bills a pure screening colonoscopy, so the replacement never applies there.
Ask your Hank representative to enable the election that fits your billing preference.
The alert "Incomplete operative documentation" (anes_op_notes_incomplete)
now carries the Coder reviewer role. It carried the Reconciler role
before. The alert itself is unchanged: it stays a HARDSTOP at severity 6,
and it fires in the same situations.
Why: the alert asks for a coding decision. The operative notes do not cover all procedures in the record, and the missing procedures were coded from the procedure summary. A coder confirms the codes against the record.
If your workflow sorts alerts by reviewer role, this alert moves from your reconciliation queue to your coder queue.
To keep the old routing, ask your Hank representative to set
"anes_op_notes_incomplete": "RECONCILER" in your facility configuration.
Alert routing is now configurable for every alert, so other alerts can also
move to the queue that fits your team.
Three fixes for screening colonoscopy and sigmoidoscopy coding on surgeon claims.
New alert when a Medicare screening code meets a non-Medicare payer. If a claim carries G0121, G0105, or G0104 and the payer is commercial or unknown, the claim is now flagged for review. Most commercial plans and most Medicaid plans expect the CPT code with modifier 33 instead (45378-33 for colonoscopy, 45330-33 for flexible sigmoidoscopy). Some plans do accept the G-codes, so the alert asks you to verify the payer's preventive policy rather than changing the code.
Modifier PT is no longer added to a pure screening. PT tells Medicare a screening converted to a diagnostic or therapeutic procedure. When a claim carries the base diagnostic code (45378 or 45330) with screening intent and no intervention, nothing converted, so PT no longer appears. The existing "use the G-code" alert still fires, and now also covers flexible sigmoidoscopy.
Less alert noise. The "modifier stripped" alert no longer fires when the predicted modifier matches what the payer rules put back. You will only see it when the prediction and the payer rules disagree.
These changes apply to practices with surgeon companion claims enabled.
A nerve block line, and the ultrasound guidance line that goes with it, carries only the diagnoses documented for the block itself. That is normally the post-procedural pain code. It does not carry the patient's other conditions, because the reason for the block is the reason for the block, not every condition on the chart.
Claim cleaning runs after coding and can add a diagnosis to a line. When it adds one to a block line that the line is not allowed to carry, the autocoder removes it again. That part is not new.
What is new is that you can see it. Before this change the removal happened quietly, and the system also cleared the "added by claim cleaner" note for that code, so nothing on the claim showed that a diagnosis had come and gone. Now the claim carries an informational alert, "Diagnosis Added After Claim Cleaning Was Removed From a Block Line". The alert names the codes it removed, names the diagnoses the line kept, and identifies the line.
Nothing about which diagnoses get removed has changed.
Expect this alert to be rare. Claim cleaning no longer copies the main anesthesia line's diagnoses onto the other lines, so the situation this cleanup was built for does not arise any more. That is exactly why the alert is worth having: if a diagnosis does get added to a block line today, something unusual put it there, and you should look at it rather than have it disappear without a record.
Read the removed codes in the alert. Confirm that none of them is the correct indication for the block. In almost every case the removed code is a condition that belongs on the main anesthesia line instead.
If one of the removed codes IS the correct indication for the block, add it to the block line and tell your coding lead. The same code will be removed again on the next claim of that shape, so it is worth reporting rather than fixing one claim at a time.
The alert follows your existing block-line diagnosis setting. On the shipped default, a block line keeps only the G89 pain-family codes. A facility configured to keep the documented pain-location codes as well will see the alert less often. A facility that has turned the policy off entirely will never see it, because nothing is removed.
We compared autocoder output with your coders' final claims across 26 facilities and adjudicated the differences record by record. This release ships the fixes from that review. It changes the diagnoses you will see on claims in seven areas.
Delivery outcome codes stay on the delivery claim. Outcome-of-delivery codes (Z37.0, Z37.9) and the normal-delivery code O80 now appear only on the claim for the delivery itself. A post-delivery pain round, a separate procedure after the delivery (for example a postpartum D and C), or a labor epidural visit where the patient did not deliver no longer carries them.
Checklist forms are read the way a coder reads them. A pre-printed condition on a checklist that is not circled or checked is not coded. A circled negation such as "No CV Issues" is read as the absence of the condition. A diagnosis written as suspected, possible, probable, or rule-out is coded as the documented sign or symptom, not as the condition.
A BMI value alone no longer produces an obesity code. The record must document obesity as a diagnosis before an E66 code or a Z68 BMI code appears. When the provider documents an obesity class, the class code (E66.811, E66.812, E66.813) is used instead of unspecified obesity (E66.9).
Diagnosis codes the provider typed are used. When the provider enters ICD codes in a diagnosis field for the visit (for example "Diagnosis [Codes]" or "Preoperative diagnosis"), every one of those codes is reported. A screening code in that field stays secondary on a symptom-driven exam and does not change the procedure code.
New alert: Header Diagnosis Code Removed. A diagnosis code that is a category header (for example M10.0), and not billable on its own, is removed at claim build. The alert names the removed code and its billable child codes. Read the record and add the correct child code.
Cleaner diagnosis pointers on line, block, and imaging-guidance items. Arterial line, central line, TEE, and imaging-guidance items now carry the diagnoses documented for that procedure, not every diagnosis on the encounter. The main anesthesia line still carries the full supporting set. An exact duplicate of one of these items (same code, modifiers, diagnoses, documentation, and times) is removed. The new alert "Removed duplicate ancillary line item" tells you when this happens so you can confirm whether a second procedure really occurred.
Medicaid claims no longer carry the PT modifier. The PT modifier waives the Medicare Part B deductible, which Medicaid does not have, and Medicaid plan manuals do not require it. A screening colonoscopy that converts to a diagnostic procedure on a Medicaid claim now bills without PT. Medicare, Medicare Advantage, VA Community Care, and TRICARE claims keep the PT convention.
Repeated diagnosis codes and silent truncation are fixed. The same diagnosis code no longer appears twice on one line. When a line carries more diagnoses than the configured limit (4 by default), the claim now shows an alert naming the dropped codes instead of dropping them silently.
What to look out for: diagnosis lists on block, line, TEE, and imaging-guidance items will look shorter than before. This is correct and intended. If you see the "Header Diagnosis Code Removed" alert often at your facility, tell your Hank representative which document carries the specific diagnosis so we can tune the reading of it.
Automated claim validation (ClaimCleaner) checks the side of service on each line: the RT and LT modifiers, and the side in each diagnosis code. Validation now changes the right or left side only when the line documents that side, with one exception below. The sides that a line documents are the sides of its diagnosis codes and of its RT, LT or 50 modifier.
For example: an interventional radiology claim bills a thrombectomy of the right leg veins (37187) with I82.411 and I82.421 (right femoral and right iliac vein thrombosis) and no side modifier. Validation adds RT and keeps both right-side codes.
The autocoder reads the anesthesiologist's attestation statements to decide whether the medical direction requirements were met before it picks the medical direction modifiers. This release makes that attestation review run on every case where medical direction is enabled, including cases whose practice settings name the coding specialty.
What changed. When a case arrives with the coding specialty named inside its practice settings, the attestation reader now starts with those settings resolved. Before this release, such a case could go to the medical direction step without the attestation review, and the claim carried no note about it.
What you will see. Medical direction modifiers on these cases now reflect the attestation statements documented in the record. Cases whose practice settings did not name a specialty are not affected.
What to look out for: the medical direction rules did not change. If a modifier looks different from what you expect on a case, check the attestation alerts on the claim and send us the alert text.
Radiology coding gains a set of denial-safety checks. Your account team turns each one on for you; nothing changes until they do.
No more empty claims. Three separate causes let a claim leave with no diagnosis or no line item: a trauma study with a negative report, a screening tomosynthesis add-on coded without its base mammogram, and a diagnosis the coder named correctly but at a category level that cannot be billed. Each is fixed: the trauma encounter code is applied, the base mammogram line is added, and a category code is resolved to its billable child that matches the report.
Procedure codes that do not exist are repaired before diagnoses are chosen. When the selected procedure code is not in the code set for the date of service, the autocoder tries, in order, your configured successor code, the exam code printed in the report header, and a pick among the code's own family by description. Every repair is recorded as a review alert. A code that cannot be repaired stops the claim for a coder instead of denying at the payer.
The exam code printed in the report is read and checked. When a report prints its exam code and no line on the claim carries it, the claim is flagged; you can choose to have single-line claims adopt the printed code.
Sides are protected. When the report names a side, the autocoder no longer lets a more frequently billed "bilateral" or opposite-side code replace it.
Screening studies lead with the screening diagnosis. A study the report classifies as a screening (for example a coronary calcium score for risk stratification) is coded with your screening diagnosis first and any incidental finding second, as the ICD-10-CM guidelines require.
An audit verdict on every claim (optional). Each finished claim can carry a denial-safety verdict: a pass or fail checklist of fifteen ICD-10-CM rules, flags for diagnoses the report does not state in words, a confidence score, a denial-risk level, and a two-to-four sentence explanation written for your coders. The Excludes1 and "code first" rules of the checklist read the ICD-10-CM notes for the fiscal year of the date of service. When those notes are not available, the verdict lists the two rules as not checkable. If your organization receives the claim data through the coding API, the verdict is in the claim metadata field radiologyAudit.
What to look out for: three new review alerts.
A review of the whole radiology coding path found a number of rules that were removing correct codes or adding incorrect modifiers. They are corrected.
Findings from the imaged area are no longer discarded. A safety check drops diagnoses that do not belong to the body part a study covers. Its list of body parts was incomplete, so it discarded findings it should have kept: cardiomegaly on a chest study, an abdominal aortic aneurysm or a kidney tumor on an abdominal CT, sciatica on a lumbar spine study, a calcaneal spur on a foot film, and a shoulder fracture on a trauma CT of the chest. It also let a few codes for other body parts through, such as bursitis of the hand on a shoulder study. Both directions are fixed.
Two codes that differ by level or type are no longer treated as left and right. One check read the last digit of a code as the side of the body and removed one of two codes it believed contradicted each other. For many code families that digit means something else, so it removed, for example, the second disc level of a two-level cervical disc disorder. It now uses the official code title and only removes a genuine opposite-side duplicate.
Professional and technical component modifiers follow the fee schedule. Modifier 26 was applied to every diagnostic radiology code on professional claims. A small group of codes, such as trabecular bone score (77089), has no professional or technical split, and the modifier would cause a denial. It is no longer added to those codes, and it is removed where another step added it.
Other corrections. A report header that prints a code deleted in a previous year is no longer adopted over a valid code. A both-knees standing study is no longer split into a right and a left line. PET studies receive the PI or PS modifier only when there is an oncologic reason for the study. A mammography mass is coded to "other abnormal findings" rather than to a calcification code. Observation codes are removed when a related symptom is coded. A fracture code missing its seventh character receives it instead of being dropped.
What you will see. Most claims are unchanged. On 600 randomly drawn studies, 45 claims changed codes, usually by keeping one additional documented finding. Each changed claim was reviewed against its report: the new coding was better on 27, equivalent on 6, and worse on 3. On the remaining 9 both versions had an error the change did not touch, and the new version was closer on most of them. The 3 that got worse exposed a separate issue in how the leading diagnosis is chosen, and that issue remains open.
Two corrections to how diagnoses are chosen on radiology claims. Your account team turns the first one on for you; the second applies wherever it is relevant.
The claim keeps the finding the study was done to answer. Several checks run after a diagnosis is chosen, and each of them can remove a code: one re-examines whether the report supports it, another restores a known condition the referring physician named. In rare combinations these ran in sequence and removed every code for the thing the radiologist actually reported, leaving a claim that described only incidental findings. On a surveillance scan ordered to look for recurrent disease, the enlarged lymph nodes the radiologist called out disappeared and a hiatal hernia was left as the first diagnosis.
The autocoder now checks, at the end, that at least one diagnosis on the claim comes from the impression finding that answers the reason for the exam. If none does, that finding is added back. It is added as a secondary diagnosis and does not displace the diagnosis your coders would expect to lead, except when the leading code is a purely incidental finding, in which case the reason for the exam takes its place. Only findings the extraction was confident about are added back, so hedged observations are not turned into diagnoses.
A cancer of an organ that has been removed is no longer billed as current. When a report documents that an organ was surgically removed and the patient's history names a cancer of that organ, the correct code is the personal-history code, not a current malignancy. The autocoder makes that substitution only when the record proves the whole site is gone: both breasts, both ovaries, a hysterectomy, or a mastectomy on the same side as the coded cancer.
Everywhere else it deliberately does not decide for you. A partial resection of lung, stomach or bowel, or an absence code that does not say which side, leaves the current cancer code exactly as it was and raises a review alert explaining the choice: if the tumour site is gone and no treatment is directed to it, use the personal-history code named in the alert; if the cancer is in the tissue that remains, the current code is already right. A cancer in the organ the patient still has is not flagged at all.
Two diagnosis tables were corrected against the official code set. A sweep of every diagnosis and procedure code written into the autocoder found a mapping that turned one hip condition into another. When a hip study is bilateral and the radiologist documented arthritis of only one side, the autocoder upgrades the diagnosis to its bilateral form. For hips it was upgrading to the wrong form: arthritis caused by hip dysplasia became post-traumatic arthritis, and post-traumatic arthritis became "other secondary". Both now map to the correct bilateral code, so the claim no longer asserts an injury the report does not describe. A second table, the one that decides which diagnoses belong to which body region, carried entries for codes that do not exist and three codes that mean "site unspecified" but were listed as if they named a joint. Both are corrected, and a new automated check refuses any code written into the autocoder that does not exist in the code set.
What you will see. On affected claims, one additional diagnosis that was previously dropped, and a new review alert where a current cancer sits beside evidence that the organ was removed. On a sample of 300 randomly drawn studies, 18 claims changed; procedure codes were unaffected.
Anesthesia cases done under monitored anesthesia care (MAC) now carry the QS modifier automatically, including cases whose notes reach the autocoder already pre-processed by the document reader. Before this fix, coders at some practices had to add QS by hand on every MAC case.
What went wrong. The autocoder decides the anesthesia type from what each note documents. Notes that arrived pre-processed were missing that per-note anesthesia-type reading, so the autocoder could not confirm where "MAC" came from. It treated the MAC as unverified, removed QS, and raised the alert "MAC Modifier on Low-Trust / Contradicted Source" with the text "MAC provenance could not be verified from the anesthesia record". Coding predictions showed AA and the physical status modifier, but no QS.
What changed. When pre-processed notes are missing that reading, the autocoder now collects it itself before it builds the claim. MAC documented in the anesthesia record is trusted the same way it is for cases the autocoder reads from scratch.
What you will see. MAC cases show AA, QS, and the P modifier together in coding predictions. The alert "MAC Modifier on Low-Trust / Contradicted Source" now appears only when MAC is supported by the surgeon's note alone or by nothing in the anesthesia record.
What to look out for: the rules for MAC did not change. A case where the anesthesia record documents an airway device or general anesthesia still codes as general with no QS, even when the surgeon's header says MAC. If a MAC case still arrives without QS, open the alert list on the claim and send us the alert text.
This release changes how the autocoder decides the anesthesia type on a claim, and what you will see when the record is unclear.
The anesthesia record decides the anesthesia type. Surgeon operative reports sometimes carry a template header such as "Anesthesia: MAC" while the anesthesia record documents a general anesthetic (an airway device, volatile agents). Before this release, that header could win, and a QS modifier could appear on a general anesthesia claim. Now the autocoder reads the anesthesia type from each note separately and trusts the anesthesia record over the surgeon's header. A general anesthetic documented in the anesthesia record produces a general anesthesia claim with no QS.
Legitimate MAC claims do not change. When the anesthesia record documents monitored anesthesia care, the claim carries QS exactly as before.
What to look out for: a new hold when MAC is not confirmed. When MAC appears only in the surgeon's note, or the anesthesia record does not confirm the MAC, the claim stops with the alert "MAC modifier suppressed - confirm MAC vs general". The QS/G8/G9 modifier is removed until a coder confirms the anesthesia type. Confirm the type from the anesthesia record and re-apply the modifier if MAC is correct.
Planned procedures that were never performed now raise an alert. When a pre-op note documents a planned nerve block, epidural, or line, and no matching procedure appears on the claim, the claim shows the alert "Planned procedure documented but no corresponding line item found". Review the record to confirm whether the procedure was performed.
More accurate source citations. The notes cited for the anesthesia type, ASA physical status, and emergency status on a claim now point to the notes that actually document those values. Reviewers land on the right document.
Radiology: duplicate lines removed. On radiology encounters with more than one report, the same procedure no longer appears as duplicate claim lines.
Modifiers 59, XE, XS, XP, and XU exist for one purpose: to bypass a Medicare NCCI edit between two codes on the same claim. When no edit exists, the codes pay separately on their own and the modifier is unnecessary. Payers flag unnecessary distinct-service modifiers in audits.
Before this change, the autocoder sometimes placed one of these modifiers on a code pair that has no NCCI edit. Example: a diagnostic cervicocerebral angiogram that bills carotid angiography (36224) and vertebral angiography (36226) together. Medicare holds no edit between those codes, so no modifier is needed, but an XS could still appear on the vertebral line.
Now the autocoder checks the licensed NCCI edit table at claim build. If a line carries 59 or an X modifier and no edit pairs its code with any other code on the claim, the modifier is removed. The claim carries an informational note, "Distinct-Service Modifier Removed (No NCCI Edit)", as an audit trail. No action is needed.
The check is careful in three ways. A modifier on a real edit pair is never touched. A modifier on a repeated code (the same code on two lines) is never touched, because it can mark a separate encounter. And when the NCCI data is not available in a deployment, nothing is removed.
A related alert also improved. The "may need distinctness modifier" review alert used to appear on every claim with two or more procedures. It now appears only when a real NCCI edit pairs the codes, so it no longer asks your team to add a modifier the claim does not need.
Medicare Advantage and managed Medicaid plans follow the Medicare colonoscopy rules. The autocoder used to pick the payer rules from the plan name alone. A plan whose name carries no Medicare or Medicaid marker, for example Humana Gold Plus, Keystone 65, Devoted Health, or AmeriHealth Caritas, could get the commercial rules of the company that administers the plan. The autocoder now also reads the insurance type recorded on the case. These plans get the Medicare or Medicaid row. A recent audit found such plans on about 2 percent of cases.
A surveillance colonoscopy is billed as a screening for every payer except three. Cigna, UHC, and BCBS Nebraska treat surveillance as diagnostic. That list is complete. Every other payer treats a personal history of colon polyps as a high-risk screening. This includes Medicare, Medicaid, VA, and Tricare. In testing, the autocoder could apply a Medicare surveillance exception that does not exist and produce 00811. The same record now produces 00812.
The discontinuous time alert no longer fires on a labor epidural with a cesarean delivery. The autocoder now groups the anesthesia time segments by anesthesia code before it counts them. A labor epidural line and a cesarean delivery line are two services, not a break in one anesthetic. A provider handover also does not count as a break when the two segments touch, for example one segment that ends at 07:00 and the next that starts at 07:01. A true gap inside one anesthesia code still raises the alert.
Many practices send the comprehensive anesthesia record for an acute pain service round. That record still contains the original surgery documentation. Before this change, the autocoder coded the SURGERY from those packets a second time. That created a duplicate of a claim you had already billed on the surgery day.
Now the autocoder detects the pain-round visit and codes THAT visit:
The claim date of service is the date of the ROUND, not the surgery date. The primary diagnosis is acute postprocedural pain (G89.18).
Pain-round visits are infrequent, and the one-page rounding forms that carry them lose checkbox marks in text extraction. So by default, every claim from a packet that contains pain-round content waits for a coder before it bills. The claim carries the alert "Post-Op Pain Rounds Review Gate". The autocoder still codes the visit. The coder confirms one of three outcomes and releases or corrects the claim:
If your facility trusts the pain-round coding, ask your HANK representative to turn the gate off, or to narrow it to only the claims the pain-round lane coded.
Post-Op Pain Rounds Review Gate; Possible Pain-Round Packet Coded as Surgery; No Billable Pain-Round Service; Pain-Round Date Not Documented; Pain Rounds on More Than One Day; Surgeon Transfer of Pain Management Not Documented; Catheter Insertion Date Not Documented; Pain-Round Coverage Is Payer Variable; Pain-Round Evidence Without a Citation.
Staff and surgeon details that your schedulers enter on the OR schedule now survive to the finished claim. This applies to anesthesia cases where the schedule is passed to the autocoder with the case.
Verified schedule identity wins over the notes. The provider name, NPI, role, and title from the schedule are treated as verified. They replace the same details read out of the notes. A provider who appears only on the schedule is added to the claim.
Times from the notes still win. Anesthesia times read from the record continue to decide the billed time. Schedule times fill in only when the record gives none.
Schedule coverage is the last resort for times. When the record has no anesthesia case times and no procedure summary time pair, the billable times can be derived from the schedule staff coverage. The claim then carries the informational alert "Anesthesia Times Derived From OR Schedule", so a reviewer can see where the times came from.
What to look out for: a role or title left blank on the schedule now stays blank on the claim. The autocoder no longer guesses it, because a wrong role changes medical direction and modifier decisions. Incomplete schedule entries therefore show up as blanks. Ask your schedulers to complete the role and title fields on every entry.
When your OR schedule names the anesthesia provider, the billed claim line now carries that provider's identity: the name, the NPI, and the role and credential when the schedule specifies one.
Before this fix, the schedule corrected the staff record but not the billed line. A provider your schedule listed with an NPI could still bill under the identity read from the chart alone. Scanned charts made this worse: a pre-printed staff grid that misfiles a physician into the CRNA row produced a claim with the right name, no NPI, the wrong role, and the wrong payment modifier (QZ instead of AA).
Now the schedule wins. The billed line takes the schedule's name and NPI. If the schedule states a role (for example DO), the line takes that role and credential too, and the payment modifier follows it. A schedule entry with no role stated never overrides the role read from the chart.
New review alert: OR Schedule Role Overrides the Note-Predicted Provider
Role (schedule_provider_role_conflict). This alert appears when the
schedule's role disagrees with the role read from the chart for the same
person. The alert names the provider, the NPI, the schedule role, and the
chart role. Because this can change the payment modifier, a coder should
confirm which source is right before the claim goes out.
What to look out for: claims where the schedule and the chart disagree on a provider's role will now bill under the schedule's role and carry the new alert. If your schedule data entry is wrong, correct the role on the claim. If the chart form was misfiled, no change is needed.
This applies only when your integration passes the OR schedule with the case. Sites that do not send schedule data see no change.
Some EMRs print the CPT code that was selected when the case was booked. The booked code does not always match the procedure that was performed. A common example is a colonoscopy booked under a polypectomy code when no polyp was removed.
The autocoder now treats a printed code number as scheduling data, not as proof. The words in the record still count, including words in the booking or scheduling area. But the autocoder does not expand a bare code number into its full code description to add details the record does not state.
What you will see differently:
What to look out for: claims where the booked code and the documentation disagree now follow the documentation. If a procedure was performed but not documented, the claim will not include it. Ask the provider to complete the record, then resubmit the case.
This release changes three things on anesthesia claims that include a peripheral nerve block. Our coding experts directed each change. No action is required on your side.
More blocks qualify for ultrasound guidance (76942). The autocoder now adds 76942 to the following block codes when the record documents ultrasound guidance and image storage: 64400, 64405, 64408, 64418, 64420, 64421, 64425, 64430, 64435, 64449, 64450, 64505, 64510, 64517, 64520, 64530, and 64999. New to the list are 64408 (vagus), 64421 (additional intercostal), 64430 (pudendal), 64435 (paracervical), 64505 (sphenopalatine), 64510 (stellate ganglion), 64517 (superior hypogastric), 64520 (lumbar or thoracic paravertebral sympathetic), and 64530 (celiac plexus). Code 64418 (suprascapular) stays on the list: an earlier version of this entry said it was removed, but our experts confirmed on 2026-08-15 that CPT does not bundle imaging into 64418, so 76942 stays billable with it when ultrasound and image storage are documented.
Add-on block lines no longer carry modifier 59 or the X modifiers. When a block is billed as a primary code plus an add-on code (for example, 64461 with 64462), the add-on line is already distinct by definition. The autocoder no longer places 59, XE, XS, XP, or XU on add-on lines. Primary lines are not affected.
The 76942 line now carries the same diagnoses as its nerve block. The ultrasound guidance line used to copy diagnoses from elsewhere on the claim. It now shows the diagnoses on the block line it supports, such as G89.18 (other acute postprocedural pain), and nothing else.
What to look out for: on claims with a suprascapular, pudendal, paracervical, stellate, celiac, hypogastric, or paravertebral sympathetic block, expect a 76942 line when ultrasound and image storage are documented. On claims with add-on block codes, expect the add-on line without 59 or an X modifier.
Reference material now matches the date of service. When the autocoder looks up code reference material while it codes a case, it reads only the reference set for the claim's date of service. CPT references follow the calendar year. Diagnosis references follow the October to September fiscal year. Before this change, a case coded for an earlier date of service could see current year material.
This matters most on back dated work: a claim for a service in a prior year is now coded against the code set that was in force on that date, not against the current one.
What to look out for: back dated cases should select codes that were valid on the date of service. When a case carries no date of service, the autocoder still reads every year, as it did before. If a claim needs the date of service to be right for this reason, confirm the date before you reprocess the case.
This release changes what you will see on anesthesia claims in four areas.
TEE codes now come from one family. A transesophageal echo (TEE) claim carries one TEE code from a single code family. Illegal pairs such as 93312 with 93317 no longer occur. Congenital codes (93315-93317) appear only when the record documents evaluation of a congenital anomaly. Monitoring-only TEE produces no separate TEE code, because NCCI bundles it into the anesthesia service.
Nerve block lines keep only their own pain diagnosis. A separately billed
nerve block line now carries the block's own pain code (a G89 code, for
example G89.18) instead of every diagnosis on the encounter. This is the new
default. If your organization prefers the old behavior, or wants the site
pain code included as well, ask your Hank representative about the
nerveBlockLineIcds setting. A block line that ends up with no diagnosis is
held for review, not billed.
What to look out for: block-line diagnoses will look shorter than before. This is correct and intended.
Paravertebral block add-on units are corrected. A multi-level paravertebral block now bills 64461 plus one unit of 64462, not one 64462 per extra level. Medicare denied the extra units in all cases. Continuous catheter blocks bill 64463. The 64484 add-on is unchanged.
Screening colonoscopy claims (combined GI). The PT modifier on combined GI endoscopy code 00813 is now decided by payer at claim build. Medicare recognizes PT on anesthesia code 00811 only, so 00813 goes to Medicare and Medicare Advantage without PT. PT stays on 00813 only for the short list of commercial payers whose policy requires it (BCBS Independence PA and Moda Health), and never when the payer name carries a Medicare or Medicaid marker. Every other payer, and an unknown payer, gets 00813 without PT. An informational note records each keep or strip. PT on any anesthesia code other than 00811, 00812, or 00813 is removed. (Correction 2026-08-15: an earlier version of this entry described the Medicare rule backwards.)
Fewer cases held for missing times. The autocoder now always asks for staff and case times during extraction. Cases that were held with a "no anesthesia times" alert, even though the times were in the record, now code normally.
ICD-10 requires combination codes when certain conditions appear together. Hypertension with chronic kidney disease codes as I12.0 or I12.9, not as I10 plus the kidney code alone. Hypertension with heart failure codes as I11.0. Type 2 diabetes with chronic kidney disease codes as E11.22.
Before this change, the autocoder applied these combinations most of the time but not every time. Some claims went out with I10 and N18.x listed separately.
Now a rules engine checks every claim after the AI review. If a standalone code and its related condition both remain, the engine replaces them with the correct combination code. The stage code (N18.x) and the heart failure code (I50.x) stay on the claim, as ICD-10 requires. The combination code is sequenced before the stage and heart failure codes, in the order ICD-10 instructs.
Hypertension with both heart failure and chronic kidney disease uses the I13 family. When all three conditions appear together, the claim codes as I13.0 or I13.2 (the code follows the kidney disease stage). When an I13 code is on the claim, the lesser hypertension codes drop off: I10, I11.x, and I12.x. A partial combination already coded as I11.x or I12.x is upgraded to I13.x when the record also documents the missing condition. You will see I13 codes the autocoder never produced before, and you will see I11 or I12 codes disappear when the full combination applies. Both outcomes follow the ICD-10-CM instructions. A separate new alert, "Diagnosis Validation Returned No Result", names a claim where the diagnosis review step returned nothing at all.
This release fixes a customer-reported problem with the extreme-age add-on code 99100 and tightens several related checks.
99100 now anchors to the date of service. The autocoder decides the extreme-age add-on (99100) from the patient's age ON THE DATE OF SERVICE. The date the case is processed no longer matters. Before this fix, a re-run of an unchanged case after the patient's 70th birthday could add 99100 that the first run correctly omitted. That cannot happen now.
Every 99100 is verified against the ASA age rule. The patient must be younger than 1 year, or at least 70 years and 1 day old, on the date of service. The 70th birthday alone does not qualify. A 99100 that qualifies is billed and gets the new alert "Extreme-Age Add-On 99100 Billed (Age Verified on Date of Service)" so a coder can confirm the demographics. A 99100 that does not qualify, or whose age cannot be verified, is kept on the claim for review and is not billed. Two new alerts name those outcomes.
What to look out for: claims for patients near their 70th birthday. A patient who turns 70 AFTER the date of service does not get 99100, even when the case is coded weeks later. This is correct and intended.
The anesthesia coder can now decline an unsupported code. When the documentation supports none of the candidate anesthesia codes, the autocoder returns no code and the claim is held for human review. It is no longer forced to pick the closest candidate. A new alert, "Anesthesia Code Cites Only Plan/History Documentation", also fires when a billed anesthesia code rests only on the pre-anesthesia evaluation although the record contains procedure documentation.
Anesthesia times now appear on more claims. When the billed anesthesia time comes from provider coverage times because the chart has no discrete anesthesia start and stop, the claim's anesthesia times field now shows the times that were billed. Those claims previously billed correctly but showed empty anesthesia times.
Contrast supply codes corrected (radiology). Q9968 and Q9969 are no longer treated as contrast agents. Q9968 is a visualization adjunct such as methylene blue. Q9969 was retired from HCPCS at the end of 2025. The high-osmolar contrast family Q9958 through Q9964 is now recognized for wastage checks alongside the low-osmolar family Q9965 through Q9967.
The autocoder now codes interventional radiology (IR) reports. Before this release, an IR report was returned with an "IR not supported" hold. Now the report is coded, and a set of IR-specific review alerts protects the result.
What you will see on IR claims:
Also fixed in this release:
What to look out for: the volume of auto-coded radiology work goes up, and the new IR alert names will appear in your review queues. Your team can ask your Hank representative to turn the IR lane off for your organization if you want to opt out.
This release changes which diagnosis codes the autocoder selects on obstetric anesthesia claims when the record does not document the delivery outcome or the gestational age. The change was directed by our coding experts. No action is required on your side.
The delivery outcome is coded only when the record documents it. Before this release, a delivery could be coded with Z37.0 (single live birth) even when the record did not state the outcome. Now the autocoder codes Z37.0 only when the record documents a single liveborn infant. When the record documents a delivery but not the outcome, the claim carries Z37.9 (outcome of delivery, unspecified) instead.
The gestational age is coded only when the record documents it. Before this release, a delivery could be assumed full term. Now, when the record does not document the weeks of gestation (for example "39w4d" or "40w"), the claim carries Z3A.00 (weeks of gestation not specified) instead of an assumed term code.
What to look out for: on obstetric claims where the chart does not state the outcome or the gestational age, expect Z37.9 or Z3A.00 where you may have seen Z37.0 or a specific term code before. The specific codes still appear whenever the record documents them. If a reviewer sees Z37.9 or Z3A.00 on a claim, the fastest resolution is to find the outcome or the gestational age in the chart and reprocess, or to correct the code by hand.
This release closes 14 findings from a full review of the anesthesia coding stack. Several of them change what your coders will see.
Every OB case is held for review. A claim whose primary anesthesia code is obstetric (01958-01969) now carries the "OB case review" hold. This rule existed in configuration before but never fired because of a defect. If your organization does not want every OB case held, the rule can be turned off or downgraded per facility.
OB add-on codes require their primary. A claim that bills 01968 or 01969 without the 01967 labor analgesia primary is held. An add-on billed alone is a guaranteed payer rejection.
Supervision cases bill both providers. When medical direction drops to supervision (more than 4 concurrent cases), the claim now bills the physician line with modifier AD and the CRNA line with modifier QX. The CRNA line used to disappear, which underbilled the case.
Deliberate hypothermia and controlled hypotension are billed again. Codes 99116 and 99135 were blocked entirely. They now bill when the record documents the technique, and every such line carries a review flag so a coder confirms the documentation and the payer.
Post-op pain epidurals follow the NCCI rule. An epidural placed for post-op pain bills separately (with modifier 59) only when the case was done under general anesthesia. Under spinal or other anesthesia it is bundled, with the NCCI reason recorded on the claim. Placement in the OR no longer causes a silent drop.
Two new safety holds.
TEFRA settings are honored. A TEFRA attestation requirement your organization turned off is now truly excluded from evaluation. Sites with disabled requirements may see fewer "TEFRA requirements unmet" holds.
What to look out for: more held OB claims (by design), two-line supervision billing, occasional 99116/99135 lines with review flags, and the two new hold reasons in your review queues.
This release makes the data the autocoder sends to the automated claim validation service (ClaimCleaner) truthful in every field. Validation verdicts become more accurate. Nothing about this change requires action on your side, with one new alert to know about.
A claim without a date of service is no longer validated against a guessed date. Before this release, when no date of service could be found in the record, the validation step silently used the processing date instead. Every date-anchored check (code validity for the year, coverage windows, unit limits) then ran against a wrong date. Now the autocoder raises the new alert "Date of Service Could Not Be Resolved - Validation Skipped" (HARDSTOP) and skips validation. Supply the date of service and reprocess; validation then runs normally. Typical handling in HANK Claim Maker: the claim is held until a reviewer resolves the alert.
Patient age now reaches validation. The validation service checks billed codes against age rules (newborn, pediatric, maternity, adult). Before this release, the patient's age almost never reached it. Now the age is sent whenever a true date of service exists: computed from the date of birth when the record has a usable one, or taken from the documented age otherwise. A date of birth that cannot be true (for example, a date after the service) is never turned into an age. The age is always the age ON the date of service, never the age on the day the case was processed.
Coverage checks can now use your real service location. Medicare coverage rules differ by region. Before this release, the claim's location came from the insurance company's mailing address, which selected the wrong region or none at all. That address is no longer used. Your HANK representative can now configure your facility's real service location, and coverage checks then run against the correct regional rules. Expect some validation findings to change on claims that previously matched a wrong region: the new findings are the correct ones.
A refused validation connection now raises a critical alert. When the validation service refuses the connection because of a deployment problem (an expired token or an exhausted quota), every claim is affected until an administrator fixes it. Those claims now get the alert "ClaimCleaner Refused the Request" (HARDSTOP). A plain network hiccup keeps the existing lower-severity alert. Typical handling in HANK Claim Maker: the refused claims wait in the review queue until the deployment is fixed and the claims are revalidated.
What to look out for: claims with no date of service were already held for the missing date. What is new: the validation step no longer runs against a made-up date on those claims, and the new alert names exactly why validation was skipped. Supplying the date clears it and validation runs normally.
The autocoder now codes Evaluation and Management (E/M) encounters. This covers office visits (99202-99215), hospital inpatient and observation care (99221-99239, including same-date admit and discharge 99234-99236), and emergency department visits (99281-99285).
How E/M leveling works. The level is never picked by the language model. The model extracts the evidence (medical decision making elements, time statements, encounter setting) with citations that are verified against the chart text word for word. A deterministic rule engine then computes the level from the verified evidence, following the AMA MDM table and the CMS time rules. A fabricated or unverifiable quote is discarded like a missing one.
What you will see:
What to look out for: E/M encounters that used to go to your coders untouched now arrive coded, with the evidence cited. Held charts carry named alerts that explain the reason. The refusal behavior is deliberate: a chart the system cannot support with cited evidence is left for a human, never guessed.
Some anesthesia records are printed forms with checkboxes, bubbles, and pre-printed option grids, for example the Graphium anesthesia record and the Graphium "Outside of OR / Patient Visit" form. Text extraction from these forms keeps every printed label but loses which boxes were marked. Before this change, the autocoder could read an empty option as a service. Examples from real records: an unticked "Labor Epid to C-Section" box became a cesarean anesthesia charge with the labor epidural, an empty "A-Line" row became an arterial line, and an empty emergency box became qualifying circumstance 99140.
Now, at facilities that submit these forms, the autocoder receives the page image together with the extracted text on every coding request. It can see which options were marked. On the same labor epidural record it now bills the labor epidural only.
The primary-diagnosis alert now reads like a person wrote it. The old alert said "Primary dx Z12.11 (Encounter for screening for malignant neoplasm of colon (billable=True)) not attested as reason for procedure. Validator: src=unattested: return record to provider." The new alert says where the diagnosis was found in plain words, what to confirm, and what to do: "Primary diagnosis Z12.11 (Encounter for screening for malignant neoplasm of colon) is not documented as the reason for this procedure in the anesthesia record or the procedure note. Where it was found: only the problem list or past history. Confirm the documentation supports this diagnosis, or select the diagnosis the record supports. Do not bill from a problem list or history alone." The alert identifier, severity, and hold behavior do not change.
The alert fires less often on screening and delivery claims. The autocoder now reads the pre-anesthesia evaluation and the other anesthesia record sections when it checks the primary diagnosis, so an indication documented only on the pre-anesthesia evaluation counts. It also treats the documented encounter type as the reason for the procedure: "screening colonoscopy" on the record supports the screening code, and a normal delivery note supports the delivery code. A procedure with no indication documented anywhere still routes to a coder.
Cesarean claims keep the documented indication as the primary diagnosis. The autocoder used to fall back to O82, "cesarean delivery without indication," whenever a cesarean was performed. Per the FY 2026 ICD-10-CM Official Guidelines, the condition that led to the cesarean is the principal diagnosis. A repeat cesarean for a prior uterine scar now bills O34.21- first. O82 appears only when the record documents that there was no indication.
Separate billing of a postoperative pain injection (62322 family) now follows the full NCCI conditions. A separate flat-fee line requires all three: the case ran under general anesthesia, the surgeon's request for postoperative pain management is documented, and the injection was not the operative anesthetic. When these are met, the line carries modifier 59 or XU automatically. When any is missing, the block folds into anesthesia time and the alert tells the coder exactly how to recover the flat fee: obtain the surgeon's request, then bill the code with modifier 59 or XU.
Pre-printed form labels are not services. On paper checkbox forms, an unmarked pre-printed option could be read as a performed service: an unticked "Labor Epid to C-Section" row became a cesarean, an empty arterial line grid row became 36620, an empty "E" box became 99140. The autocoder now requires real documentation: cesarean codes need documented cesarean anesthesia, a line needs a placement note or a time, and 99140 needs a documented emergency condition.
If your review workflow matches on the exact text of the primary-diagnosis
alert, update the match: the identifier primary_icd_not_attested is
unchanged, but the description text is new.
The autocoder can now build a companion claim for the operating surgeon alongside the anesthesia claim, from the same case documents. The feature is OFF by default and is enabled per organization on request.
What it does when enabled:
What to look out for: nothing changes unless your organization asks for the feature. If you want surgeon-side claims from the documentation you already send, contact your Hank representative.
BREAKING API changes: 2 added, 8 removed, 1 changed.
BREAKING API changes: 11 added, 3 removed, 2 changed.
The autocoder applies its radiology claim rules again. A configuration defect switched off every radiology rule, so none of the radiology alerts could appear on a claim. The rules now load and run.
Add-on codes are checked on every radiology claim. When a claim carries an add-on code and none of the primary codes CMS accepts for that add-on, the claim carries the alert "IR Add-On Code Without CMS-Acceptable Primary". The alert names the acceptable primary codes. The check reads the CMS add-on code edit data. It stays silent when CMS defines no primary list for the add-on. This check runs on diagnostic radiology claims as well as interventional radiology claims.
The radiology bundling and documentation alerts can appear on any radiology claim whose codes match the rule, not only on interventional work. The July interventional radiology update lists those alerts by name.
What to look out for: expect these alerts on ordinary diagnostic radiology claims that never raised them before. The checks were not running at all, so a claim that passed clean last month can raise an alert this month. Your organization can ask your Hank representative to retune or switch off an individual radiology rule.
Code 29826 can no longer stand alone as the surgical code on a claim. 29826 is arthroscopic subacromial decompression, an add-on code. An add-on code reports work that is done with a base procedure, so it cannot be the only surgical code on a claim. The autocoder now holds a claim whose only surgical code is 29826. Codes 99100 and 99140 were already held this way, and 29826 joins them.
What to look out for: a shoulder arthroscopy case documented only as the decompression will hold until a coder supplies the base procedure. The base procedure is usually stated in the operative report. Find it, add it, and reprocess the case. If the record documents no base procedure, ask the surgeon for the missing detail before you bill the case.
Our coding experts reviewed the autocoder and directed the rules below. No action is required on your side.
Spine anesthesia 00670 follows the overall extent of the operation. The autocoder selects 00670 when the operation uses instrumentation, or covers three or more vertebral bodies, or covers two or more disc levels. The levels do not need to be next to each other.
Abdominal cases route by the operative field. The autocoder selects between upper abdomen 00790 and lower abdomen 00840 from the field the record documents, not from the name of the procedure alone. A colon case routes to 00790 unless the work is only on the sigmoid or the rectum. An exploratory laparotomy (49000) routes to 00790.
Three diagnosis rules changed. A symptom code or a site pain code is dropped when it is part of a documented condition. A personal history code is dropped when the autocoder codes the current condition. A status code never ranks first on the claim.
What to look out for: spine and abdominal code selection will look different on affected cases. Diagnosis lists will be shorter and ordered differently. Both changes follow the expert review.
Both capabilities below are off unless your organization asks for them. Nothing changes on your claims until then.
A documentation check before a post-operative pain block is billed separately. Your organization declares, per payer type, which evidence must be in the record. The choices are a surgeon order or request, acceptance of transfer of care, a completed consult, a signed block consent, and a separate procedure note. One scan of the whole record checks for that evidence after the claim is built. When evidence is missing, your organization decides the outcome. The block either stays billable and the claim carries a compliance alert, or the block moves to the non-billable list with an informational alert that explains why. The alert names the payer, the evidence found, and the evidence still missing. A record that contains handwritten documents is never moved to non-billable automatically, because a text scan cannot verify marks on paper.
Coding guidance written for your organization. The autocoder can apply your own coding guidance on top of the standard guidance, on your cases only. It covers your guidance for individual codes in anesthesia code selection, your guidance for individual codes in the diagnosis review, and your own instructions for the coding steps. Coverage today is anesthesia.
What to look out for: ask your Hank representative if you want either capability turned on for your organization.
This change affects only organizations that chose the X modifier set in place of modifier 59.
Modifier 59 stays on the lines CMS excludes. Per CMS guidance (MLN1783722), modifier 59 and its X modifier subsets identify services other than evaluation and management. E/M services use modifier 25 instead. The autocoder no longer converts a 59 into XE or XS on an E/M line, an anesthesia line, or a qualifying circumstance line. A modifier 59 that arrives on one of those lines stays 59.
The catch-all XU rule already worked this way. The XE rule (return to the operating room) and the XS rule (separate structure) now follow the same exclusion.
What to look out for: if your organization uses the X modifier preference, expect 59 to remain on E/M, anesthesia, and qualifying circumstance lines. Other lines still receive the X modifiers as before. Organizations that bill with modifier 59 see no change at all.
Modifier G8 is now limited to the six codes CMS names for it. Those codes are 00100, 00160, 00300, 00400, 00532 and 00920. On any other code the autocoder removes G8 and applies QS in its place.
An anesthesia line now carries exactly one of QS, G8 or G9. These modifiers can no longer stack on the same line. QS is the default for monitored anesthesia care. G8 wins when the code qualifies for it, then G9, then QS.
Three new review flags. A line that keeps G8 or G9 carries an informational note to verify the documentation. A line with G9 is flagged when no severe heart or lung diagnosis is coded on the claim. A physical status of P3, P4 or P5 is flagged when no supporting condition is coded on the claim.
What to look out for: expect G8 to disappear from cases outside the six approved codes, and expect QS in its place. Expect new review flags on G9 lines and on claims with a high physical status. When the record supports the modifier or the physical status, confirm that the supporting diagnosis is coded on the claim.
Radiology claims apply the component modifiers your configuration asks for. The rules that decide the professional component (modifier 26) and the technical component (modifier TC) read the billing component set for your organization. That setting stopped reaching the coding step, so the rules had nothing to act on, so no radiology claim received a component modifier from them. The setting is live again, and radiology coding follows it.
While the setting was not reaching the coding step, radiology claims were coded as if no component preference existed. Claims coded in that window may therefore be missing the modifier your configuration calls for. Check them before you submit them.
What to look out for: a radiology claim may now carry a 26 or a TC modifier where recent claims carried none. Check that the billing component configured for your organization matches how you bill: professional, technical, global, or split. Ask your Hank representative if the setting needs to change.
Cystoscopy coding is corrected. Before this change, the autocoder sent laser stone cases to the tumor codes.
A laser used on a bladder tumor codes to the tumor codes. Transurethral resection of a bladder tumor with a laser codes to 52234, 52235, or 52240. The code follows the size of the tumor.
A laser used on a stone codes to the lithotripsy codes. Cystoscopy with laser lithotripsy codes to 52353. When a stent is placed at the same session, the case codes to 52356 instead. Placing a stent by itself codes to 52332.
What to look out for: the anesthesia code can change with the surgical code, because the anesthesia code follows the surgical procedure. Review your cystoscopy cases that document a laser after this update, and confirm that the record states what the laser treated. A record that says only "laser used" does not separate tumor work from stone work.
Two claim building defects are fixed.
Each case is handled on its own. When one case in a batch was a gastrointestinal or an obstetric case, the special note handling for that case could carry over into the cases processed after it. Those later cases could then read the record differently than they would on their own. The special handling now stays inside the case that needs it.
The surgeon on the first line is the surgeon on the claim. When a case documents more than one surgeon, the autocoder used whichever surgeon it read last. The surgeon on the first line item now fills the claim surgeon. A later line from a different surgeon is recorded in the notes on the claim and does not overwrite it.
What to look out for: in high volume batches, a case that follows a GI or an obstetric case should now code the same way it would code on its own. On a case with more than one surgeon, check that the claim surgeon is the one your billing rules expect.
The qualifying circumstance codes are no longer billed on Medicare claims. The codes are 99100, 99116, 99135 and 99140. CMS bundles them into the base anesthesia service, so they are not separately payable. When the primary payer is Medicare or Medicare Advantage, the autocoder keeps these codes on the claim as documentation and does not bill them. The claim carries an informational note that records the change.
Commercial payers and unknown payers are not affected. On those claims the qualifying circumstance codes stay billable, exactly as before.
What to look out for: tell your Hank representative if your contract pays these codes on all payers, including Medicare Advantage plans that reimburse them. This behavior is on by default, and it can be turned off for your organization. Make that change before the build reaches production. There is no error message when a code moves to documentation only. An unprepared organization finds the change only by auditing claims by hand.
The screening diagnosis stays on a combined upper and lower GI claim. On a combined endoscopy case coded as 00813, both procedures need a supporting diagnosis. The autocoder now keeps the screening code Z12.11 on the claim as the second ranked diagnosis instead of dropping it. The order is fixed: the upper GI diagnosis ranks first, the screening code ranks second, and the colon findings (for example K63.5 or K62.1) rank third.
A new alert names a claim where the screening code is dropped anyway. The diagnosis validation step, or the limit on how many diagnoses a line can carry, can still remove the code. When that happens the claim carries the informational alert "Screening Diagnosis Dropped from Combined GI Claim", and the alert names what was removed.
The PT modifier rule for 00813 is described in the July anesthesia update.
What to look out for: on combined GI claims, expect Z12.11 to stay on the claim in second position. If you see the dropped screening alert, check whether the screening diagnosis belongs back on the claim before you release it.
A missing provider name inside a procedure note no longer makes the procedure non billable. The autocoder was marking clearly documented procedures as non billable, with the reason "provider not documented", whenever the procedure section did not name the performer in line. That reason was never a valid rule. The autocoder resolves provider attribution later, so a missing name in one section is not a reason to withhold the code.
Flat fee procedures and neuraxial procedures are the ones you will notice. One case seen in production is a pre-operative combined spinal epidural catheter, code 62326. The procedure was documented, and the autocoder still marked it non billable. It bills now.
What to look out for: expect these procedures to appear as billable lines on notes where the performer is not named in the procedure section. Compare a few recent claims of this type against the record. When a procedure must not bill for a different reason, the autocoder still reports that reason.
O80 is coded only when a delivery happened during this stay. O80 reports an encounter for a full term uncomplicated delivery. A labor only case that carried O80 could be billed as a delivery again when the patient came back. The autocoder now requires a documented delivery in this stay. It also requires an outcome of delivery code (Z37) as a secondary diagnosis. It blocks O80 whenever any pregnancy complication is coded.
External cause codes are suppressed on anesthesia claims. Codes from the V, W, X and Y chapters no longer appear on these claims.
A condition documented as a past event is coded as history. A prior heart attack or a prior stroke gets a history code, not a code for a current condition.
An abdominal case documented above the navel routes to 00790. The autocoder selects the upper abdomen code when the record documents an incision or an exploration above the umbilicus. Anesthesia billing follows the operative field, not only the name of the procedure.
What to look out for: a labor only encounter no longer carries a delivery diagnosis. Confirm that the record states the delivery when you expect O80. An abdominal case documented above the navel carries 00790 and the base units of that code.
The anesthesia code is now selected from all of the notes. The autocoder was dropping the procedure summary whenever the pre-anesthesia evaluation was also cited. That happens on nearly every GI case, so the anesthesia code was often selected from the pre-anesthesia plan alone. The plan states what was intended, not what was done.
Anesthesia codes on GI cases can change, and that is the correction. A colonoscopy planned as screening and completed with a polypectomy is the clearest example. The plan supports 00812. The procedure report documents the polypectomy, and 00811 is correct. The autocoder now reads that report.
Code lookups now use the date of service. Code descriptions and code validity resolve from the real date of service, not from the current calendar year. A back dated claim now gets the codes of the correct year.
The notes cited on the final anesthesia code are the notes the autocoder used. The citation was previously taken from the first matching note in the record.
What to look out for: review GI anesthesia codes after this change, because the selected code can differ from what you saw before. Back dated claims should stop showing current year code descriptions.
Z86.010 is not billable, and the autocoder no longer uses it. That code became non billable on 2024-10-01 and was split into five character codes. The autocoder now selects Z86.0101 for a history of adenomatous or serrated polyps, which is the most common surveillance case. It selects Z86.0100 when the record does not document the type of polyp. It selects Z86.0102 for a history of hyperplastic polyps only. It selects Z86.0109 for another documented history of colon polyps.
A documented family history of polyps now codes to Z83.71. The autocoder used the family history code for digestive cancer before this change. A family history of polyps is not a family history of cancer, and Z83.71 is the correct code.
What to look out for: lower endoscopy claims with a documented polyp history no longer carry the parent code Z86.010. Review any claim that you already submitted with Z86.010, because the payer rejects that line. Correct it to the five character code that the record supports, then resubmit.
A code billed as the anesthesia code must belong to the anesthesia code family. The autocoder now checks the anesthesia code against that family. A code outside the family raises a review alert on the claim. A code that is not a real CPT code at all holds the claim.
A code valid only in 2025 could reach a 2026 claim. The check that validates surgical coding was broken, so a retired code could pass onto a claim with a 2026 date of service. That check works again. The autocoder is also told the target code year while it selects codes.
What to look out for: expect alerts that name an anesthesia code which does not belong to the anesthesia code family. Read the record, then select the correct anesthesia code. Review any recent claim that carries a code retired at the end of 2025.
QZ is no longer forced onto every CRNA placed labor epidural. Code 01967 got QZ regardless of your organization's medical direction configuration. The autocoder now applies the same rules that it uses for every other line.
What each configuration gets now. An organization with medical direction turned off gets the provider on the line and no modifier, because that organization assigns anesthesia payment modifiers downstream. An organization that chose to hold CRNA alone cases now gets a hold, instead of a QZ that was billed silently. Every other organization still gets QZ, plus a new informational note for the audit trail.
What to look out for: code 01967 still requires one of AA, QK, QX, QY, QZ or AD on the submitted claim. Payers deny the line without one of them. If your organization assigns modifiers downstream, confirm that the downstream process supplies the modifier on labor epidurals. If your organization holds CRNA alone cases, expect new review queue items where QZ was billed automatically before.
Codes from a handwritten record now carry a real confidence value. Before this change, every code from a handwritten note was stamped with a confidence of 33. The autocoder now scores the handwriting on how legible it is. Clear handwriting scores high. Genuinely illegible handwriting scores low, and the reason appears in the rationale.
Paper charts produce fewer held claims. The low confidence holds on anesthesia codes, surgical codes and diagnosis codes no longer fire when the autocoder reads the handwriting confidently. An illegible record still scores low and still holds.
Code selection changed on records that mix typed and handwritten notes. A legible handwritten code now competes on equal footing when the primary code is selected. A code that scores below 30 drops out of that selection.
What to look out for: expect fewer review queue items on paper charts. If your team used the confidence value of 33 as a marker for "this is a paper chart", that marker no longer exists. Use the handwritten alerts on the claim instead. They state that a handwritten note is the source.
Aetna no longer turns surveillance into diagnostic. Aetna treats surveillance as screening, per the commercial payer guidance dated 2025-12-02. Aetna is removed from the surveillance to diagnostic list, and from the 00811 with PT group.
One payer label is corrected. The row that read BCBS DE, NY, PA and WV now reads Highmark in any state, plus BCBS DE and BCBS WV. The old label mixed Highmark plans with BCBS Pennsylvania plans that are not Highmark. BCBS Independence (Pennsylvania) now has its own rows: 00811 with PT for a lower endoscopy, and 00813 with Z12.11 first for a combined upper and lower endoscopy.
Five payers move to a different group. BCBS Michigan and Priority Health (Michigan) move to the 00811 with PT group. BCBS Arkansas, Anthem Connecticut and BCBS Illinois move to the 00812 with PT group.
The surveillance rule for Cigna, UHC and BCBS Nebraska now applies. An ordering defect meant that this rule never took effect. A surveillance case for these three payers now becomes diagnostic and produces 00811 without PT.
What to look out for: the code and the modifier can differ for the payers named above. Accuracy improves for each of those payers on a screening colonoscopy that converts to diagnostic.
A claim that finishes with no primary anesthesia line is held. The hold fires when an anesthesia claim has no anesthesia line that carries a code. It catches a line that was produced and then removed later, and it catches a case where no code was ever found. A labor epidural (01967) counts as a valid anesthesia line and does not cause the hold.
A claim whose first ranked diagnosis cannot be traced is held. The autocoder must trace the first ranked diagnosis to a stated reason for the procedure. It looks at the anesthesia record after the case, then the record during the case, then the pre-anesthesia evaluation, then the surgeon operative report. The alert names the document that it used.
Modifiers are placed in the order that you configure. Your organization sets the order for surgical modifiers and for anesthesia modifiers. A modifier that is not in your list goes after the listed ones, in alphabetical order.
Two more holds started to fire on 2026-07-01. Those two rules never fired before. One holds a claim with no primary anesthesia code. The other holds a claim with a date of service more than one year old.
What to look out for: organizations that bill procedures only (ICU lines, emergency department blocks, blood patches, canceled cases) will see more held claims. So will organizations that take the first ranked diagnosis from a problem list. Every hold above can be turned off or softened for your organization.