Changelog

What you will see

Medicare Advantage and managed Medicaid plans follow the Medicare colonoscopy rules. The autocoder used to pick the payer rules from the plan name alone. A plan whose name carries no Medicare or Medicaid marker, for example Humana Gold Plus, Keystone 65, Devoted Health, or AmeriHealth Caritas, could get the commercial rules of the company that administers the plan. The autocoder now also reads the insurance type recorded on the case. These plans get the Medicare or Medicaid row. A recent audit found such plans on about 2 percent of cases.

A surveillance colonoscopy is billed as a screening for every payer except three. Cigna, UHC, and BCBS Nebraska treat surveillance as diagnostic. That list is complete. Every other payer treats a personal history of colon polyps as a high-risk screening. This includes Medicare, Medicaid, VA, and Tricare. In testing, the autocoder could apply a Medicare surveillance exception that does not exist and produce 00811. The same record now produces 00812.

The discontinuous time alert no longer fires on a labor epidural with a cesarean delivery. The autocoder now groups the anesthesia time segments by anesthesia code before it counts them. A labor epidural line and a cesarean delivery line are two services, not a break in one anesthetic. A provider handover also does not count as a break when the two segments touch, for example one segment that ends at 07:00 and the next that starts at 07:01. A true gap inside one anesthesia code still raises the alert.

What to look out for

• The claim itself does not change. The total minutes and the combined time range stay the same. Only the alert changes.
• Obstetric claims show fewer FINANCIAL alerts at severity 4. Before this change, this alert was often the only reason a coder had to open a labor epidural claim.
• The gap that counts as a break is 5 minutes by default. Your facility can change this value. Tell your Hank representative if you want a different value.
• On a GI case, read the rationale first. It names the payer bucket and the intent that the autocoder used, so you can check the result fast.
• If a Medicare Advantage or a managed Medicaid case still gets commercial colonoscopy rules, check the insurance type recorded on the case, then tell your Hank representative.

Staff and surgeon details that your schedulers enter on the OR schedule now survive to the finished claim. This applies to anesthesia cases where the schedule is passed to the autocoder with the case.

Verified schedule identity wins over the notes. The provider name, NPI, role, and title from the schedule are treated as verified. They replace the same details read out of the notes. A provider who appears only on the schedule is added to the claim.

Times from the notes still win. Anesthesia times read from the record continue to decide the billed time. Schedule times fill in only when the record gives none.

Schedule coverage is the last resort for times. When the record has no anesthesia case times and no procedure summary time pair, the billable times can be derived from the schedule staff coverage. The claim then carries the informational alert "Anesthesia Times Derived From OR Schedule", so a reviewer can see where the times came from.

What to look out for: a role or title left blank on the schedule now stays blank on the claim. The autocoder no longer guesses it, because a wrong role changes medical direction and modifier decisions. Incomplete schedule entries therefore show up as blanks. Ask your schedulers to complete the role and title fields on every entry.

This release changes three things on anesthesia claims that include a peripheral nerve block. Our coding experts directed each change. No action is required on your side.

More blocks qualify for ultrasound guidance (76942). The autocoder now adds 76942 to the following block codes when the record documents ultrasound guidance and image storage: 64400, 64405, 64408, 64418, 64420, 64421, 64425, 64430, 64435, 64449, 64450, 64505, 64510, 64517, 64520, 64530, and 64999. New to the list are 64408 (vagus), 64421 (additional intercostal), 64430 (pudendal), 64435 (paracervical), 64505 (sphenopalatine), 64510 (stellate ganglion), 64517 (superior hypogastric), 64520 (lumbar or thoracic paravertebral sympathetic), and 64530 (celiac plexus). Code 64418 (suprascapular) stays on the list: an earlier version of this entry said it was removed, but our experts confirmed on 2026-08-15 that CPT does not bundle imaging into 64418, so 76942 stays billable with it when ultrasound and image storage are documented.

Add-on block lines no longer carry modifier 59 or the X modifiers. When a block is billed as a primary code plus an add-on code (for example, 64461 with 64462), the add-on line is already distinct by definition. The autocoder no longer places 59, XE, XS, XP, or XU on add-on lines. Primary lines are not affected.

The 76942 line now carries the same diagnoses as its nerve block. The ultrasound guidance line used to copy diagnoses from elsewhere on the claim. It now shows the diagnoses on the block line it supports, such as G89.18 (other acute postprocedural pain), and nothing else.

What to look out for: on claims with a suprascapular, pudendal, paracervical, stellate, celiac, hypogastric, or paravertebral sympathetic block, expect a 76942 line when ultrasound and image storage are documented. On claims with add-on block codes, expect the add-on line without 59 or an X modifier.

This release changes what you will see on anesthesia claims in four areas.

TEE codes now come from one family. A transesophageal echo (TEE) claim carries one TEE code from a single code family. Illegal pairs such as 93312 with 93317 no longer occur. Congenital codes (93315-93317) appear only when the record documents evaluation of a congenital anomaly. Monitoring-only TEE produces no separate TEE code, because NCCI bundles it into the anesthesia service.

Nerve block lines keep only their own pain diagnosis. A separately billed nerve block line now carries the block's own pain code (a G89 code, for example G89.18) instead of every diagnosis on the encounter. This is the new default. If your organization prefers the old behavior, or wants the site pain code included as well, ask your Hank representative about the nerveBlockLineIcds setting. A block line that ends up with no diagnosis is held for review, not billed.

What to look out for: block-line diagnoses will look shorter than before. This is correct and intended.

Paravertebral block add-on units are corrected. A multi-level paravertebral block now bills 64461 plus one unit of 64462, not one 64462 per extra level. Medicare denied the extra units in all cases. Continuous catheter blocks bill 64463. The 64484 add-on is unchanged.

Screening colonoscopy claims (combined GI). The PT modifier on combined GI endoscopy code 00813 is now decided by payer at claim build. Medicare recognizes PT on anesthesia code 00811 only, so 00813 goes to Medicare and Medicare Advantage without PT. PT stays on 00813 only for the short list of commercial payers whose policy requires it (BCBS Independence PA and Moda Health), and never when the payer name carries a Medicare or Medicaid marker. Every other payer, and an unknown payer, gets 00813 without PT. An informational note records each keep or strip. PT on any anesthesia code other than 00811, 00812, or 00813 is removed. (Correction 2026-08-15: an earlier version of this entry described the Medicare rule backwards.)

Fewer cases held for missing times. The autocoder now always asks for staff and case times during extraction. Cases that were held with a "no anesthesia times" alert, even though the times were in the record, now code normally.

This release closes 14 findings from a full review of the anesthesia coding stack. Several of them change what your coders will see.

Every OB case is held for review. A claim whose primary anesthesia code is obstetric (01958-01969) now carries the "OB case review" hold. This rule existed in configuration before but never fired because of a defect. If your organization does not want every OB case held, the rule can be turned off or downgraded per facility.

OB add-on codes require their primary. A claim that bills 01968 or 01969 without the 01967 labor analgesia primary is held. An add-on billed alone is a guaranteed payer rejection.

Supervision cases bill both providers. When medical direction drops to supervision (more than 4 concurrent cases), the claim now bills the physician line with modifier AD and the CRNA line with modifier QX. The CRNA line used to disappear, which underbilled the case.

Deliberate hypothermia and controlled hypotension are billed again. Codes 99116 and 99135 were blocked entirely. They now bill when the record documents the technique, and every such line carries a review flag so a coder confirms the documentation and the payer.

Post-op pain epidurals follow the NCCI rule. An epidural placed for post-op pain bills separately (with modifier 59) only when the case was done under general anesthesia. Under spinal or other anesthesia it is bundled, with the NCCI reason recorded on the claim. Placement in the OR no longer causes a silent drop.

Two new safety holds.

• If the extracted anesthesia provider is the operating surgeon, the claim is held. Medicare does not pay the operating physician for anesthesia.
• If a surgical procedure has no anesthesia crosswalk (an unlisted code, for example) and may outweigh the crosswalked procedures, the claim is flagged so a coder verifies the anesthesia code and its base units.

TEFRA settings are honored. A TEFRA attestation requirement your organization turned off is now truly excluded from evaluation. Sites with disabled requirements may see fewer "TEFRA requirements unmet" holds.

What to look out for: more held OB claims (by design), two-line supervision billing, occasional 99116/99135 lines with review flags, and the two new hold reasons in your review queues.

Code 29826 can no longer stand alone as the surgical code on a claim. 29826 is arthroscopic subacromial decompression, an add-on code. An add-on code reports work that is done with a base procedure, so it cannot be the only surgical code on a claim. The autocoder now holds a claim whose only surgical code is 29826. Codes 99100 and 99140 were already held this way, and 29826 joins them.

What to look out for: a shoulder arthroscopy case documented only as the decompression will hold until a coder supplies the base procedure. The base procedure is usually stated in the operative report. Find it, add it, and reprocess the case. If the record documents no base procedure, ask the surgeon for the missing detail before you bill the case.

Our coding experts reviewed the autocoder and directed the rules below. No action is required on your side.

Spine anesthesia 00670 follows the overall extent of the operation. The autocoder selects 00670 when the operation uses instrumentation, or covers three or more vertebral bodies, or covers two or more disc levels. The levels do not need to be next to each other.

Abdominal cases route by the operative field. The autocoder selects between upper abdomen 00790 and lower abdomen 00840 from the field the record documents, not from the name of the procedure alone. A colon case routes to 00790 unless the work is only on the sigmoid or the rectum. An exploratory laparotomy (49000) routes to 00790.

Three diagnosis rules changed. A symptom code or a site pain code is dropped when it is part of a documented condition. A personal history code is dropped when the autocoder codes the current condition. A status code never ranks first on the claim.

What to look out for: spine and abdominal code selection will look different on affected cases. Diagnosis lists will be shorter and ordered differently. Both changes follow the expert review.

O80 is coded only when a delivery happened during this stay. O80 reports an encounter for a full term uncomplicated delivery. A labor only case that carried O80 could be billed as a delivery again when the patient came back. The autocoder now requires a documented delivery in this stay. It also requires an outcome of delivery code (Z37) as a secondary diagnosis. It blocks O80 whenever any pregnancy complication is coded.

External cause codes are suppressed on anesthesia claims. Codes from the V, W, X and Y chapters no longer appear on these claims.

A condition documented as a past event is coded as history. A prior heart attack or a prior stroke gets a history code, not a code for a current condition.

An abdominal case documented above the navel routes to 00790. The autocoder selects the upper abdomen code when the record documents an incision or an exploration above the umbilicus. Anesthesia billing follows the operative field, not only the name of the procedure.

What to look out for: a labor only encounter no longer carries a delivery diagnosis. Confirm that the record states the delivery when you expect O80. An abdominal case documented above the navel carries 00790 and the base units of that code.

The anesthesia code is now selected from all of the notes. The autocoder was dropping the procedure summary whenever the pre-anesthesia evaluation was also cited. That happens on nearly every GI case, so the anesthesia code was often selected from the pre-anesthesia plan alone. The plan states what was intended, not what was done.

Anesthesia codes on GI cases can change, and that is the correction. A colonoscopy planned as screening and completed with a polypectomy is the clearest example. The plan supports 00812. The procedure report documents the polypectomy, and 00811 is correct. The autocoder now reads that report.

Code lookups now use the date of service. Code descriptions and code validity resolve from the real date of service, not from the current calendar year. A back dated claim now gets the codes of the correct year.

The notes cited on the final anesthesia code are the notes the autocoder used. The citation was previously taken from the first matching note in the record.

What to look out for: review GI anesthesia codes after this change, because the selected code can differ from what you saw before. Back dated claims should stop showing current year code descriptions.

A code billed as the anesthesia code must belong to the anesthesia code family. The autocoder now checks the anesthesia code against that family. A code outside the family raises a review alert on the claim. A code that is not a real CPT code at all holds the claim.

A code valid only in 2025 could reach a 2026 claim. The check that validates surgical coding was broken, so a retired code could pass onto a claim with a 2026 date of service. That check works again. The autocoder is also told the target code year while it selects codes.

What to look out for: expect alerts that name an anesthesia code which does not belong to the anesthesia code family. Read the record, then select the correct anesthesia code. Review any recent claim that carries a code retired at the end of 2025.

Codes from a handwritten record now carry a real confidence value. Before this change, every code from a handwritten note was stamped with a confidence of 33. The autocoder now scores the handwriting on how legible it is. Clear handwriting scores high. Genuinely illegible handwriting scores low, and the reason appears in the rationale.

Paper charts produce fewer held claims. The low confidence holds on anesthesia codes, surgical codes and diagnosis codes no longer fire when the autocoder reads the handwriting confidently. An illegible record still scores low and still holds.

Code selection changed on records that mix typed and handwritten notes. A legible handwritten code now competes on equal footing when the primary code is selected. A code that scores below 30 drops out of that selection.

What to look out for: expect fewer review queue items on paper charts. If your team used the confidence value of 33 as a marker for "this is a paper chart", that marker no longer exists. Use the handwritten alerts on the claim instead. They state that a handwritten note is the source.