Fix
Radiology claim rules now run on every radiology claim
Work processed after carries this change.
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| Status | Kind | What changed | Version | Ticket | Date |
|---|---|---|---|---|---|
| Released | Fix | Radiology claim rules now run on every radiology claim | No version | No ticket | |
| Released | Fix | Monitored anesthesia care modifiers are now enforced on every anesthesia line | No version | No ticket |
Work processed after carries this change.
Work processed after carries this change.
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.
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.