Radiology Alert Reference
8 min read
Last updated
DevelopersWhat's newUpdates
This page covers the review alerts the autocoder raises on diagnostic radiology and interventional radiology claims. Every alert carries a plain-language description, a type, a severity from 1 to 10, and a suggested reviewer role. The list below is curated: it names the alerts a coder meets most often, not every check the autocoder runs.
These alerts compare the side named in the report, the side on the CPT modifier, and the side encoded in the ICD code.
radiology_laterality_missing). FINANCIAL, default severity 5. Fires when a diagnostic radiology or ultrasound procedure (CPT 70000-76999) carries no laterality modifier (RT, LT, or 50) and the report does not mention bilateral. Read the report and add the correct side. Paired body parts such as shoulders and knees deny without it.radiology_icd_laterality_mismatch). COMPLIANCE, default severity 8. Fires when the CPT code carries RT or LT but the ICD code ends in 9 for unspecified laterality. Replace the unspecified ICD code with the lateralized version that matches the modifier.radiology_icd_laterality_wrong_side). COMPLIANCE, default severity 9. Fires when the ICD code names one side and the CPT modifier names the other. Find the correct side in the report. Then correct whichever of the two is wrong.radiology_mixed_billing). FINANCIAL, default severity 6. Fires when one claim mixes professional (26), technical (TC), and global line items. Confirm each line carries the billing component your facility bills. Most facilities bill all 26, all TC, or all global.radiology_supervision_required). HARDSTOP, default severity 9. Fires when a diagnostic radiology line item has no provider assigned. Assign the interpreting radiologist to the line item.radiology_duplicate_study). FINANCIAL, default severity 6. Fires when the same radiology CPT code appears more than once with no laterality modifier to separate the lines. Decide if the lines are truly different studies. Add distinguishing modifiers, or remove the duplicate line.radiology_repeat_no_modifier). FINANCIAL, default severity 5. Fires when the same CPT code repeats with no repeat modifier (76 or 77) and no laterality modifier. Add modifier 76 when the same radiologist interpreted both studies. Add modifier 77 when a different radiologist did.radiology_x_modifier_missing). FINANCIAL, default severity 5. Fires when several procedures are billed on the same service date and the later lines may need an X modifier (XS, XE, XU, XP) or modifier 59. Pick the modifier that matches the clinical scenario: XS for a separate structure, XE for a separate encounter, XU for unusual non-overlapping service, XP for a separate practitioner.radiology_addon_without_primary). COMPLIANCE, default severity 7. Fires when an add-on code (76376, 76377, 77001, 77002, 77003) is on the claim with no primary procedure code. Add the primary code that the add-on supplements. Remove the add-on if no primary procedure was performed.radiology_screening_diagnostic_mismatch). COMPLIANCE, default severity 6. Fires when the claim uses screening mammogram code 77067 but the report carries diagnostic indicators such as mass, abnormal, or suspicious. Confirm whether the study was screening or diagnostic. Change to the diagnostic mammography code when the report supports it.radiology_complete_limited_mismatch). FINANCIAL, default severity 5. Fires when a complete ultrasound or complete study code is on the claim but the report says limited, focused, or targeted. Read the report and use the limited code when only a limited study was done.radiology_contrast_no_admin_code). INFORMATIONAL, default severity 4. Fires when the report documents contrast-enhanced imaging but no contrast administration code (96374-96376) is on the claim. Decide whether your practice bills contrast administration separately.radiology_contrast_missing_wastage_modifier). COMPLIANCE, default severity 6. Fires when a contrast supply Q-code (Q9965-Q9969) carries neither JW nor JZ. Add JW with the documented wasted amount, or JZ when the whole vial was administered.radiology_jw_jz_mutual_exclusive). COMPLIANCE, default severity 8. Fires when one contrast supply code carries both modifiers. The two are mutually exclusive. Keep the one the report supports and remove the other.radiology_jw_no_wastage_amount). COMPLIANCE, default severity 7. Fires when JW is present but no wastage amount is documented. Document the wasted volume in mL.radiology_jz_has_wastage). COMPLIANCE, default severity 8. Fires when JZ (zero wastage) is present and a non-zero wastage amount is documented. Change JZ to JW and document the amount, or remove the wastage amount.These alerts come from configurable radiology rules. Your facility configuration controls each one. Contact your Hank representative to change a severity or turn a rule off.
radiology_3d_addon_review). INFORMATIONAL, default severity 4. Fires when a 3D rendering add-on code (76376 or 76377) is on the claim. Confirm the primary imaging code is also present.radiology_contrast_verify). INFORMATIONAL, default severity 3. Fires when a contrast-enhanced study code (70460, 70470, 72126, 72127) is on the claim. Confirm the report records the contrast type, route, and amount.radiology_guidance_bundling). FINANCIAL, default severity 5. Fires when an imaging guidance code (77001, 77002, 77003) is on the claim. Check the bundling edits for the primary procedure before you keep the guidance line.radiology_jw_wastage_applied). INFORMATIONAL, default severity 3. Fires when a contrast supply code carries JW. Confirm the wastage amount reaches the claim form.radiology_jz_no_wastage). INFORMATIONAL, default severity 2. Fires when a contrast supply code carries JZ. No action is needed. The alert is a confirmation.The autocoder codes a case as interventional radiology when the report describes an interventional procedure. Your facility configuration controls whether interventional coding is active, through the irCoding.enabled setting, and it controls each interventional processing rule below, so you can change a severity or disable a rule. Contact your Hank representative to change any of this.
radiology_ir_not_supported). COMPLIANCE, default severity 8. Fires when a CPT code outside the diagnostic radiology range (70000-79999) is on a radiology claim and the autocoder did not code the case as interventional radiology. The case needs a coder who works interventional radiology. When interventional coding is enabled and the autocoder coded the case as interventional, this alert does not fire, and the interventional checks below run instead.ir_addon_without_primary). FINANCIAL, default severity 6, suggested reviewer Coder. Fires when an add-on code is on the claim, the CMS add-on edit data lists specific acceptable primary codes for it, and none of those primaries is on the claim. The alert names the acceptable primaries. Add the primary procedure, or remove the add-on when no primary was performed. The check reads the CMS add-on edit data directly, so it flags only CMS-defined (Type 1) add-on codes.ir_picc_bundled_imaging_conflict). COMPLIANCE, default severity 6, suggested reviewer Coder. Fires when a PICC code whose descriptor bundles all imaging guidance (36572, 36573, or 36584) appears with a separate guidance code (76937 or 77001). Remove the guidance code. Do not add a distinctness modifier to force it through: the bundling comes from the CPT descriptor, not from a modifier-bypassable edit pair.ir_combined_sni_conflict). COMPLIANCE, default severity 6, suggested reviewer Coder. Fires when a combined interventional code whose descriptor already includes catheterization, imaging supervision and interpretation, or guidance appears with a separate code for that same work. Shipped families cover cervicocerebral angiography (36221-36228 against 36215-36218), renal angiography (36251-36254 against 36245-36248), dialysis circuit (36902-36906 against 36901), vascular embolization (37241-37244 against 75894 and 75898), lung core biopsy (32408 against 76942, 77002, 77012, 77021), image-guided breast biopsy (19081, 19083, 19085 against 76942, 77012, 77021), bone and lung ablation (20982, 20983, 32994, 32998 against 76940 and 77013), and imaging-inclusive drainage (49083, 32555, 32557 against 76942). Remove the separate line unless the report shows a genuinely distinct vessel or procedure. Each family has its own rule, named ir_combined_sni_cervicocerebral, ir_combined_sni_renal, ir_combined_sni_dialysis, ir_combined_sni_embolization, ir_combined_sni_lung_biopsy, ir_combined_sni_breast_biopsy, ir_combined_sni_ablation, and ir_combined_sni_drainage.ir_us_guidance_documentation). COMPLIANCE, default severity 5, suggested reviewer Coder. Fires when 76937 is billed. Confirm the report documents all four required elements: evaluation of potential access sites, vessel patency, real-time visualization of needle entry, and a permanently stored image. Remove the guidance code when an element is absent. Site marking without live needle guidance does not qualify.ir_moderate_sedation_documentation). COMPLIANCE, default severity 5, suggested reviewer Coder. Fires when a moderate sedation code is billed from the operator series (99151-99153) or the second-provider series (99155-99157). Confirm the documented intraservice time and the independent trained observer. The first unit needs a 10-minute minimum, and each additional 15-minute unit needs at least 8 minutes beyond the prior block. Use 99155-99157 only when a provider other than the proceduralist gave the sedation. Note that 99153 is technical-component only and is not physician-payable in a facility setting.Radiology claims also receive the alerts that fire across all specialties. These cover patient and claim information, such as a missing or unmatched provider; coding confidence, such as a low-confidence code selection; and claim scrubbing, such as a line item the claim checking service removed. They reach a radiology coder as often as the radiology alerts above; ask your Hank representative for the full catalog of shared alerts.
What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a COMPLIANCE alert flags the claim for your compliance team. 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.