Work that is planned, in progress, or merged and waiting for a production deploy. It is not released yet.
Fix mergedImprovement
Excludes1 diagnosis pairs are resolved by the book on anesthesia, surgery, E/M and radiology claims, plus obstetric modifier and validation refinements
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
