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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.
| Status | Kind | What changed | Version | Ticket |
|---|---|---|---|---|
| Fix merged | Fix | Screening colonoscopy codes checked against the payer on surgeon claims | No version | No ticket |
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.