Fix
Automated claim validation keeps the side of service that the record documents
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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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Work processed after carries this change.
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Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
Work processed after carries this change.
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.
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.
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.
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.
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.
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.
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 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 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.
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.
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.
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.
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.