The autocoder places three families of modifiers on an anesthesia line: provider modifiers, MAC modifiers, and ASA physical status modifiers. This page names the trigger for each modifier. It describes what the autocoder produces. It does not restate payer policy.

Your facility configuration controls the behavior on this page. Contact your Hank representative to change it.

## Provider modifiers

The provider types on the case, plus the medical direction evaluation, decide these modifiers.

| Modifier | The autocoder applies it when |
|---|---|
| AA | A physician performs the case alone. It also applies on the attending line of a teaching case. |
| QK | A physician directs a CRNA or an anesthesiologist assistant. |
| QX | The directed CRNA or assistant line is billed. |
| QZ | A CRNA works alone, with no directing physician. |
| AD | The medical direction outcome is `drop_to_supervision`. |
| GC | A teaching case bills the attending line with AA. |

The autocoder does not apply QY. It applies QK on every directed case. Your downstream billing system converts QK to QY when direction is one to one.

The autocoder does not count concurrent cases. It never picks QK or AD from a concurrency count. For the settings behind these outcomes, read [Medical Direction and Attestation](/hank-codes/configuration-guide/medical-direction-and-attestation).

## MAC modifiers

QS, G8, and G9 mark monitored anesthesia care. Exactly one of them appears on an anesthesia line.

- QS is the default mark on any MAC case.
- G8 marks MAC for a deep, complex, or markedly invasive procedure. The autocoder allows G8 on six anesthesia codes only: 00100, 00160, 00300, 00400, 00532, and 00920. On any other code it replaces G8 with QS.
- G9 marks MAC performed because of a documented severe cardiopulmonary history.

When a line keeps G8 or G9, the autocoder raises the `mac_modifier_g8g9_review` alert. The alert is INFORMATIONAL at severity 2. It asks a coder to confirm the record supports the choice.

The autocoder removes QS, G8, and G9 from every line when the case is not a MAC case. It also removes them when your configuration disables the `mac_modifier_control` processing rule. If the anesthesia type is missing, the autocoder treats the case as non-MAC and removes the modifiers.

## Physical status modifiers

The autocoder places one ASA physical status modifier, P1 through P6, on each anesthesia line. It places physical status modifiers on the anesthesia code only, never on a surgical code. The `asa_p_modifier_control` processing rule turns this behavior off.

For P3, P4, or P5, the autocoder checks the diagnoses on the claim. If no clinical secondary diagnosis supports the level, it raises the `physical_status_unsupported` alert. The alert is FINANCIAL at severity 5. A coder confirms the chart documents the severe systemic disease, or downgrades the physical status, or adds the supporting diagnosis. P6 is exempt from this check.

## Modifier order on the claim

The autocoder sorts the modifiers on each line as the last step of the build. The order runs from your configuration, so the final order reflects anything an earlier step added or removed.

- Anesthesia codes: QK, QX, QZ, AA, AD, GC, QS, G8, G9.
- Surgical codes: 59, XS, XE, XP, XU, LT, RT, 50.

Any modifier that the list does not name goes at the end, in alphabetical order.

## Distinct service modifiers

By default the autocoder keeps modifier 59 as coded. The `ncciModifierPreference` setting controls this. When your configuration sets it to `x_modifiers`, the autocoder converts a modifier 59 into the more specific XE, XS, or XU after the claim scrubbing step. It never places both 59 and an X modifier on one line. It never converts a 59 on an anesthesia line or on an E/M line. It does not apply XP.

## How this reaches you

What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a FINANCIAL alert flags the claim for the matching 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.