Changelog

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.