Fix
Automated claim validation keeps the side of service that the record documents
Work processed after carries this change.
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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.
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.
Radiology coding gains a set of denial-safety checks. Your account team turns each one on for you; nothing changes until they do.
No more empty claims. Three separate causes let a claim leave with no diagnosis or no line item: a trauma study with a negative report, a screening tomosynthesis add-on coded without its base mammogram, and a diagnosis the coder named correctly but at a category level that cannot be billed. Each is fixed: the trauma encounter code is applied, the base mammogram line is added, and a category code is resolved to its billable child that matches the report.
Procedure codes that do not exist are repaired before diagnoses are chosen. When the selected procedure code is not in the code set for the date of service, the autocoder tries, in order, your configured successor code, the exam code printed in the report header, and a pick among the code's own family by description. Every repair is recorded as a review alert. A code that cannot be repaired stops the claim for a coder instead of denying at the payer.
The exam code printed in the report is read and checked. When a report prints its exam code and no line on the claim carries it, the claim is flagged; you can choose to have single-line claims adopt the printed code.
Sides are protected. When the report names a side, the autocoder no longer lets a more frequently billed "bilateral" or opposite-side code replace it.
Screening studies lead with the screening diagnosis. A study the report classifies as a screening (for example a coronary calcium score for risk stratification) is coded with your screening diagnosis first and any incidental finding second, as the ICD-10-CM guidelines require.
An audit verdict on every claim (optional). Each finished claim can carry a denial-safety verdict: a pass or fail checklist of fifteen ICD-10-CM rules, flags for diagnoses the report does not state in words, a confidence score, a denial-risk level, and a two-to-four sentence explanation written for your coders. The Excludes1 and "code first" rules of the checklist read the ICD-10-CM notes for the fiscal year of the date of service. When those notes are not available, the verdict lists the two rules as not checkable. If your organization receives the claim data through the coding API, the verdict is in the claim metadata field radiologyAudit.
What to look out for: three new review alerts.
A review of the whole radiology coding path found a number of rules that were removing correct codes or adding incorrect modifiers. They are corrected.
Findings from the imaged area are no longer discarded. A safety check drops diagnoses that do not belong to the body part a study covers. Its list of body parts was incomplete, so it discarded findings it should have kept: cardiomegaly on a chest study, an abdominal aortic aneurysm or a kidney tumor on an abdominal CT, sciatica on a lumbar spine study, a calcaneal spur on a foot film, and a shoulder fracture on a trauma CT of the chest. It also let a few codes for other body parts through, such as bursitis of the hand on a shoulder study. Both directions are fixed.
Two codes that differ by level or type are no longer treated as left and right. One check read the last digit of a code as the side of the body and removed one of two codes it believed contradicted each other. For many code families that digit means something else, so it removed, for example, the second disc level of a two-level cervical disc disorder. It now uses the official code title and only removes a genuine opposite-side duplicate.
Professional and technical component modifiers follow the fee schedule. Modifier 26 was applied to every diagnostic radiology code on professional claims. A small group of codes, such as trabecular bone score (77089), has no professional or technical split, and the modifier would cause a denial. It is no longer added to those codes, and it is removed where another step added it.
Other corrections. A report header that prints a code deleted in a previous year is no longer adopted over a valid code. A both-knees standing study is no longer split into a right and a left line. PET studies receive the PI or PS modifier only when there is an oncologic reason for the study. A mammography mass is coded to "other abnormal findings" rather than to a calcification code. Observation codes are removed when a related symptom is coded. A fracture code missing its seventh character receives it instead of being dropped.
What you will see. Most claims are unchanged. On 600 randomly drawn studies, 45 claims changed codes, usually by keeping one additional documented finding. Each changed claim was reviewed against its report: the new coding was better on 27, equivalent on 6, and worse on 3. On the remaining 9 both versions had an error the change did not touch, and the new version was closer on most of them. The 3 that got worse exposed a separate issue in how the leading diagnosis is chosen, and that issue remains open.
Two corrections to how diagnoses are chosen on radiology claims. Your account team turns the first one on for you; the second applies wherever it is relevant.
The claim keeps the finding the study was done to answer. Several checks run after a diagnosis is chosen, and each of them can remove a code: one re-examines whether the report supports it, another restores a known condition the referring physician named. In rare combinations these ran in sequence and removed every code for the thing the radiologist actually reported, leaving a claim that described only incidental findings. On a surveillance scan ordered to look for recurrent disease, the enlarged lymph nodes the radiologist called out disappeared and a hiatal hernia was left as the first diagnosis.
The autocoder now checks, at the end, that at least one diagnosis on the claim comes from the impression finding that answers the reason for the exam. If none does, that finding is added back. It is added as a secondary diagnosis and does not displace the diagnosis your coders would expect to lead, except when the leading code is a purely incidental finding, in which case the reason for the exam takes its place. Only findings the extraction was confident about are added back, so hedged observations are not turned into diagnoses.
A cancer of an organ that has been removed is no longer billed as current. When a report documents that an organ was surgically removed and the patient's history names a cancer of that organ, the correct code is the personal-history code, not a current malignancy. The autocoder makes that substitution only when the record proves the whole site is gone: both breasts, both ovaries, a hysterectomy, or a mastectomy on the same side as the coded cancer.
Everywhere else it deliberately does not decide for you. A partial resection of lung, stomach or bowel, or an absence code that does not say which side, leaves the current cancer code exactly as it was and raises a review alert explaining the choice: if the tumour site is gone and no treatment is directed to it, use the personal-history code named in the alert; if the cancer is in the tissue that remains, the current code is already right. A cancer in the organ the patient still has is not flagged at all.
Two diagnosis tables were corrected against the official code set. A sweep of every diagnosis and procedure code written into the autocoder found a mapping that turned one hip condition into another. When a hip study is bilateral and the radiologist documented arthritis of only one side, the autocoder upgrades the diagnosis to its bilateral form. For hips it was upgrading to the wrong form: arthritis caused by hip dysplasia became post-traumatic arthritis, and post-traumatic arthritis became "other secondary". Both now map to the correct bilateral code, so the claim no longer asserts an injury the report does not describe. A second table, the one that decides which diagnoses belong to which body region, carried entries for codes that do not exist and three codes that mean "site unspecified" but were listed as if they named a joint. Both are corrected, and a new automated check refuses any code written into the autocoder that does not exist in the code set.
What you will see. On affected claims, one additional diagnosis that was previously dropped, and a new review alert where a current cancer sits beside evidence that the organ was removed. On a sample of 300 randomly drawn studies, 18 claims changed; procedure codes were unaffected.
Modifiers 59, XE, XS, XP, and XU exist for one purpose: to bypass a Medicare NCCI edit between two codes on the same claim. When no edit exists, the codes pay separately on their own and the modifier is unnecessary. Payers flag unnecessary distinct-service modifiers in audits.
Before this change, the autocoder sometimes placed one of these modifiers on a code pair that has no NCCI edit. Example: a diagnostic cervicocerebral angiogram that bills carotid angiography (36224) and vertebral angiography (36226) together. Medicare holds no edit between those codes, so no modifier is needed, but an XS could still appear on the vertebral line.
Now the autocoder checks the licensed NCCI edit table at claim build. If a line carries 59 or an X modifier and no edit pairs its code with any other code on the claim, the modifier is removed. The claim carries an informational note, "Distinct-Service Modifier Removed (No NCCI Edit)", as an audit trail. No action is needed.
The check is careful in three ways. A modifier on a real edit pair is never touched. A modifier on a repeated code (the same code on two lines) is never touched, because it can mark a separate encounter. And when the NCCI data is not available in a deployment, nothing is removed.
A related alert also improved. The "may need distinctness modifier" review alert used to appear on every claim with two or more procedures. It now appears only when a real NCCI edit pairs the codes, so it no longer asks your team to add a modifier the claim does not need.
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.
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 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 autocoder applies its radiology claim rules again. A configuration defect switched off every radiology rule, so none of the radiology alerts could appear on a claim. The rules now load and run.
Add-on codes are checked on every radiology claim. When a claim carries an add-on code and none of the primary codes CMS accepts for that add-on, the claim carries the alert "IR Add-On Code Without CMS-Acceptable Primary". The alert names the acceptable primary codes. The check reads the CMS add-on code edit data. It stays silent when CMS defines no primary list for the add-on. This check runs on diagnostic radiology claims as well as interventional radiology claims.
The radiology bundling and documentation alerts can appear on any radiology claim whose codes match the rule, not only on interventional work. The July interventional radiology update lists those alerts by name.
What to look out for: expect these alerts on ordinary diagnostic radiology claims that never raised them before. The checks were not running at all, so a claim that passed clean last month can raise an alert this month. Your organization can ask your Hank representative to retune or switch off an individual radiology rule.
Radiology claims apply the component modifiers your configuration asks for. The rules that decide the professional component (modifier 26) and the technical component (modifier TC) read the billing component set for your organization. That setting stopped reaching the coding step, so the rules had nothing to act on, so no radiology claim received a component modifier from them. The setting is live again, and radiology coding follows it.
While the setting was not reaching the coding step, radiology claims were coded as if no component preference existed. Claims coded in that window may therefore be missing the modifier your configuration calls for. Check them before you submit them.
What to look out for: a radiology claim may now carry a 26 or a TC modifier where recent claims carried none. Check that the billing component configured for your organization matches how you bill: professional, technical, global, or split. Ask your Hank representative if the setting needs to change.