Qualifying Circumstance Codes
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The autocoder can add four qualifying circumstance add-on codes to an anesthesia claim: 99100 (extreme age), 99116 (total body hypothermia), 99135 (controlled hypotension), and 99140 (emergency conditions). It codes each one only from the documentation in the record.
These codes are add-ons. They never stand alone on a claim. A claim whose only surgical code is an add-on raises a HARDSTOP review alert.
The autocoder anchors the age test to the date of service, not to the day the case is coded. It bills 99100 when the patient is younger than 1 year, or at least 70 years and 1 day on the date of service. The 70th birthday alone does not qualify.
Three review alerts describe the result:
| Alert | Type | Default severity | What it means |
|---|---|---|---|
extreme_age_99100_billed | FINANCIAL | 4 | The age on the date of service qualifies. The alert asks a coder to confirm the patient demographics before billing. |
extreme_age_99100_not_qualified | FINANCIAL | 5 | The age on the date of service does not qualify. The autocoder keeps 99100 on the claim as a bundled, non-billed entry. |
extreme_age_99100_unverified | FINANCIAL | 6 | No date of birth, resolvable date of service, or documented age was available. The alert asks a coder to verify the demographics. |
The autocoder codes 99116 when the record documents deliberate therapeutic total body cooling. It codes 99135 when the record documents deliberate induced hypotension as a technique. Incidental low temperature and hypotension treated with pressors do not qualify.
Every 99116 or 99135 line raises the qc_addon_review alert (FINANCIAL, severity 5). The alert asks a coder to confirm the documentation and the payer's payment policy before billing. Your facility configuration controls this rule. Contact your Hank representative to change it.
The autocoder codes 99140 when the record states an emergency in words, for example "emergent" or a physical status modified with E. It does not read an emergency from an anesthesia postoperative note.
On a Medicare or Medicare Advantage claim, the autocoder moves all four codes off the billable lines and keeps them on the claim as bundled entries. It raises the medicare_qualifying_circumstances_bundled alert (INFORMATIONAL, severity 1). Commercial and unknown payers keep the codes as billable lines.
The qualifyingCircumstances.suppressForMedicare setting controls this behavior, and it is on by default. If your organization bills qualifying circumstance codes to all payers by contract, contact your Hank representative to turn it off before your next deploy.
Three different causes produce the same result. Check the alert to tell them apart.
medicare_qualifying_circumstances_bundled alert is present. Medicare suppression moved the code. See the section above.A settings change fixes only the first cause.
What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a FINANCIAL alert flags the claim for the team 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.