Radiology Auto-Coding
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The autocoder reads the radiology report and produces a coded claim. It assigns a CPT code for each documented imaging study. It also assigns ICD-10 diagnoses from the findings and the clinical indication.
The autocoder parses the modality, the body region, and the laterality. It also reads the number of views or sequences, the contrast technique, any guidance modality, and add-ons such as 3D rendering or tomosynthesis. It reads the findings and the impression to build the diagnosis list.
Supported modality families include plain film, ultrasound, CT, MRI, mammography, DEXA, nuclear medicine, PET, and fluoroscopy.
The autocoder selects the family member that matches the documented contrast technique. It treats intravenous, intrathecal, and intra-articular contrast as "with contrast". It treats oral or rectal contrast alone as "without contrast". For a CT head, that produces 70450 without contrast, 70460 with contrast, or 70470 with and without contrast.
When the report documents contrast, the autocoder adds the contrast supply code as its own line item. It applies a JW or JZ wastage modifier only when the report documents the wastage status.
The autocoder applies laterality from the documented side. Breast imaging uses one line item with modifier 50 when the study is bilateral. Other radiology studies use two line items with RT and LT. The autocoder does not add 50, RT, or LT to a code that is already bilateral, such as 77066 or 77067.
The autocoder also compares the ICD-10 laterality against the CPT modifier. A mismatch raises a review alert instead of a silent correction.
The autocoder separates the studies documented in one report. Separate modalities become separate procedures. The same modality on unrelated regions also becomes separate procedures, for example an ultrasound of the thyroid plus an ultrasound of the kidneys. The autocoder then evaluates a distinctness modifier (XS, XE, XU, XP, or 59) for the additional lines. When the report leaves the performance of a second study ambiguous, the autocoder codes conservatively and records the uncertainty.
Processing rules can adjust a radiology claim for your facility. Seventeen processing rules ship for radiology. Every rule key starts with radiology_, contrast_supply_, or ir_. No rule key starts with rad_. Each rule raises a review alert for a coder to confirm. Your facility configuration controls these rules. Contact your Hank representative to change one.
A rule key is not the same as the alert id that the rule emits. The rule contrast_supply_jw_validation, for example, emits the alert radiology_jw_wastage_applied. Give your representative the rule key to change a rule. Give the alert id to suppress an alert.
Radiology claims carry their own alert set, including missing laterality, mixed billing components, duplicate studies, and contrast wastage checks. Read the radiology alert reference for each trigger and the recommended coder action.
What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a HARDSTOP alert places the claim in the review queue your administrators configured for it. Organizations that consume the coding API directly decide in their own workflow which alerts pause a claim, who reviews them, and when a claim is released.