What you will see

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.

• The time of an anesthesiologist overlaps. The line bills the directed modifiers from your medical direction settings with that anesthesiologist, for example QK for the anesthesiologist and QX on the CRNA line. At a shift change, the night anesthesiologist who directed the epidural can be a different person from the day anesthesiologist who did the cesarean.
• The time of no anesthesiologist overlaps. The case gets one question. For a CRNA placer, the line bills your CRNA-alone setting (QZ with the shipped settings) until the direction is confirmed.
• An AA or a resident placed the epidural. An AA or a resident cannot bill without a directing or teaching anesthesiologist. So the line keeps the directed modifiers, and the coder decides.

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.

Alert changes

• Labor Epidural Direction Not Shown (new, 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.
• When your facility requires a directing anesthesiologist for every CRNA line (the 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.

What to look out for

• Read the labor note. If an anesthesiologist directed the placement, bill the directed modifiers with that anesthesiologist. If not, keep the non-directed billing for a CRNA, or correct the line for an AA or a resident.
• An anesthesiologist who places the epidural never gets this question.
• Your organization can silence this alert or change who it asks. Your CRNA-alone setting decides what a CRNA placer bills while the question is open, and who gets the question. Ask your Hank representative.

See Obstetric Anesthesia and the Anesthesia Alert Reference.

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 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:

• IR procedures (vascular access, drainage, embolization, and similar image-guided interventions) are coded automatically from the report.
• New review alerts can appear on IR claims:
  • An add-on code billed without an acceptable primary code. The alert names the primary codes CMS accepts.
  • PICC placement billed together with bundled imaging.
  • A conflict between selective and non-selective catheterization codes.
  • Ultrasound guidance billed without the required documentation.
  • Moderate sedation billed without the required documentation.
• Diagnostic radiology reports that contain out-of-range codes still receive the existing "not supported" hold.

Also fixed in this release:

• Radiology claims no longer carry code 99100 for patients under 1 or over 70. That code is an anesthesia add-on and never belonged on a radiology claim. If you see 99100 disappear from radiology claims, that is correct.

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.

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:

• E/M codes on charts that contain a qualifying visit note.
• A chart with NO qualifying visit note is refused, not guessed. The refusal carries an alert that says why.
• Review alerts when the evidence is thin: insufficient evidence for a level, a disagreement between the time-based and MDM-based level, a level that rests only on an uncorroborated time statement, or a same-day procedure that needs a modifier 25 decision. None of these are decided silently.
• Hospital stays shorter than 8 hours follow the CMS length-of-stay rules: discharge day management is suppressed when the stay provably does not qualify, with an alert.
• Medicare observation-status consultations are directed to office codes, with an alert, per Medicare policy.

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.

What you will see

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.

What to look out for

• This is on for facilities that submit paper or checkbox anesthesia forms. If your facility uses these forms and you still see charges that match empty form options, tell your Hank representative.
• Handwritten pages were already read as images. That does not change.
• Long records are limited to ten page images per coding request. The extracted text is always included, so nothing is lost when the limit applies.

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:

• Surgeon-authored documentation (operative notes, procedure reports) is coded into a separate surgical claim with the surgeon as the billing provider.
• A deterministic Medicare fee schedule engine applies the payment rules: multiple-procedure ranking, bilateral handling, assistant and co-surgeon checks, and modifier placement.
• Screening colonoscopy conversions follow the payer rules (PT or 33), and the anesthesia claim and the companion claim are cross-checked so the two never disagree on the screening story. A disagreement is held, not billed.
• Every companion line carries its evidence quote from the surgeon's own document. A line whose evidence cannot be verified in the source document is excluded and flagged.

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.

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.

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.