Fix
Medicare claims no longer bill the anesthesia qualifying circumstance codes
Work processed after carries this change.
GuidesDevelopersChangelog
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 | Date |
|---|---|---|---|---|---|
| Released | Fix | Medicare claims no longer bill the anesthesia qualifying circumstance codes | No version | No ticket |
Work processed after carries this change.
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.