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.

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.

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.