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Every release and every piece of in-flight work for Medical Auto Coding. Filter by status, kind, or tag, then read the full notes below.
Work that is planned, in progress, or merged and waiting for a production deploy. It is not released yet.
A labor epidural line (01967) bills the directed or teaching modifiers only when the record shows that an anesthesiologist was there for the epidural. The autocoder compares the time of the 01967 line with the documented time of each anesthesiologist on the case. This applies when a CRNA, an anesthesiologist assistant (AA), or a resident placed the epidural.
For example: a CRNA places a labor epidural early in the morning, and the anesthesiologist's documented time starts at the cesarean delivery hours later. The 01967 line bills QZ, and the coder confirms whether the anesthesiologist directed the placement.
ob_labor_epidural_direction_unverified). Reviewer: a coder. Type: Compliance, severity 8. It names the placer, the epidural time and the time of each anesthesiologist on the case, and asks whether an anesthesiologist medically directed the placement. In HANK Claim Maker, this Compliance alert pulls a coder by default. It is the one alert for the line: the CRNA-alone audit alert does not appear beside it.hardstop CRNA-alone setting), the CRNA line bills no payment modifier while the question is open. The question then follows that setting: it is a Hardstop, severity 10, for your charge entry team.In a sample of 2,336 recent fully automated anesthesia cases, 1.4% had a 01967 line, so this question can apply to at most 1.4% of such cases.
When no anesthesiologist has documented time at all, the existing missing-times alert asks instead, so the case gets one question, not two.
See Obstetric Anesthesia and the Anesthesia Alert Reference.
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:
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.
See the Anesthesia Alert Reference and Diagnosis Coding for the triggers and what to verify.
Some anesthesia claims bill one anesthesia code on two lines on purpose, one line for each provider:
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.
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.
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.
Your facility processing rules can create an alert. When a rule creates an alert and does not set an alert type, the autocoder now picks the type from what the rule does to the claim.
A rule that sets its own alert type always keeps it. The autocoder's shipped rules already set their type, so their alerts do not change.
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:
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.
A routine extreme-age add-on no longer raises an alert. Before this release, every claim that billed 99100 carried a review alert asking a coder to confirm the patient's age. The autocoder had already verified that age against the date of service. That alert is gone, and so is the alert for a 99100 the autocoder withheld. The decision is on the claim instead:
No alert when a payer class bundles the add-ons. Medicare bundles 99100, 99116, 99135, and 99140 into the base anesthesia code, and your configuration can list other payer classes that do the same. Those claims no longer carry an informational alert. The codes move to the bundled procedures, and the reason on each entry names the payer class that bundles it.
One new alert, for demographics that cannot both be right. If the patient's date of birth is later than the date of service, the claim now carries the Date of Birth Is After the Date of Service alert (HARDSTOP, severity 8), and the extreme-age add-on is withheld. Every date-anchored rule reads those two dates, so this is a demographics question, not an add-on question. The alert fires on every specialty.
A new option to review a 99140 that rests on weak evidence. The autocoder trusts a documented emergency and raises no alert for it. Your organization can now ask for a review of the weak cases only. With the Emergency Add-On 99140 Billed On Weak Documentation rule turned on (FINANCIAL, severity 5), a coder is asked when a billed 99140 cites documentation that shows neither a physical status with the E suffix nor a statement that a delay in treatment would significantly increase the threat to life or body part. The rule is off unless you ask for it. A record that reaches you only as handwriting still raises the handwritten emergency-status alert.
The 99116 and 99135 review alert reads more precisely. It now asks you to confirm the record documents deliberate total body hypothermia (99116) or deliberate controlled hypotension (99135) as an anesthetic technique. The cooling and the low blood pressure that come with cardiopulmonary bypass are not the same thing, and they do not support these codes.
Why: a review alert is a question for a human. When the autocoder has no question, it should record what it did and stay quiet. The extreme-age alert asked a coder to re-check arithmetic the autocoder had already verified against the ASA rule, on a large share of anesthesia cases. The payer-class alert reported a decision your own configuration had made.
Physical status modifiers (P1 to P6) now follow your facility setting exactly. If your facility turns physical status modifiers off, no P1 to P6 value reaches a claim line, no matter where it came from. Before this fix, a physical status value that the coding step placed on a code by itself could stay on the claim after the setting said no. When the autocoder removes such a value, it records the removal with the Physical Status Modifier Removed Per Facility Configuration alert (INFORMATIONAL, severity 2). The documented ASA status still shows on the claim when the record has one.
Two new checks protect facilities that do bill physical status. A P1 to P6 value can be on a claim when the record documents no ASA physical status. The Physical Status Modifier Without a Documented ASA Status alert (FINANCIAL, severity 5) then asks a coder to confirm the status. If the setting is off and a value still slips through, the Physical Status Modifier Present Although the Facility Disables Them alert (FINANCIAL, severity 5) reports it.
The extreme-age add-on 99100 is never reported with 00326, 00561, 00834, or 00836. These anesthesia codes already describe a patient younger than 1 year, and CPT does not allow 99100 with them. The autocoder now moves such a 99100 to the bundled procedures, with a reason that names the anesthesia code. No bypass modifier is added.
99100 is re-decided when the demographics arrive late. When the date of birth is missing at coding time and the automatic gap fill recovers it from the record, the autocoder runs the age test again. A patient who qualifies gets 99100 back on the billable lines. A patient the recovered date of birth disproves loses a 99100 that was billing: it moves to the bundled procedures with the reason. The code also stays bundled when the anesthesia code excludes it, when a facility rule withholds it, or when the payer class does not pay it. Before this fix the code stayed off the claim with no trace.
Configuration problems are now visible on the claim. A qualifying circumstance setting that cannot be read as written raises the Qualifying Circumstance Configuration Is Malformed alert (FINANCIAL, severity 5) and names the fault and the posture the autocoder applied. A processing rules setting that cannot be read raises the Processing Rules Could Not Be Read alert (HARDSTOP, severity 9). Every claim now records which facility configuration built it and which qualifying circumstance posture applied to its payer class.
Facility instructions now follow GI and OB cases. An additional coding instruction configured for the anesthesia lane now also applies when the autocoder handles the case as a GI or obstetric case. Before this fix the instruction was dropped on those cases.
What to look out for:
Teams that used the extreme-age alert as a prompt to review patient demographics will not see it any more. If you want a reviewer on every 99100, ask your Hank representative to turn the alert on for the rule that adds the code:
"processingRules": {
"special_circumstances_99100": {
"action": {
"setBillable": true,
"createHRE": true,
"hreTag": "FINANCIAL",
"hreSeverity": 4,
"hreReviewerRole": "CODER",
"hreTemplate": "99100 billed for an extreme-age patient - confirm the date of birth."
}
}
}The same shape works on the 99140 rule. Give every key: the switch turns the alert on, and the other keys set the type, the severity, the suggested reviewer, and the text the reviewer reads.
Two more points. The "enabled" switch on the physical status rule is now ignored; only its value decides. If you set the value to false and also switched the rule off, the modifiers used to appear anyway. They now stop, which lowers the base units billed on P3 and higher. If you switched the rule off but left the value true, nothing changes. And if your reports counted the informational payer-class alert to find bundled add-ons, count the bundled procedures on the claim instead.
Some billing groups prefer CPT codes only as the surgical code on anesthesia claims, and do not want HCPCS screening codes such as G0121, G0105, or G0104 to appear there. A new facility election supports this.
What it does. When enabled, the autocoder replaces those HCPCS codes with their CPT equivalents on the anesthesia claim: G0121 and G0105 become 45378, and G0104 becomes 45330. The billed anesthesia code (00811, 00812) is never affected. Each replacement is noted with a low-severity informational alert so your audit trail shows what changed.
Three settings. Keep the codes as coded (the default), replace them on every payer, or replace them only when the payer is not Medicare. Medicare Advantage counts as Medicare.
What is not affected. Surgeon claims keep the G-codes. Medicare requires G0121 or G0105 on the claim that bills a pure screening colonoscopy, so the replacement never applies there.
Ask your Hank representative to enable the election that fits your billing preference.
The alert "Incomplete operative documentation" (anes_op_notes_incomplete)
now carries the Coder reviewer role. It carried the Reconciler role
before. The alert itself is unchanged: it stays a HARDSTOP at severity 6,
and it fires in the same situations.
Why: the alert asks for a coding decision. The operative notes do not cover all procedures in the record, and the missing procedures were coded from the procedure summary. A coder confirms the codes against the record.
If your workflow sorts alerts by reviewer role, this alert moves from your reconciliation queue to your coder queue.
To keep the old routing, ask your Hank representative to set
"anes_op_notes_incomplete": "RECONCILER" in your facility configuration.
Alert routing is now configurable for every alert, so other alerts can also
move to the queue that fits your team.
Three fixes for screening colonoscopy and sigmoidoscopy coding on surgeon claims.
New alert when a Medicare screening code meets a non-Medicare payer. If a claim carries G0121, G0105, or G0104 and the payer is commercial or unknown, the claim is now flagged for review. Most commercial plans and most Medicaid plans expect the CPT code with modifier 33 instead (45378-33 for colonoscopy, 45330-33 for flexible sigmoidoscopy). Some plans do accept the G-codes, so the alert asks you to verify the payer's preventive policy rather than changing the code.
Modifier PT is no longer added to a pure screening. PT tells Medicare a screening converted to a diagnostic or therapeutic procedure. When a claim carries the base diagnostic code (45378 or 45330) with screening intent and no intervention, nothing converted, so PT no longer appears. The existing "use the G-code" alert still fires, and now also covers flexible sigmoidoscopy.
Less alert noise. The "modifier stripped" alert no longer fires when the predicted modifier matches what the payer rules put back. You will only see it when the prediction and the payer rules disagree.
These changes apply to practices with surgeon companion claims enabled.
A nerve block line, and the ultrasound guidance line that goes with it, carries only the diagnoses documented for the block itself. That is normally the post-procedural pain code. It does not carry the patient's other conditions, because the reason for the block is the reason for the block, not every condition on the chart.
Claim cleaning runs after coding and can add a diagnosis to a line. When it adds one to a block line that the line is not allowed to carry, the autocoder removes it again. That part is not new.
What is new is that you can see it. Before this change the removal happened quietly, and the system also cleared the "added by claim cleaner" note for that code, so nothing on the claim showed that a diagnosis had come and gone. Now the claim carries an informational alert, "Diagnosis Added After Claim Cleaning Was Removed From a Block Line". The alert names the codes it removed, names the diagnoses the line kept, and identifies the line.
Nothing about which diagnoses get removed has changed.
Expect this alert to be rare. Claim cleaning no longer copies the main anesthesia line's diagnoses onto the other lines, so the situation this cleanup was built for does not arise any more. That is exactly why the alert is worth having: if a diagnosis does get added to a block line today, something unusual put it there, and you should look at it rather than have it disappear without a record.
Read the removed codes in the alert. Confirm that none of them is the correct indication for the block. In almost every case the removed code is a condition that belongs on the main anesthesia line instead.
If one of the removed codes IS the correct indication for the block, add it to the block line and tell your coding lead. The same code will be removed again on the next claim of that shape, so it is worth reporting rather than fixing one claim at a time.
The alert follows your existing block-line diagnosis setting. On the shipped default, a block line keeps only the G89 pain-family codes. A facility configured to keep the documented pain-location codes as well will see the alert less often. A facility that has turned the policy off entirely will never see it, because nothing is removed.
We compared autocoder output with your coders' final claims across 26 facilities and adjudicated the differences record by record. This release ships the fixes from that review. It changes the diagnoses you will see on claims in seven areas.
Delivery outcome codes stay on the delivery claim. Outcome-of-delivery codes (Z37.0, Z37.9) and the normal-delivery code O80 now appear only on the claim for the delivery itself. A post-delivery pain round, a separate procedure after the delivery (for example a postpartum D and C), or a labor epidural visit where the patient did not deliver no longer carries them.
Checklist forms are read the way a coder reads them. A pre-printed condition on a checklist that is not circled or checked is not coded. A circled negation such as "No CV Issues" is read as the absence of the condition. A diagnosis written as suspected, possible, probable, or rule-out is coded as the documented sign or symptom, not as the condition.
A BMI value alone no longer produces an obesity code. The record must document obesity as a diagnosis before an E66 code or a Z68 BMI code appears. When the provider documents an obesity class, the class code (E66.811, E66.812, E66.813) is used instead of unspecified obesity (E66.9).
Diagnosis codes the provider typed are used. When the provider enters ICD codes in a diagnosis field for the visit (for example "Diagnosis [Codes]" or "Preoperative diagnosis"), every one of those codes is reported. A screening code in that field stays secondary on a symptom-driven exam and does not change the procedure code.
New alert: Header Diagnosis Code Removed. A diagnosis code that is a category header (for example M10.0), and not billable on its own, is removed at claim build. The alert names the removed code and its billable child codes. Read the record and add the correct child code.
Cleaner diagnosis pointers on line, block, and imaging-guidance items. Arterial line, central line, TEE, and imaging-guidance items now carry the diagnoses documented for that procedure, not every diagnosis on the encounter. The main anesthesia line still carries the full supporting set. An exact duplicate of one of these items (same code, modifiers, diagnoses, documentation, and times) is removed. The new alert "Removed duplicate ancillary line item" tells you when this happens so you can confirm whether a second procedure really occurred.
Medicaid claims no longer carry the PT modifier. The PT modifier waives the Medicare Part B deductible, which Medicaid does not have, and Medicaid plan manuals do not require it. A screening colonoscopy that converts to a diagnostic procedure on a Medicaid claim now bills without PT. Medicare, Medicare Advantage, VA Community Care, and TRICARE claims keep the PT convention.
Repeated diagnosis codes and silent truncation are fixed. The same diagnosis code no longer appears twice on one line. When a line carries more diagnoses than the configured limit (4 by default), the claim now shows an alert naming the dropped codes instead of dropping them silently.
What to look out for: diagnosis lists on block, line, TEE, and imaging-guidance items will look shorter than before. This is correct and intended. If you see the "Header Diagnosis Code Removed" alert often at your facility, tell your Hank representative which document carries the specific diagnosis so we can tune the reading of it.