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.

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.

Some EMRs print the CPT code that was selected when the case was booked. The booked code does not always match the procedure that was performed. A common example is a colonoscopy booked under a polypectomy code when no polyp was removed.

The autocoder now treats a printed code number as scheduling data, not as proof. The words in the record still count, including words in the booking or scheduling area. But the autocoder does not expand a bare code number into its full code description to add details the record does not state.

What you will see differently:

• Surgical codes follow the documented procedure. If the booking shows a polypectomy code but the report documents a diagnostic exam with no polyp removal, the claim carries the diagnostic code.
• Anesthesia codes for GI cases no longer inherit polyp removal or biopsy from the booked code. A screening colonoscopy with no intervention codes as a screening exam, with the correct payer handling for the PT modifier.
• Diagnosis codes tied to an assumed intervention (for example, a colon polyp diagnosis) appear only when the record documents the finding.

What to look out for: claims where the booked code and the documentation disagree now follow the documentation. If a procedure was performed but not documented, the claim will not include it. Ask the provider to complete the record, then resubmit the case.

Reference material now matches the date of service. When the autocoder looks up code reference material while it codes a case, it reads only the reference set for the claim's date of service. CPT references follow the calendar year. Diagnosis references follow the October to September fiscal year. Before this change, a case coded for an earlier date of service could see current year material.

This matters most on back dated work: a claim for a service in a prior year is now coded against the code set that was in force on that date, not against the current one.

What to look out for: back dated cases should select codes that were valid on the date of service. When a case carries no date of service, the autocoder still reads every year, as it did before. If a claim needs the date of service to be right for this reason, confirm the date before you reprocess the case.

The autocoder can now build a companion claim for the operating surgeon alongside the anesthesia claim, from the same case documents. The feature is OFF by default and is enabled per organization on request.

What it does when enabled:

• Surgeon-authored documentation (operative notes, procedure reports) is coded into a separate surgical claim with the surgeon as the billing provider.
• A deterministic Medicare fee schedule engine applies the payment rules: multiple-procedure ranking, bilateral handling, assistant and co-surgeon checks, and modifier placement.
• Screening colonoscopy conversions follow the payer rules (PT or 33), and the anesthesia claim and the companion claim are cross-checked so the two never disagree on the screening story. A disagreement is held, not billed.
• Every companion line carries its evidence quote from the surgeon's own document. A line whose evidence cannot be verified in the source document is excluded and flagged.

What to look out for: nothing changes unless your organization asks for the feature. If you want surgeon-side claims from the documentation you already send, contact your Hank representative.

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.

Cystoscopy coding is corrected. Before this change, the autocoder sent laser stone cases to the tumor codes.

A laser used on a bladder tumor codes to the tumor codes. Transurethral resection of a bladder tumor with a laser codes to 52234, 52235, or 52240. The code follows the size of the tumor.

A laser used on a stone codes to the lithotripsy codes. Cystoscopy with laser lithotripsy codes to 52353. When a stent is placed at the same session, the case codes to 52356 instead. Placing a stent by itself codes to 52332.

What to look out for: the anesthesia code can change with the surgical code, because the anesthesia code follows the surgical procedure. Review your cystoscopy cases that document a laser after this update, and confirm that the record states what the laser treated. A record that says only "laser used" does not separate tumor work from stone work.

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.