Surgery Alert Reference
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This page covers the alerts that the autocoder raises on surgeon claims. It covers the surgeon companion claim, which HANK CODES can build from the same chart as the anesthesia claim, and the standalone surgery claim. Every alert carries a plain-language description, a type, a severity from 1 to 10, and a suggested reviewer role.
The surgeon companion feature is off in the shipped defaults. Your facility configuration controls it through the companionClaims.SURGERY.enabled setting. Contact your Hank representative to change it. The feature runs in one of two modes: worksheet mode produces codes and evidence for a coder to review, and claim mode produces a billable surgeon claim.
Alert ids that end in a code number repeat once per affected code. For example, surgeon_companion_incomplete_colonoscopy_45385 names the line it applies to. Match these alerts on the leading text of the id.
These alerts tell you what the autocoder built for the surgeon and why.
| Alert | Alert id | Type |
|---|
| Severity |
|---|
| When it fires and what to verify |
|---|
| Build status summary | surgeon_companion_status | INFORMATIONAL | 1 (5 after a build error) | The autocoder attaches a one-line summary of the surgeon output to the anesthesia claim on every run. It reports how many outputs it built, how many source lines it excluded, and how many errors occurred. Open the surgeon output when the summary names errors or review items. |
| No surgical results available | surgeon_companion_no_surgical_results | INFORMATIONAL | 4 | The feature is on, but the run produced no surgical coding results, so no surgeon output exists. Confirm that a surgeon procedure was expected for this encounter. |
| Source document gate refusal | surgeon_companion_source_doc_refusal | COMPLIANCE | 5 | The feature is in claim mode, and the packet holds no signed, surgeon-authored procedure report. A billable surgeon claim is refused. Obtain the signed operative or procedure report, or use worksheet mode. Your configuration controls the accepted note types through companionClaims.SURGERY.sourceDocumentGate. |
| All lines refused | surgeon_companion_all_lines_refused | COMPLIANCE | 5 | Every candidate surgeon line failed the billing checks, so no billable line remains. Review the surgeon documentation and code the encounter manually. |
| Evidence not verified | surgeon_companion_evidence_unverified_{code} | COMPLIANCE | 7 | In claim mode, a line's evidence quote is missing, or the quote does not appear in the surgeon's source document. The autocoder excludes the line rather than bill an unsupported procedure. Read the operative report and confirm whether the procedure was performed. |
| Diagnosis dropped by the claim-wide verdict | surgeon_companion_icd_verdict_drop | FINANCIAL when a line loses every diagnosis pointer, otherwise INFORMATIONAL | 6 or 3 | A diagnosis code that the claim-wide diagnosis check removed from the anesthesia claim was also removed from the surgeon claim. Verify that the removed diagnoses are correctly absent. Add a supported diagnosis pointer to any line that has none, because a line with no pointer rejects. |
| Diagnosis verdict failed (standalone) | surgeon_standalone_icd_verdict_error | COMPLIANCE | 5 | The claim-wide diagnosis check failed on a standalone surgery claim. The claim ships with the diagnosis codes exactly as extracted. Review each line's diagnosis pointers against the operative report. |
These alerts route to your data entry and charge entry roles, not to a coder.
| Alert | Alert id | Type | Severity | When it fires and what to verify |
|---|---|---|---|---|
| Surgeon not identified | surgeon_companion_unidentified_surgeon | INFORMATIONAL | 6 | In claim mode, the autocoder could not identify the billing surgeon for a group of lines, so it refused that group. Supply the surgeon identity and rerun the chart. |
| Surgeon NPI missing | surgeon_companion_surgeon_npi_missing | INFORMATIONAL | 5 | In claim mode, the surgeon is named, but no NPI resolved. Add the NPI before submission. |
| No date of service on a line | surgeon_companion_no_line_dos | INFORMATIONAL | 5 | In claim mode, one or more surgeon lines carry no procedure date. Supply the date of service. |
These checks compare the surgeon claim against the anesthesia claim for the same case. Payers cross-validate the two claims, so a disagreement invites a denial.
| Alert | Alert id | Type | Severity | When it fires and what to verify |
|---|---|---|---|---|
| Date-of-service mismatch | surgeon_companion_dos_mismatch | HARDSTOP | 7 | The surgeon procedure date does not match the anesthesia date of service. The alert attaches to both claims. Reconcile the dates before submission. |
| Screening story mismatch | surgeon_companion_screening_story_mismatch | HARDSTOP | 7 or 6 | The two claims tell different stories about screening intent. Either the surgeon claim codes a screening encounter and the anesthesia claim carries no Z12.11, or the anesthesia claim carries Z12.11 and the surgeon claim codes no screening. The alert attaches to both claims. Align the screening intent on both. |
| Conversion modifier divergence | surgeon_companion_conversion_modifier_divergence | COMPLIANCE | 6 | On a government payer, the anesthesia gastrointestinal line and the surgeon colonoscopy or sigmoidoscopy line disagree about the screening conversion modifier. One carries PT and the other does not. The alert attaches to both claims. Reconcile the conversion story. |
| Alert | Alert id | Type | Severity | When it fires and what to verify |
|---|---|---|---|---|
| Screening conversion modifier missing | surgeon_companion_screening_modifier_missing | COMPLIANCE | 6 | The surgeon claim codes a screening encounter for a government payer, but a colonoscopy-range line carries no PT conversion modifier. Append PT to the flagged line, or correct the screening flag. This alert stays on the surgeon claim only. |
| Screening modifier withheld, payer unknown | surgeon_companion_screening_payer_unknown | INFORMATIONAL | 5 | A screening colonoscopy converted to a therapeutic or diagnostic endoscopy, but the payer did not resolve. The autocoder withholds the conversion modifier rather than guess it. Identify the payer, then append PT or 33 to the therapeutic line. |
| Screening conversion applied | surgeon_companion_screening_conversion_applied_{code} | INFORMATIONAL | 2 | The autocoder applied the screening conversion modifier deterministically from the resolved payer. The alert records the payer and the path it used. No action is routine. |
| KX for follow-on screening | surgeon_companion_kx_followon_screening_{code} | INFORMATIONAL | 2 | The screening exam follows a positive non-invasive stool test, so the autocoder appended KX. Confirm the positive stool test is documented. |
| Surveillance review | surgeon_companion_surveillance_review_{code} | COMPLIANCE | 5 | A surveillance colonoscopy or sigmoidoscopy carries payer-dependent treatment: some payers route polyp-history surveillance to the high-risk screening lane, and others treat it as diagnostic. The autocoder flags the case and never decides it. Apply your payer's rule. |
| Pure screening should use a G-code | surgeon_companion_pure_screening_gcode | INFORMATIONAL | 5 | A screening encounter for a Medicare payer sits on the diagnostic colonoscopy base 45378. Verify the findings. Use G0121 or G0105 when the exam was pure screening. |
| Distinct-lesion XS applied | surgeon_companion_distinct_lesion_xs | COMPLIANCE | 4 | 45380 is reported with 45385, and the record documents separate lesions, so the autocoder applied modifier XS. The alert stores both supporting quotes as an audit record. Confirm the two techniques treated separate lesions. |
| Distinct lesions not verified | surgeon_companion_distinct_lesion_unverified_{code} | COMPLIANCE | 6 | 45380 is reported with 45385, but the record does not document distinct lesions. The autocoder withholds modifier XS. Read the report and document the separate lesions, or remove one line. |
| Colonoscopy extent undocumented | surgeon_companion_extent_undocumented_{code} | INFORMATIONAL | 5 | The extent of exam is not documented for a colonoscopy in the 45378-45398 range, so completeness cannot be verified. Confirm completeness. An incomplete exam takes modifier 53 or modifier 52. |
| Incomplete colonoscopy | surgeon_companion_incomplete_colonoscopy_{code} | COMPLIANCE | 6 | The documented extent does not establish cecal intubation. The report says the exam was aborted or incomplete, or it names no cecum or terminal ileum landmark. Apply modifier 53 for a screening or diagnostic exam, or modifier 52 for a therapeutic exam. |
| Alert | Alert id | Type | Severity | When it fires and what to verify |
|---|---|---|---|---|
| Complex cataract criteria not documented | surgeon_companion_66982_criteria_{code} | COMPLIANCE | 6 | 66982 is billed without a documented qualifying device or technique. Extra time alone does not qualify. Confirm a qualifying technique, or use 66984. The alert text notes that payers vary on which dyes qualify. |
| Cataract laterality missing | surgeon_companion_cataract_laterality_{code} | INFORMATIONAL | 6 | A cataract procedure carries no documented laterality and no RT or LT modifier. Determine the operative eye, then append RT or LT. |
| Cataract post-op co-management | surgeon_companion_cataract_comanagement | INFORMATIONAL | 5 | The record shows post-op care transferred to another provider. Confirm the arrangement. Apply modifier 54 when the surgeon gives up post-op care. |
| Obstetric postpartum-care variant | surgeon_companion_ob_postpartum_variant | INFORMATIONAL | 6 | A delivery-plus-postpartum-care code (59410, 59515, 59614, or 59622) was coded. Confirm the postpartum-care commitment, or use the delivery-only code (59409, 59514, 59612, or 59620). |
| Ureteral stent bundled | surgeon_companion_stent_bundled | INFORMATIONAL | 6 | 52332 is reported with 52356. Verify the laterality. Keep 52332 only when the stent went into the other ureter. |
| Lap chole with cholangiography | surgeon_companion_ioc_47563 | INFORMATIONAL | 6 | 47562 is coded, but intraoperative cholangiography is present. Use 47563 when cholangiography was performed. Add 74300-26 only for a separate formal interpretation. |
The autocoder runs a deterministic payment-rule engine over the surgeon lines. These alert ids follow the pattern SURG_{rule}_{kind}_{code}, for example SURG_R2_orphan_addon_44705. Every one of these alerts carries Coder as the suggested reviewer.
| Rule | Alert id pattern | What it checks |
|---|---|---|
| Payment status | SURG_R1_{kind}_{code} | Per-line payment status. Kinds cover status T (payable only as the sole procedure, FINANCIAL, severity 5), status C (priced by the payer and needs a report, COMPLIANCE, severity 5), non-payable status (the line is marked non-billable, COMPLIANCE, severity 5), and no status row found (INFORMATIONAL, severity 3). Review the payment status of every flagged line. |
| Add-on integrity | SURG_R2_{kind}_{code} | Add-on codes with no required primary procedure present. An orphan add-on is COMPLIANCE at severity 8 and the line is marked non-billable. Softer kinds are INFORMATIONAL at severity 3. Confirm the primary procedure is present, or remove the add-on. |
| Multiple endoscopy | SURG_R5_{kind}_{code} | Same-family endoscopy handling. An endoscopic base code that is not separately payable next to a family member is FINANCIAL at severity 5 and non-billable. Two or more same-family endoscopies with no documented distinct site are INFORMATIONAL at severity 3. Confirm distinct lesions or sites. |
| Bilateral handling | SURG_R6_{kind}_{code} | A modifier 50 that does not apply, because the code is inherently bilateral or is not payable as bilateral. The autocoder removes the modifier. FINANCIAL, severity 3. Confirm the bilateral status. Your configuration chooses modifier 50 or split RT and LT lines through bilateralReportingMode. |
| Assistant and co-surgeon gating | SURG_R7_{kind}_{code} | Second-provider payability. Payable kinds that need documentation are COMPLIANCE at severity 5. Not-payable kinds strip the assistant, co-surgeon, or team modifier and are COMPLIANCE at severity 5. Unverifiable kinds are INFORMATIONAL at severity 3. Supply the required documentation, or confirm the removal. |
| Unit ceilings | SURG_R8_{kind}_{code} | Medically Unlikely Edit ceilings against same-code units per day. An absolute cap breach makes the excess line non-billable (FINANCIAL, severity 5). A date-of-service cap keeps the multiples and requires documentation (INFORMATIONAL, severity 3). Confirm the unit count. |
| Global period | SURG_R9_global_{prior_code}_{code} | A line with a 10-day or 90-day global period plus a prior procedure inside that window. The autocoder surfaces candidate modifiers 58, 78, and 79, and never applies them. INFORMATIONAL, severity 5. Decide whether the service is related, staged, or unplanned. |
| Professional and technical component | SURG_R10_{kind}_{code} | Component modifiers. A code with no professional or technical split that carried 26 or TC has it removed (FINANCIAL, severity 3). An imaging-adjacent code with neither gets modifier 26 on the facility-site assumption (INFORMATIONAL, severity 3). Verify the place of service before you rely on the appended 26. |
When the documentation supports a payable assistant or co-surgeon, the autocoder produces that provider's own claim. Your facility configuration controls this through secondProviderClaims, which is on by default.
| Alert | Alert id | Type | Severity | When it fires and what to verify |
|---|---|---|---|---|
| Second-provider claim built | surgeon_second_provider_claim_built | INFORMATIONAL | 3 | An audit marker on the assistant or co-surgeon claim. Verify the provider NPI and the payer assistant policy before submission. |
| Documentation required | surgeon_second_provider_documentation_required | COMPLIANCE | 6 | The payment tables require medical-necessity documentation with the second provider's claim. Attach the documentation. |
| Credential not verified | surgeon_second_provider_credential_unverified | INFORMATIONAL | 5 | The second provider's credential did not resolve exactly, so the autocoder defaulted to the conservative AS modifier. Verify the credential and correct the modifier when needed. |
| Second-provider claim error | surgeon_second_provider_claim_error | COMPLIANCE | 5 | A payable second-provider claim failed to build. Produce that claim manually. |
| Assistant documented, not billed | surgeon_companion_assistant_documented | INFORMATIONAL | 4 | The record documents an assistant, and the autocoder did not bill that assistant. Decide whether an assistant claim is due. |
Surgeon claims also carry the shared alert families. Patient and claim information alerts cover missing demographics, insurance, and provider identifiers. Coding confidence alerts cover low-confidence code selection and unresolved diagnosis support. Those alerts fire across every specialty; 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 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.