Changelog

What you will see

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.

• The rule removes billed time or a billed line. The alert is Financial and asks a coder. This covers three rule types: a procedure with no times (the line moves to the bundled list), a nerve block that bills as anesthesia time instead of a flat fee, and discontinuous anesthesia times (the gap minutes leave the billed units).
• Every other rule. The alert is Informational and nobody is pulled.

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.

Alert changes

• Processing-rule alerts with no alert type. Reviewer: a coder, unless the rule names another reviewer. Type: Financial on the three rule types above, Informational on every other rule. In HANK Claim Maker, a Financial alert for a coder stops the case until a coder reviews it, and an Informational alert does not stop the case.

What to look out for

• If one of your rules on these three types must not stop the case, set its alert type to Informational.
• If a rule of another type must stop the case, set its alert type to Hardstop, Compliance or Financial.
• When your configuration loads, the autocoder logs each rule that creates an alert without a type. Ask your Hank representative to review those rules with you and to set the type you want.

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:

• A billed 99100 line states the age in its rationale. The rationale opens with "Extreme age verified on the date of service", then names the date of service and the exact age the rule used, for example "70 years 1 day".
• A withheld 99100 sits in the bundled procedures. The reason states why: the age on the date of service does not qualify, the anesthesia code already describes the age, or the age could not be verified.
• The extreme-age add-on is reported once per anesthetic. If the documentation produces more than one 99100, the first line bills and each further copy moves to the bundled procedures as a duplicate.

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.

Both capabilities below are off unless your organization asks for them. Nothing changes on your claims until then.

A documentation check before a post-operative pain block is billed separately. Your organization declares, per payer type, which evidence must be in the record. The choices are a surgeon order or request, acceptance of transfer of care, a completed consult, a signed block consent, and a separate procedure note. One scan of the whole record checks for that evidence after the claim is built. When evidence is missing, your organization decides the outcome. The block either stays billable and the claim carries a compliance alert, or the block moves to the non-billable list with an informational alert that explains why. The alert names the payer, the evidence found, and the evidence still missing. A record that contains handwritten documents is never moved to non-billable automatically, because a text scan cannot verify marks on paper.

Coding guidance written for your organization. The autocoder can apply your own coding guidance on top of the standard guidance, on your cases only. It covers your guidance for individual codes in anesthesia code selection, your guidance for individual codes in the diagnosis review, and your own instructions for the coding steps. Coverage today is anesthesia.

What to look out for: ask your Hank representative if you want either capability turned on for your organization.

The qualifying circumstance codes are no longer billed on Medicare claims. The codes are 99100, 99116, 99135 and 99140. CMS bundles them into the base anesthesia service, so they are not separately payable. When the primary payer is Medicare or Medicare Advantage, the autocoder keeps these codes on the claim as documentation and does not bill them. The claim carries an informational note that records the change.

Commercial payers and unknown payers are not affected. On those claims the qualifying circumstance codes stay billable, exactly as before.

What to look out for: tell your Hank representative if your contract pays these codes on all payers, including Medicare Advantage plans that reimburse them. This behavior is on by default, and it can be turned off for your organization. Make that change before the build reaches production. There is no error message when a code moves to documentation only. An unprepared organization finds the change only by auditing claims by hand.

A claim that finishes with no primary anesthesia line is held. The hold fires when an anesthesia claim has no anesthesia line that carries a code. It catches a line that was produced and then removed later, and it catches a case where no code was ever found. A labor epidural (01967) counts as a valid anesthesia line and does not cause the hold.

A claim whose first ranked diagnosis cannot be traced is held. The autocoder must trace the first ranked diagnosis to a stated reason for the procedure. It looks at the anesthesia record after the case, then the record during the case, then the pre-anesthesia evaluation, then the surgeon operative report. The alert names the document that it used.

Modifiers are placed in the order that you configure. Your organization sets the order for surgical modifiers and for anesthesia modifiers. A modifier that is not in your list goes after the listed ones, in alphabetical order.

Two more holds started to fire on 2026-07-01. Those two rules never fired before. One holds a claim with no primary anesthesia code. The other holds a claim with a date of service more than one year old.

What to look out for: organizations that bill procedures only (ICU lines, emergency department blocks, blood patches, canceled cases) will see more held claims. So will organizations that take the first ranked diagnosis from a problem list. Every hold above can be turned off or softened for your organization.