Changelog

What you will see

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.

• The time of an anesthesiologist overlaps. The line bills the directed modifiers from your medical direction settings with that anesthesiologist, for example QK for the anesthesiologist and QX on the CRNA line. At a shift change, the night anesthesiologist who directed the epidural can be a different person from the day anesthesiologist who did the cesarean.
• The time of no anesthesiologist overlaps. The case gets one question. For a CRNA placer, the line bills your CRNA-alone setting (QZ with the shipped settings) until the direction is confirmed.
• An AA or a resident placed the epidural. An AA or a resident cannot bill without a directing or teaching anesthesiologist. So the line keeps the directed modifiers, and the coder decides.

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.

Alert changes

• Labor Epidural Direction Not Shown (new, 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.
• When your facility requires a directing anesthesiologist for every CRNA line (the 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.

What to look out for

• Read the labor note. If an anesthesiologist directed the placement, bill the directed modifiers with that anesthesiologist. If not, keep the non-directed billing for a CRNA, or correct the line for an AA or a resident.
• An anesthesiologist who places the epidural never gets this question.
• Your organization can silence this alert or change who it asks. Your CRNA-alone setting decides what a CRNA placer bills while the question is open, and who gets the question. Ask your Hank representative.

See Obstetric Anesthesia and the Anesthesia Alert Reference.

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.

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.

What you will see

Automated claim validation (ClaimCleaner) checks the side of service on each line: the RT and LT modifiers, and the side in each diagnosis code. Validation now changes the right or left side only when the line documents that side, with one exception below. The sides that a line documents are the sides of its diagnosis codes and of its RT, LT or 50 modifier.

• No undocumented side. Validation does not add an RT or LT modifier, or a right or left diagnosis code, for a side that the line does not document.
• No reversed side. Validation does not change a documented right side to left, a left side to right, or a sided code to an unspecified code.
• Both sides on one line. When a line documents both sides, validation does not choose one side. It can only make the line bilateral: modifier 50, or the bilateral code of the same condition.
• Same condition only. When validation adds the side to a diagnosis code with an unspecified side, the new code must describe the same condition. For example, a dislocation code does not become a subluxation code.
• Every diagnosis stays on the line. When validation corrects the side of two or more diagnoses on one line, each diagnosis gets its own correction and keeps its place in the list. A secondary diagnosis does not move to the first-listed position.
• No retired codes. Validation does not add a diagnosis code that is not valid for the date of service. For example, it does not add M54.5 (low back pain), which is not billable for dates of service after September 30, 2021.
• One exception. Validation reads the side of a diagnosis code from the code set. A few bilateral codes, for example M17.0 (bilateral primary osteoarthritis of knee), do not carry a side there yet. Validation reads such a code as a code with no side, so it can still add that code to a line that documents one side or no side, or put it in place of a right or left code of the same condition.

For example: an interventional radiology claim bills a thrombectomy of the right leg veins (37187) with I82.411 and I82.421 (right femoral and right iliac vein thrombosis) and no side modifier. Validation adds RT and keeps both right-side codes.

Nerve block lines and the side of the surgery

• Validation no longer changes the side of the diagnoses on the main anesthesia line to match the RT or LT modifier of a nerve block line. The main anesthesia line keeps the side that the surgery documentation states.
• When a nerve block line carries RT or LT and the surgery documentation states the other side, validation reports the difference. The autocoder does not show this report to a coder yet, so no alert appears for it. In a sample of 2,336 recent fully automated anesthesia cases, the difference occurred on 1 case.

Alert changes

• No alert is added or removed.
• ClaimCleaner Added ICD Code, ClaimCleaner Added Anesthesia Modifier and ClaimCleaner Added Surgical Modifier can appear less often, because validation makes fewer side changes. On radiology claims, ClaimCleaner-Added Contralateral Diagnosis Stripped (Undocumented) can also appear less often.

What to look out for

• Expect fewer side changes from validation on anesthesia and radiology claims.
• When the record does not document a side, the line keeps the side as coded. Add the side from the record when your payer requires it.
• On a line that documents one side or no side, check a bilateral diagnosis that validation added, for example M17.0.
• On a claim with a nerve block, compare the side of the block line with the side of the surgery. The autocoder does not ask about a difference yet.
• Nothing changes in your configuration.

What you will see

Modifiers 59, XE, XS, XP, and XU exist for one purpose: to bypass a Medicare NCCI edit between two codes on the same claim. When no edit exists, the codes pay separately on their own and the modifier is unnecessary. Payers flag unnecessary distinct-service modifiers in audits.

Before this change, the autocoder sometimes placed one of these modifiers on a code pair that has no NCCI edit. Example: a diagnostic cervicocerebral angiogram that bills carotid angiography (36224) and vertebral angiography (36226) together. Medicare holds no edit between those codes, so no modifier is needed, but an XS could still appear on the vertebral line.

Now the autocoder checks the licensed NCCI edit table at claim build. If a line carries 59 or an X modifier and no edit pairs its code with any other code on the claim, the modifier is removed. The claim carries an informational note, "Distinct-Service Modifier Removed (No NCCI Edit)", as an audit trail. No action is needed.

The check is careful in three ways. A modifier on a real edit pair is never touched. A modifier on a repeated code (the same code on two lines) is never touched, because it can mark a separate encounter. And when the NCCI data is not available in a deployment, nothing is removed.

A related alert also improved. The "may need distinctness modifier" review alert used to appear on every claim with two or more procedures. It now appears only when a real NCCI edit pairs the codes, so it no longer asks your team to add a modifier the claim does not need.

What to look out for

• Radiology and interventional radiology claims with several procedures will show fewer 59 and X modifiers. The removed ones were unnecessary.
• If a payer outside Medicare requires a distinct-service modifier for a policy of its own, tell your Hank representative.

This change affects only organizations that chose the X modifier set in place of modifier 59.

Modifier 59 stays on the lines CMS excludes. Per CMS guidance (MLN1783722), modifier 59 and its X modifier subsets identify services other than evaluation and management. E/M services use modifier 25 instead. The autocoder no longer converts a 59 into XE or XS on an E/M line, an anesthesia line, or a qualifying circumstance line. A modifier 59 that arrives on one of those lines stays 59.

The catch-all XU rule already worked this way. The XE rule (return to the operating room) and the XS rule (separate structure) now follow the same exclusion.

What to look out for: if your organization uses the X modifier preference, expect 59 to remain on E/M, anesthesia, and qualifying circumstance lines. Other lines still receive the X modifiers as before. Organizations that bill with modifier 59 see no change at all.

Modifier G8 is now limited to the six codes CMS names for it. Those codes are 00100, 00160, 00300, 00400, 00532 and 00920. On any other code the autocoder removes G8 and applies QS in its place.

An anesthesia line now carries exactly one of QS, G8 or G9. These modifiers can no longer stack on the same line. QS is the default for monitored anesthesia care. G8 wins when the code qualifies for it, then G9, then QS.

Three new review flags. A line that keeps G8 or G9 carries an informational note to verify the documentation. A line with G9 is flagged when no severe heart or lung diagnosis is coded on the claim. A physical status of P3, P4 or P5 is flagged when no supporting condition is coded on the claim.

What to look out for: expect G8 to disappear from cases outside the six approved codes, and expect QS in its place. Expect new review flags on G9 lines and on claims with a high physical status. When the record supports the modifier or the physical status, confirm that the supporting diagnosis is coded on the claim.

Radiology claims apply the component modifiers your configuration asks for. The rules that decide the professional component (modifier 26) and the technical component (modifier TC) read the billing component set for your organization. That setting stopped reaching the coding step, so the rules had nothing to act on, so no radiology claim received a component modifier from them. The setting is live again, and radiology coding follows it.

While the setting was not reaching the coding step, radiology claims were coded as if no component preference existed. Claims coded in that window may therefore be missing the modifier your configuration calls for. Check them before you submit them.

What to look out for: a radiology claim may now carry a 26 or a TC modifier where recent claims carried none. Check that the billing component configured for your organization matches how you bill: professional, technical, global, or split. Ask your Hank representative if the setting needs to change.

QZ is no longer forced onto every CRNA placed labor epidural. Code 01967 got QZ regardless of your organization's medical direction configuration. The autocoder now applies the same rules that it uses for every other line.

What each configuration gets now. An organization with medical direction turned off gets the provider on the line and no modifier, because that organization assigns anesthesia payment modifiers downstream. An organization that chose to hold CRNA alone cases now gets a hold, instead of a QZ that was billed silently. Every other organization still gets QZ, plus a new informational note for the audit trail.

What to look out for: code 01967 still requires one of AA, QK, QX, QY, QZ or AD on the submitted claim. Payers deny the line without one of them. If your organization assigns modifiers downstream, confirm that the downstream process supplies the modifier on labor epidurals. If your organization holds CRNA alone cases, expect new review queue items where QZ was billed automatically before.

Aetna no longer turns surveillance into diagnostic. Aetna treats surveillance as screening, per the commercial payer guidance dated 2025-12-02. Aetna is removed from the surveillance to diagnostic list, and from the 00811 with PT group.

One payer label is corrected. The row that read BCBS DE, NY, PA and WV now reads Highmark in any state, plus BCBS DE and BCBS WV. The old label mixed Highmark plans with BCBS Pennsylvania plans that are not Highmark. BCBS Independence (Pennsylvania) now has its own rows: 00811 with PT for a lower endoscopy, and 00813 with Z12.11 first for a combined upper and lower endoscopy.

Five payers move to a different group. BCBS Michigan and Priority Health (Michigan) move to the 00811 with PT group. BCBS Arkansas, Anthem Connecticut and BCBS Illinois move to the 00812 with PT group.

The surveillance rule for Cigna, UHC and BCBS Nebraska now applies. An ordering defect meant that this rule never took effect. A surveillance case for these three payers now becomes diagnostic and produces 00811 without PT.

What to look out for: the code and the modifier can differ for the payers named above. Accuracy improves for each of those payers on a screening colonoscopy that converts to diagnostic.