Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

This release changes how the autocoder decides the anesthesia type on a claim, and what you will see when the record is unclear.

The anesthesia record decides the anesthesia type. Surgeon operative reports sometimes carry a template header such as "Anesthesia: MAC" while the anesthesia record documents a general anesthetic (an airway device, volatile agents). Before this release, that header could win, and a QS modifier could appear on a general anesthesia claim. Now the autocoder reads the anesthesia type from each note separately and trusts the anesthesia record over the surgeon's header. A general anesthetic documented in the anesthesia record produces a general anesthesia claim with no QS.

Legitimate MAC claims do not change. When the anesthesia record documents monitored anesthesia care, the claim carries QS exactly as before.

What to look out for: a new hold when MAC is not confirmed. When MAC appears only in the surgeon's note, or the anesthesia record does not confirm the MAC, the claim stops with the alert "MAC modifier suppressed - confirm MAC vs general". The QS/G8/G9 modifier is removed until a coder confirms the anesthesia type. Confirm the type from the anesthesia record and re-apply the modifier if MAC is correct.

Planned procedures that were never performed now raise an alert. When a pre-op note documents a planned nerve block, epidural, or line, and no matching procedure appears on the claim, the claim shows the alert "Planned procedure documented but no corresponding line item found". Review the record to confirm whether the procedure was performed.

More accurate source citations. The notes cited for the anesthesia type, ASA physical status, and emergency status on a claim now point to the notes that actually document those values. Reviewers land on the right document.

Radiology: duplicate lines removed. On radiology encounters with more than one report, the same procedure no longer appears as duplicate claim lines.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

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.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

What you will see

ICD-10 requires combination codes when certain conditions appear together. Hypertension with chronic kidney disease codes as I12.0 or I12.9, not as I10 plus the kidney code alone. Hypertension with heart failure codes as I11.0. Type 2 diabetes with chronic kidney disease codes as E11.22.

Before this change, the autocoder applied these combinations most of the time but not every time. Some claims went out with I10 and N18.x listed separately.

Now a rules engine checks every claim after the AI review. If a standalone code and its related condition both remain, the engine replaces them with the correct combination code. The stage code (N18.x) and the heart failure code (I50.x) stay on the claim, as ICD-10 requires. The combination code is sequenced before the stage and heart failure codes, in the order ICD-10 instructs.

What to look out for

• Claims where this correction fired carry the informational note "Diagnosis Combination Code Applied". No action is needed. The note is an audit trail.
• You will no longer see I10 next to N18.x, I10 next to I50.x, or E11.9 next to N18.x on the same claim.
• If the record shows the conditions are unrelated, flag the claim to your coding team. The presumption of a causal link comes from ICD-10-CM rules and applies unless the provider documents otherwise.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

What you will see

Many practices send the comprehensive anesthesia record for an acute pain service round. That record still contains the original surgery documentation. Before this change, the autocoder coded the SURGERY from those packets a second time. That created a duplicate of a claim you had already billed on the surgery day.

Now the autocoder detects the pain-round visit and codes THAT visit:

• 01996, one unit when the provider managed an epidural or spinal catheter that was still in place, on a day after catheter placement. This is a flat daily fee. It has no anesthesia time and no physical status modifier. That is correct for 01996.
• Subsequent hospital care (99231-99233) when the provider rounded on a peripheral nerve catheter, for example an interscalene or adductor canal catheter. Payer rules do not allow 01996 for these catheters.
• No charge when the visit does not support a billable service, for example a check on the same day the catheter was placed. The claim then carries the alert "No Billable Pain-Round Service" with the exact reason.

The claim date of service is the date of the ROUND, not the surgery date. The primary diagnosis is acute postprocedural pain (G89.18).

What to look out for

• Pain-round claims with 01996 show one unit and NO minutes. Do not add time to these lines.
• If a packet mixes surgery documentation with a partial pain-round note and the autocoder cannot decide which visit to bill, the claim holds with the alert "Possible Pain-Round Packet Coded as Surgery". A person must confirm the correct visit before the claim releases.
• If the record does not show that the surgeon handed pain management to the anesthesia team, the claim carries the alert "Surgeon Transfer of Pain Management Not Documented". Ask the practice to document the surgeon's request.

Optional review gate

Your facility can require a person to validate EVERY pain-round claim before it becomes billable. Ask your HANK representative to enable the pain-rounds review gate. You can gate only the claims coded as pain rounds, or every claim from a packet that contains pain-round content.

Alerts added

Post-Op Pain Rounds Review Gate; Possible Pain-Round Packet Coded as Surgery; No Billable Pain-Round Service; Pain-Round Date Not Documented; Pain Rounds on More Than One Day; Surgeon Transfer of Pain Management Not Documented; Catheter Insertion Date Not Documented; Pain-Round Coverage Is Payer Variable; Pain-Round Evidence Without a Citation.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

This release fixes a customer-reported problem with the extreme-age add-on code 99100 and tightens several related checks.

99100 now anchors to the date of service. The autocoder decides the extreme-age add-on (99100) from the patient's age ON THE DATE OF SERVICE. The date the case is processed no longer matters. Before this fix, a re-run of an unchanged case after the patient's 70th birthday could add 99100 that the first run correctly omitted. That cannot happen now.

Every 99100 is verified against the ASA age rule. The patient must be younger than 1 year, or at least 70 years and 1 day old, on the date of service. The 70th birthday alone does not qualify. A 99100 that qualifies is billed and gets the new alert "Extreme-Age Add-On 99100 Billed (Age Verified on Date of Service)" so a coder can confirm the demographics. A 99100 that does not qualify, or whose age cannot be verified, is kept on the claim for review and is not billed. Two new alerts name those outcomes.

What to look out for: claims for patients near their 70th birthday. A patient who turns 70 AFTER the date of service does not get 99100, even when the case is coded weeks later. This is correct and intended.

The anesthesia coder can now decline an unsupported code. When the documentation supports none of the candidate anesthesia codes, the autocoder returns no code and the claim is held for human review. It is no longer forced to pick the closest candidate. A new alert, "Anesthesia Code Cites Only Plan/History Documentation", also fires when a billed anesthesia code rests only on the pre-anesthesia evaluation although the record contains procedure documentation.

Anesthesia times now appear on more claims. When the billed anesthesia time comes from provider coverage times because the chart has no discrete anesthesia start and stop, the claim's anesthesia times field now shows the times that were billed. Those claims previously billed correctly but showed empty anesthesia times.

Contrast supply codes corrected (radiology). Q9968 and Q9969 are no longer treated as contrast agents. Q9968 is a visualization adjunct such as methylene blue. Q9969 was retired from HCPCS at the end of 2025. The high-osmolar contrast family Q9958 through Q9964 is now recognized for wastage checks alongside the low-osmolar family Q9965 through Q9967.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

This release changes what you will see on anesthesia claims in four areas.

TEE codes now come from one family. A transesophageal echo (TEE) claim carries one TEE code from a single code family. Illegal pairs such as 93312 with 93317 no longer occur. Congenital codes (93315-93317) appear only when the record documents evaluation of a congenital anomaly. Monitoring-only TEE produces no separate TEE code, because NCCI bundles it into the anesthesia service.

Nerve block lines keep only their own pain diagnosis. A separately billed nerve block line now carries the block's own pain code (a G89 code, for example G89.18) instead of every diagnosis on the encounter. This is the new default. If your organization prefers the old behavior, or wants the site pain code included as well, ask your Hank representative about the nerveBlockLineIcds setting. A block line that ends up with no diagnosis is held for review, not billed.

What to look out for: block-line diagnoses will look shorter than before. This is correct and intended.

Paravertebral block add-on units are corrected. A multi-level paravertebral block now bills 64461 plus one unit of 64462, not one 64462 per extra level. Medicare denied the extra units in all cases. Continuous catheter blocks bill 64463. The 64484 add-on is unchanged.

Screening colonoscopy claims (combined GI). The PT modifier on combined GI endoscopy code 00813 is now applied by payer. Medicare and Medicare Advantage claims keep PT when a screening diagnosis is present. Commercial payers that use modifier 33 get 33 instead. If the payer cannot be determined, the claim is flagged for review instead of guessing.

Fewer cases held for missing times. The autocoder now always asks for staff and case times during extraction. Cases that were held with a "no anesthesia times" alert, even though the times were in the record, now code normally.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

The autocoder now codes interventional radiology (IR) reports. Before this release, an IR report was returned with an "IR not supported" hold. Now the report is coded, and a set of IR-specific review alerts protects the result.

What you will see on IR claims:

• IR procedures (vascular access, drainage, embolization, and similar image-guided interventions) are coded automatically from the report.
• New review alerts can appear on IR claims:
  • An add-on code billed without an acceptable primary code. The alert names the primary codes CMS accepts.
  • PICC placement billed together with bundled imaging.
  • A conflict between selective and non-selective catheterization codes.
  • Ultrasound guidance billed without the required documentation.
  • Moderate sedation billed without the required documentation.
• Diagnostic radiology reports that contain out-of-range codes still receive the existing "not supported" hold.

Also fixed in this release:

• Radiology claims no longer carry code 99100 for patients under 1 or over 70. That code is an anesthesia add-on and never belonged on a radiology claim. If you see 99100 disappear from radiology claims, that is correct.

What to look out for: the volume of auto-coded radiology work goes up, and the new IR alert names will appear in your review queues. Your team can ask your Hank representative to turn the IR lane off for your organization if you want to opt out.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

This release closes 14 findings from a full review of the anesthesia coding stack. Several of them change what your coders will see.

Every OB case is held for review. A claim whose primary anesthesia code is obstetric (01958-01969) now carries the "OB case review" hold. This rule existed in configuration before but never fired because of a defect. If your organization does not want every OB case held, the rule can be turned off or downgraded per facility.

OB add-on codes require their primary. A claim that bills 01968 or 01969 without the 01967 labor analgesia primary is held. An add-on billed alone is a guaranteed payer rejection.

Supervision cases bill both providers. When medical direction drops to supervision (more than 4 concurrent cases), the claim now bills the physician line with modifier AD and the CRNA line with modifier QX. The CRNA line used to disappear, which underbilled the case.

Deliberate hypothermia and controlled hypotension are billed again. Codes 99116 and 99135 were blocked entirely. They now bill when the record documents the technique, and every such line carries a review flag so a coder confirms the documentation and the payer.

Post-op pain epidurals follow the NCCI rule. An epidural placed for post-op pain bills separately (with modifier 59) only when the case was done under general anesthesia. Under spinal or other anesthesia it is bundled, with the NCCI reason recorded on the claim. Placement in the OR no longer causes a silent drop.

Two new safety holds.

• If the extracted anesthesia provider is the operating surgeon, the claim is held. Medicare does not pay the operating physician for anesthesia.
• If a surgical procedure has no anesthesia crosswalk (an unlisted code, for example) and may outweigh the crosswalked procedures, the claim is flagged so a coder verifies the anesthesia code and its base units.

TEFRA settings are honored. A TEFRA attestation requirement your organization turned off is now truly excluded from evaluation. Sites with disabled requirements may see fewer "TEFRA requirements unmet" holds.

What to look out for: more held OB claims (by design), two-line supervision billing, occasional 99116/99135 lines with review flags, and the two new hold reasons in your review queues.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

The autocoder now codes Evaluation and Management (E/M) encounters. This covers office visits (99202-99215), hospital inpatient and observation care (99221-99239, including same-date admit and discharge 99234-99236), and emergency department visits (99281-99285).

How E/M leveling works. The level is never picked by the language model. The model extracts the evidence (medical decision making elements, time statements, encounter setting) with citations that are verified against the chart text word for word. A deterministic rule engine then computes the level from the verified evidence, following the AMA MDM table and the CMS time rules. A fabricated or unverifiable quote is discarded like a missing one.

What you will see:

• E/M codes on charts that contain a qualifying visit note.
• A chart with NO qualifying visit note is refused, not guessed. The refusal carries an alert that says why.
• Review alerts when the evidence is thin: insufficient evidence for a level, a disagreement between the time-based and MDM-based level, a level that rests only on an uncorroborated time statement, or a same-day procedure that needs a modifier 25 decision. None of these are decided silently.
• Hospital stays shorter than 8 hours follow the CMS length-of-stay rules: discharge day management is suppressed when the stay provably does not qualify, with an alert.
• Medicare observation-status consultations are directed to office codes, with an alert, per Medicare policy.

What to look out for: E/M encounters that used to go to your coders untouched now arrive coded, with the evidence cited. Held charts carry named alerts that explain the reason. The refusal behavior is deliberate: a chart the system cannot support with cited evidence is left for a human, never guessed.

Status: in development. This improvement is built and tested. It waits on the next production deploy. You will not see these changes on your claims yet. This entry will be updated when the change is live.

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.