Changelog

What you will see

Diagnosis pairs the classification says cannot be coded together are now resolved by the book, and you see a note instead of a question.

An Excludes1 note in the ICD-10-CM Tabular List says that two conditions are not coded together. For example, the note at K83.1 (obstruction of bile duct) excludes "obstruction of bile duct with cholelithiasis (K80.-)". The autocoder now reads these notes for the fiscal year of the date of service. It gives the diagnosis check each conflicting pair, the note, and any combination code that the classification offers. Then it verifies the result on the finished claim. This applies to anesthesia, surgery, E/M and radiology claims.

Each pair ends in one of these outcomes:

• A combination code describes both conditions. The claim bills the combination code alone. For example, K80.51 (calculus of bile duct without cholangitis or cholecystitis with obstruction) replaces K80.50 and K83.1 when the record states that the stone caused the obstruction. The autocoder confirms that the combination code is billable, belongs to the note's family, is offered for the note, is not less specific, and does not start a new conflict. When the code is not billable, is outside the note's family, or starts a new conflict, the two original diagnoses come back and a coder gets one question. When the code only fails the offered or specificity check, the code stays and a coder gets one question.
• The record supports only one diagnosis. The claim keeps that diagnosis.
• The record states that the two conditions are not related. The claim keeps both diagnoses. An Informational note quotes the documented cause and records the payer edit risk.
• The record does not settle the pair. A coder gets one question.

Alert changes

• Excludes1 Diagnosis Pair Resolved (new). Reviewer: a coder. Type: Informational, severity 3. It records how the pair was resolved. In HANK Claim Maker, this Informational alert does not stop the case.
• Excludes1 Diagnosis Pair Needs Review (new). Reviewer: a coder. Type: Compliance, severity 7. It names both diagnoses, the note, what the autocoder kept and removed, and any combination code that the classification offers. In HANK Claim Maker, this Compliance alert pulls a coder by default.
• ClaimCleaner Question: Diagnosis Convention Conflict. When the autocoder answers an Excludes1 pair, this alert no longer appears for the same pair. You get one question per pair at most.
• Diagnosis Order Changed for a Code First Note (new). Reviewer: a coder. Type: Informational, severity 3. When a line carries a manifestation code and the etiology that its "code first" note names, the autocoder puts the etiology first. For example, D57.1 (sickle-cell disease without crisis) now comes before M90.551 (osteonecrosis in diseases classified elsewhere). On an anesthesia line with a diagnosis limit, the etiology now stays on the line. Only the order changes. In HANK Claim Maker, this Informational alert does not stop the case. This applies to anesthesia, surgery and E/M claims, and to radiology claims when your organization turns on the radiology first-listed diagnosis check.
• ClaimCleaner ICD Edit Applied (radiology). This alert no longer fires for an Excludes1 pair. The autocoder resolves the pair from the report, as described above. The alert still fires when validation removes a header code that is not billable.
• Validator Added a New ICD (radiology). This alert no longer fires for a combination code that the classification offers for a pair on the claim, when the finished claim passes the checks above.

Automated validation checks the finished anesthesia claim

Automated claim validation (ClaimCleaner) now runs two times on an anesthesia claim. The second run checks the finished claim, after the diagnosis check and the Excludes1 resolution. So a combination code that the autocoder applies is checked before the claim reaches you. ClaimCleaner questions come from the second run only, so a question never names a diagnosis that has already left the claim. If the first run fails, the claim carries one failure alert, not two.

Obstetric anesthesia

• The payment modifier on a labor epidural line (01967) now follows the provider who placed the epidural and your medical direction settings, the same as on every other anesthesia line. For example, with the shipped settings, an anesthesiologist who places the epidural alone bills AA. Before, 01967 received a payment modifier only when a CRNA worked alone.
• Modifier 76 no longer appears on 01967 or on the add-on codes 01968 and 01969. Validation added 76 to 01968 because both obstetric lines carry the same delivery procedure. The autocoder now removes that 76, and the Modifier Added To An Anesthesia Code alert for it no longer appears. The claim records the removal.
• When a cesarean delivery follows a labor epidural, the autocoder bills the 01968 add-on with the 01967 line.
• When a cesarean hysterectomy follows a labor epidural, the autocoder now bills the 01969 add-on with the 01967 line. The 01969 line carries the time of the cesarean hysterectomy, and 01967 keeps the labor time.

Other refinements

• Records with no date of service. When no date of service is found, the autocoder checks code validity against the current code year and labels that year as an assumption. The claim records the assumed year and the reason. Radiology coding now uses the claim's date of service when the report itself has no date.
• Lines that validation adds. When validation adds a line to the claim, the autocoder does not use that line and records the count on the claim. The ClaimCleaner Processing Failed alert no longer appears for it.
• Corrected diagnoses on every line. When the diagnosis check corrects a code that several lines share, every line now gets the corrected code.

Configuration note

• Processing-rule alerts. A facility processing rule that creates an alert with no alert type now creates an Informational alert, and nobody is pulled. The exception is the three rule types that remove billed time or a billed line (a procedure with no times, a nerve block that bills as anesthesia time, and discontinuous times): there the alert is Financial and asks a coder. A rule with no reviewer role now routes its alert to a coder, and a configured role always applies. If one of your rules must stop the case, give it the type Hardstop, Compliance or Financial. The autocoder's own shipped rules already set their type.
• Excludes1 posture. Your organization can ask for a coder question on every Excludes1 pair that the claim still bills, or turn the Excludes1 resolution off. Ask your Hank representative.

What to look out for

• On anesthesia, surgery and E/M claims, expect fewer diagnosis questions and more Informational notes. Read Excludes1 Diagnosis Pair Resolved when you audit why a combination code is on the claim or why a diagnosis left it.
• On radiology claims, each Excludes1 pair now ends in an Informational note or in one question. When the report settles the pair, you see Excludes1 Diagnosis Pair Resolved. When the report does not settle it, a coder gets one question. The autocoder no longer removes a diagnosis from an Excludes1 pair without a note, so you can see a small number of new questions on radiology claims.
• A question stays when the record does not settle a pair. Read the record, then bill the combination code, remove one diagnosis, or keep both only when the record states that the conditions are not related.
• For dates of service on or after October 1, 2026, the Excludes1 resolution starts when the fiscal year 2027 notes are loaded. Until then, the ClaimCleaner Question: Diagnosis Convention Conflict alert asks about those pairs.

See the Anesthesia Alert Reference and Diagnosis Coding for the triggers and what to verify.

What you will see

Some anesthesia claims bill one anesthesia code on two lines on purpose, one line for each provider:

• Supervised cases. The anesthesiologist line carries AD, and the anesthetist line carries QX.
• One-to-one directed cases. The anesthesiologist line carries QY, and the anesthetist line carries QX.
• Relief cases. Each anesthesiologist who took over the case gets a line with AA for the time that anesthesiologist covered.

Automated claim validation (ClaimCleaner) can read these two lines as a duplicate. The second validation check on an anesthesia claim now keeps both lines. Every provider line stays billed, and the claim records the removal that the autocoder did not apply. The kept line also receives the diagnosis and modifier corrections that validation made on the other line of the same anesthesia code. The payment modifiers stay as they are, because the two lines differ there on purpose.

For example: an anesthesiologist supervises five concurrent rooms, and a CRNA gives the anesthetic in one of them. The CRNA line with QX stays on the claim beside the anesthesiologist line with AD.

Alert changes

• ClaimCleaner Returned the Line With No Codes (Informational, severity 3). This alert does not appear for a provider line that the autocoder keeps. It still appears for each line when validation removes every line of the anesthesia code. In HANK Claim Maker, this Informational alert does not stop the case.

What to look out for

• On supervised, one-to-one directed and relief claims, expect both provider lines on the finished claim.
• A true duplicate line is still removed as before. When validation removes every line of an anesthesia code, for example because a different crosswalk code with more base units replaces it, the autocoder applies the removal to each line.
• The two provider lines of one anesthesia code carry the same diagnoses after validation.

What you will see

Automated claim validation (ClaimCleaner) checks an anesthesia claim two times. The second check runs on the finished claim, after the claim-wide diagnosis check. The second check now keeps every diagnosis that the diagnosis check decided from the record.

• A diagnosis the diagnosis check decided. When the second check proposes to add, remove, or swap that diagnosis, the autocoder does not apply the change. The claim records the proposed change and the rule that proposed it.
• Every other diagnosis. The second check works as before. For example, it still removes a code that the autocoder added and that is not valid for the date of service.
• A claim that did not change. When the claim did not change after the first check, the autocoder does not send it again. The findings of the first check apply.

For example: the record documents a left knee replacement, and the diagnosis check keeps Z96.652 (presence of left artificial knee joint). The second check no longer swaps that code for the right side.

Alert changes

• ClaimCleaner Added ICD Code (Compliance, severity 8, reviewer: a coder). This alert no longer appears for a change that the autocoder did not apply on the second check. The alert still appears when validation adds a diagnosis that the diagnosis check did not decide. In HANK Claim Maker, this Compliance alert pulls a coder by default.
• ClaimCleaner Question alerts. When the rule of that finding is on the autocoder's review list, for example a side modifier that disagrees with the diagnosis, or a code that validation reads as not valid for the date of service, the question still appears, because two checks disagree about the claim. The question states what the diagnosis check decided, the codes and modifiers on the line, and the change that validation proposed. A finding on any other rule stays recorded on the claim and does not raise a question.

What to look out for

• Expect fewer diagnosis changes from the second validation check on anesthesia claims.
• A diagnosis that the record supports stays on the claim through both validation checks.
• When a question names the decision of the diagnosis check and a proposal from validation, read the record and keep the diagnosis that it supports.

Every finished claim runs through automated claim validation before it reaches you. Validation checks NCCI procedure pairs, add-on code rules, Medicare payment rules, coverage articles, code validity for the date of service, and diagnosis conventions. This release changes what you see from it in two ways.

Validation alerts now name the rule. Before this release, an alert read "Modifier 59 added by ClaimCleaner" and stopped there. You could see the change but not the rule behind it, so confirming the change meant looking the rule up yourself. Each of these alerts now ends with the rule, in the form "Reason: [the rule's own explanation] [the rule id]". Read that sentence first. It names the payment rule or coding convention that produced the change. The alerts themselves are unchanged: same names, same types, same severities.

The alerts that gained the reason are Anesthesia Code Changed, Diagnosis Added, Modifier Added To An Anesthesia Code, Modifier Added To A Surgical Code, Line Left With No Code, and Line Removed By Validation.

Ten new alerts carry the questions validation could not answer. Validation also reports problems it will not correct on its own, because the answer needs the record, not a rule. Until now none of those reports reached a coder. Ten new alerts carry the ones worth your time:

• Diagnosis Convention Conflict: two diagnoses on the finished claim break an ICD-10-CM Excludes1 note. When the claim-wide diagnosis check could not decide between the two, the alert names the diagnosis it kept and the diagnosis it removed. Findings on other diagnosis conventions are recorded on the claim and raise no alert.
• Add-On Code Without Its Primary: the claim bills a CMS type-1 add-on and carries none of the primary codes CMS requires with it.
• Age Or Sex Conflicts With The Code: the patient age or sex conflicts with a billed diagnosis or procedure.
• Side Modifier Disagrees With The Diagnosis: the modifier names one side and the diagnosis names the other, or no diagnosis supports the side billed.
• Evaluation And Management Modifier Against A Global Period: modifier 25, 57 or 24 does not fit the procedure's global period.
• NCCI Procedure Pair: two codes form a procedure-to-procedure pair and the autocoder did not apply the bypass.
• Coverage Article Disagrees With The Diagnosis: a Medicare coverage article covers none of the billed diagnoses, or states one does not support medical necessity.
• Code Not Valid For The Date Of Service: validation and the autocoder disagree on whether a billed code is valid for that year.
• Anesthesia Code Suggested But Not Billed: validation suggests an anesthesia code the claim does not carry.
• Units Over The Medically Unlikely Edit: the units billed for a code exceed its NCCI Medically Unlikely Edit (MUE). The autocoder never changes units. When validation would reduce units above an absolute limit, the line still bills the original units and this alert asks you to confirm the units the record supports.

Each alert reads "ClaimCleaner:" then the rule's explanation and its rule id. The type and the severity come from the rule. Every rule in this set classifies as Compliance today. The alert carries the rule's own classification, so a future validation rule could arrive as Financial. One exception: the units alert for a single line over an absolute limit is Compliance, severity 5, set by the autocoder, because validation marks that finding Informational after reducing the units in its own copy of the claim.

What to look out for. Expect a small number of new alerts, not a flood. An alert appears only when five conditions are true.

The rule is on the autocoder's review list. The rule's own classification is not Informational. Validation did not fix the problem itself. The line is still billable on the finished claim. The diagnosis problem that the finding names is still on the finished claim.

For an Excludes1 pair, the alert stays while the diagnosis that carries the Excludes1 note, or another code under the same note, is still billed together with a diagnosis from the note's family. When the autocoder cannot read the note from the finding, it checks the two named diagnoses instead.

The autocoder removes an alert again when it later moves the line out of billing, or when the diagnosis problem that the finding names is no longer on the finished claim. If the claim-wide diagnosis check replaces the diagnosis that carries the note with another code under the same note, or replaces the other diagnosis with another code from the note's family, the alert stays, because the conflict is still on the claim. The alert then also names the pair that the claim bills now. When the diagnosis check leaves two findings on the same pair of billed diagnoses, or two conflicts land on one line, you get one alert that names each pair. Conflicts on different lines raise one alert each. For the other diagnosis findings, and for an Excludes1 finding whose note the autocoder cannot read, a replacement or removal of a named diagnosis removes the alert. A finding about a diagnosis that is missing, for example no diagnosis for the side billed or no diagnosis that a coverage article covers, stays, because the autocoder cannot tell whether a diagnosis added later qualifies.

Start with the rule text in the alert, then check the record for the fact the rule needs: the side of service, the patient demographics, the covered diagnosis, the distinct service, or the units of service.

If a family of these questions does not fit your workflow, your organization can silence it or route it to a different reviewer role. Ask your Hank representative. A silenced alert still appears as an informational note.

See the Anesthesia Alert Reference for the full list, the trigger for each alert, and what to verify.