Changelog

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.

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.