HANK CODES reads your clinical documents and produces structured claims. Each claim carries CPT codes, ICD-10 codes, modifiers, provider assignments, and review alerts. This guide lists every billing decision your facility can set. Each section states the options and the default.

You do not edit the configuration yourself. Read this guide, record your choices, and give them to your Hank representative. Your representative applies them to your facility configuration.

## How to use this guide

Each decision below shows the available options. The word *Default* marks what happens if you state no preference. Each decision also explains what changes on the claim.

Sections carry a tier. Use the tier to set your priority:

- **REQUIRED**: decide these before go-live.
- **ADVANCED**: decide these if the default does not match your billing policy.
- **RARE**: most facilities never change these.

This guide covers the Anesthesia specialty in Sections 1 to 13. Section 14 covers E/M visits. Section 15 covers Radiology. Section 16 covers post-op pain rounds. Ask your Hank representative for the guide that matches your specialty.

If you leave everything at default, the autocoder does the following:

- It bills medical direction with QK and QX modifiers when both an MD and a CRNA or AA are present.
- It checks all 7 TEFRA requirements and raises a review alert for each unmet requirement.
- It raises a review alert for codes below 80 to 85 percent confidence.
- It requires the patient name, the date of service, and at least one billable code.
- It applies standard bundling rules. A Swan-Ganz catheter supersedes a central line at the same site, and duplicate procedures are removed.
- It codes every case without a forced review alert.

After you complete your choices, do the following:

1. Review your choices with your coding manager.
2. Send your choices to your Hank representative.
3. Test the configuration with sample cases before go-live.
4. Keep a signed copy for your records.

## Glossary

| Term | Meaning |
|---|---|
| AA (modifier) | The modifier for an MD who personally performs the anesthesia. |
| AA (role) | Anesthesiologist Assistant. This provider role is not the AA modifier. |
| AD | The modifier for medical supervision of more than 4 concurrent cases. |
| ASA | American Society of Anesthesiologists. Their physical status classification is P1 to P6. |
| ASRA | American Society of Regional Anesthesia and Pain Medicine. |
| Claim checking service | An automated service that checks claims against NCCI bundling edits and payer rules. |
| COMPLIANCE | An alert type for a possible regulatory or audit concern. |
| CRNA | Certified Registered Nurse Anesthetist. |
| DOS | Date of service. |
| FINANCIAL | An alert type for a possible revenue impact. |
| HARDSTOP | An alert type for something missing or conflicting that a person must resolve. |
| INFORMATIONAL | An alert type for information only. No action is required. |
| LDA | Lines, drains, and airways. These procedures include arterial lines, central lines, and intubation. |
| MAC | Monitored anesthesia care. |
| NCCI | National Correct Coding Initiative. These are the CMS bundling rules. |
| NPI | National Provider Identifier. Each provider has one 10-digit number. |
| Processing rule | A configurable rule that controls whether the autocoder bills a procedure, bundles it, or raises an alert. |
| QK | The modifier for the directing physician in medical direction. |
| QX | The modifier for the directed CRNA or AA. |
| QY | The modifier for medical direction of one CRNA by an anesthesiologist. |
| QZ | The modifier for a CRNA who practices independently. |
| RVU | Relative value unit. |
| Review alert | A notification attached to a claim for a person to review. Each alert carries a type, a severity from 1 to 10, and a suggested reviewer role. |
| TEFRA | Tax Equity and Fiscal Responsibility Act. TEFRA sets the 7 CMS requirements for medical direction billing. |

## Section 1: General controls

**Tier: REQUIRED**

### 1.1 Force review on every claim

Decide if every claim gets a review alert, whatever its confidence score.

- **Yes**: every claim gets a review alert.
- **No**: only claims with a problem get an alert. A problem is low confidence, missing data, or a rule violation. *Default*

**What this changes**: with forced review on, every claim carries a review alert. With forced review off, a high-confidence claim with no problem carries no alert. The setting is `forceHumanReview`.

### 1.2 Starting point: practice type

Select the practice type that matches your facility. The practice type sets the defaults for medical direction, TEFRA checks, and provider scenarios. You can still change any single setting in the sections below.

| Practice type | Description | Key behavior |
|---|---|---|
| Standard medical direction | The most common US anesthesia group. One MD directs 2 to 4 CRNAs or AAs. | MD plus CRNA bills the QK and QX pair. A CRNA alone bills QZ. All 7 TEFRA requirements apply. |
| Teaching hospital | An academic program with residents in anesthesia. | The same as standard. A CRNA alone raises a HARDSTOP alert, because an MD is required on every case. Pre-op, intra-op, and post-op notes are required. |
| CRNA independent practice | For states where CRNAs practice independently. An MD who is present is not directing. | MD plus CRNA bills the CRNA with QZ, not QX. TEFRA checks are skipped for CRNA cases. |
| MD only practice | A solo MD performs all anesthesia. The facility employs no CRNAs or AAs. | A CRNA or AA in the data raises a HARDSTOP alert, because it is probably an extraction error. Only MD-alone cases produce claims. |
| No direction modifiers | Your downstream billing system adds all modifier logic. | The autocoder assigns providers to lines and adds no direction modifier. It adds no AA, QZ, QK, QX, GC, or AD. |
| Custom | None of the above matches. Configure each setting on its own. | Any setting you do not state uses the standard medical direction behavior. |

**Why this matters**: a practice type sets the correct defaults for your facility. A teaching hospital, for example, alerts on every CRNA-alone case and requires the full note set. You save time and you avoid errors.

**Note**: CRNA independent practice is not the same as no direction modifiers. CRNA independent still assigns QZ and AA modifiers from the staffing. Select it when you want modifier-ready claims. No direction modifiers skips every modifier. Select it when your downstream billing system adds the modifiers.

## Section 2: Medical direction and TEFRA

**Tier: REQUIRED**

### 2.1 Enable medical direction billing

Decide if the autocoder bills medical direction when an anesthesiologist works with a CRNA or an AA.

- **Yes, enable medical direction billing**: bill both providers. The MD gets QK and the CRNA or AA gets QX. *Default*
- **No, disable medical direction**: assign providers to billing lines and add no direction modifier.

**What this changes**: with medical direction on, a case with both an MD and a CRNA or AA produces two billing lines. Each line carries the correct modifier for that provider. With medical direction off, the autocoder still assigns the correct provider to each line, but it adds no direction modifier at all. Your downstream billing system must add them. If you want QZ on CRNA-alone cases or AA on MD-alone cases, keep medical direction on and use the billing scenarios in Section 2.7. The setting is `medicalDirection`.

If you choose No, go to Section 3.

### 2.2 The 7 TEFRA requirements

CMS requires the anesthesiologist to meet seven requirements for Medicare medical direction billing. Select the requirements your facility enforces.

| Number | Requirement | Options | Default |
|---|---|---|---|
| 1 | The MD performed the pre-anesthetic examination and evaluation. | Enforce or Skip | Enforce |
| 2 | The MD prescribed the anesthesia plan. | Enforce or Skip | Enforce |
| 3a | The MD was personally present for induction. | Enforce or Skip | Enforce |
| 3b | The MD was personally present for emergence. | Enforce or Skip | Enforce |
| 4 | The MD confirmed that all providers who performed procedures were qualified. | Enforce or Skip | Enforce |
| 5 | The MD monitored the course of anesthesia at frequent intervals. | Enforce or Skip | Enforce |
| 6 | The MD was physically present and immediately available. | Enforce or Skip | Enforce |
| 7 | The MD provided the indicated post-anesthesia care. | Enforce or Skip | Enforce |

**What this changes**: the autocoder reads the documentation for evidence of each enforced requirement. If the documentation does not support one or more enforced requirements, your choice in Section 2.3 decides what happens.

### 2.3 Action when TEFRA requirements are not met

Decide what happens when the documentation does not prove every enforced TEFRA requirement.

- **Bill medical direction and raise a compliance alert**: the claim keeps the QK and QX modifiers, and a reviewer sees a COMPLIANCE alert. *Default*
- **Drop to CRNA non-directed**: remove the MD line. Only the CRNA bills, with the QZ modifier.
- **Drop to CRNA non-directed and suppress the alert**: the same as above, and no TEFRA alert appears. Use this when the drop to CRNA is your policy, not an exception.
- **Drop to supervision**: change the MD modifier from QK to AD.
- **Keep the MD on the line and raise a HARDSTOP alert**: the MD stays on the line with no modifier. A coder resolves the alert.

If you bill with an alert, you also choose:

- Alert severity from 1 to 10. *Default: 8*
- Alert type: HARDSTOP, COMPLIANCE (*Default*), FINANCIAL, or INFORMATIONAL.

**Provider-conditional actions (optional)**: if you employ both CRNAs and AAs, you can set a different action for AA-only cases.

- **The same action for all provider types**. *Default*
- **A different action for AA cases**. For example, keep the MD on the line and alert for AAs, while CRNAs drop to QZ.

**What this changes**: "Bill with an alert" sends the claim with QK and QX, and a reviewer checks the TEFRA documentation. "Drop to CRNA" removes the MD from the claim. Only the CRNA with QZ reaches the payer. "Drop to supervision" changes the MD line from QK to AD, which reimburses less. "Keep the MD on the line" leaves the modifier decision to a coder.

### 2.3a Action when TEFRA requirements are met

**Tier: ADVANCED**

By default, normal billing proceeds when the TEFRA requirements are met. The MD and CRNA get QK and QX as you configured them. Some facilities want to override the billing scenario when TEFRA passes.

- **Normal billing proceeds**: use the configured scenario. *Default*
- **Bill the MD with no direction modifier**: the MD is on the line with no QK, QX, QZ, or AA modifier.

**What this changes**: the override puts only the MD on the line with no direction modifier. Most facilities keep the default. Use the override when a TEFRA pass at your facility means the MD can bill without a direction modifier, and a TEFRA failure triggers a fallback such as a drop to CRNA.

### 2.4 MD validation rules

This rule controls how strictly the autocoder verifies MD involvement.

| Rule | Options | Default |
|---|---|---|
| Require explicit MD documentation, such as note identifiers or staff times, before the autocoder applies QK or QY. | Yes or No | Yes |

**What this changes**: if you require MD evidence and the documentation contains none, the MD line gets no QK or QY modifier.

**Note**: two related decisions live in Section 2.7. How a CRNA without a documented MD bills is the "CRNA alone" scenario. What happens when an AA appears without a directing MD is the "AA alone" scenario. Set both there.

### 2.5 Time allocation

Decide how the autocoder allocates anesthesia time when it bills an MD and a CRNA or AA on separate lines.

- **Both providers bill the full anesthesia time**: on a 60-minute case, the MD bills 60 minutes and the CRNA bills 60 minutes. *Default*
- **Each provider bills the documented time**: not yet available. See the caution below.
- **Only the primary provider bills time**: not yet available. See the caution below.

**What this changes**: "Both full time" is the most common and the most conservative choice. The payer sees the full time on both lines.

**Caution.** The "documented time" and "primary only" strategies are accepted in the configuration but not applied. The autocoder puts the full anesthesia time on both lines whatever you select. Tell your Hank representative if your facility needs one of these strategies. Do not rely on this setting until the feature ships.

### 2.6 Handover and relief

Decide how the claim is structured when one anesthesiologist relieves another during a case.

- **Keep one primary provider**: bill everything under the provider with the most time. *Default*
- **Split at handovers**: create a separate billing line for each provider's time period.

If you keep one primary provider, choose how the autocoder picks the primary for each provider role. The options are most time, started the case, or finished the case. Most time is the default for the attending MD, the CRNA, the AA, and the resident.

**What this changes**: "Keep primary" puts all the time under one name and NPI. If one physician was present for 120 minutes and another for 60 minutes, all 180 minutes go under the first physician. "Split" produces two lines with different providers and different time ranges. A split produces more line items, and it reflects who was present at each point.

### 2.7 Billing scenarios by provider combination

Choose how the autocoder bills each staffing scenario.

| Scenario | Options | Default |
|---|---|---|
| MD directing a CRNA | Bill both (QK and QX), bill the MD only, or bill the CRNA only | Bill both (QK and QX) |
| MD directing an AA | Bill both (QK and QX), or bill the MD only | Bill both (QK and QX) |
| MD with a resident | Bill the MD with the teaching modifiers (AA and GC), or bill the MD only | AA and GC |
| CRNA alone, no MD | Bill as non-directed (QZ), or raise a HARDSTOP alert | Bill QZ |
| AA alone, no MD | Raise a HARDSTOP alert. CMS requires this. | HARDSTOP alert |
| MD alone | Bill as personally performed (AA), or raise a HARDSTOP alert | Bill AA |

**Note**: select the CRNA independent practice type in Section 1.2 if your CRNAs practice independently while an MD is present but not directing. That practice type changes the "MD directing a CRNA" scenario to bill the CRNA as non-directed with QZ, instead of the QK and QX pair.

**What this changes**: each scenario controls the modifier on each claim line. "MD directing a CRNA, bill both" produces two lines. The MD line carries QK and the CRNA line carries QX. "CRNA alone, QZ" produces one line with QZ. An AA alone always raises a HARDSTOP alert, per the CMS rule.

### 2.8 Concurrent case limits

**Caution.** The autocoder accepts these settings and does not apply them. The autocoder codes one case at a time, and it does not track how many cases an MD directs at once. It enforces no concurrency limit and it changes no modifier. Tell your Hank representative if your facility needs concurrency checks. Do not rely on these settings until the feature ships. Track concurrency in your practice-management system meanwhile.

The maximum number of cases one MD can medically direct at the same time defaults to 4, which is the CMS maximum. The action when the MD exceeds the limit defaults to a drop to supervision, which changes QK to AD on the excess cases. The alternative action is a HARDSTOP alert.

## Section 3: ASA physical status modifiers

**Tier: ADVANCED**

Decide if the autocoder adds ASA physical status modifiers P1 to P6 to anesthesia line items.

- **Yes, add the P-modifier automatically**: the autocoder reads the ASA status from the documentation and adds the matching modifier. *Default*
- **No, do not add the P-modifier**: your coders or an external workflow assign it.

**What this changes**: with the P-modifier on, each anesthesia line carries a P-modifier. Some payers reimburse differently by ASA status. With the P-modifier off, no P-modifier appears, and your team adds one where you need it. The autocoder also raises no alert for a missing P-modifier. The rule is `asa_p_modifier_control`.

**Example**: a facility that assigns the ASA status in a separate workflow turns the automatic P-modifier off.

## Section 4: Procedure billing rules

**Tier: REQUIRED**

These rules control when the autocoder bills a procedure. Each rule reads the documentation details, the note source, or a special condition. Each rule can make a procedure billable, make it non-billable, or raise a review alert.

### 4.1 Ultrasound guidance, 76937 and 76942

CPT requires stored images for the ultrasound guidance codes.

When the documentation does not mention image storage:

| Code | Bill it? | Alert type | Alert severity |
|---|---|---|---|
| 76937, vascular access guidance | Yes (*Default*) or No | COMPLIANCE (*Default*), FINANCIAL, or INFORMATIONAL | *Default: 7* |
| 76942, needle placement guidance | Yes (*Default*) or No | COMPLIANCE (*Default*), FINANCIAL, or INFORMATIONAL | *Default: 7* |

When the documentation states that the images were not stored:

| Code | Bill it? | Alert type | Alert severity |
|---|---|---|---|
| 76937 | Yes, or No (*Default*) | FINANCIAL (*Default*) or COMPLIANCE | *Default: 9* |
| 76942 | Yes, or No (*Default*) | FINANCIAL (*Default*) or COMPLIANCE | *Default: 9* |

**What this changes**: if you bill the ultrasound code without storage documentation, the code appears on the claim and an alert notifies your reviewer. If you do not bill it, the code moves to the bundled and non-billable list. CPT does not support billing when the documentation states that the images were not stored. The rules are `ultrasound_76937_no_storage_documented`, `ultrasound_76942_no_storage_documented`, `ultrasound_76937_explicitly_not_stored`, and `ultrasound_76942_explicitly_not_stored`.

**Example**: a conservative facility bills these codes without storage documentation and lowers the alert to INFORMATIONAL at severity 5.

### 4.2 TEE from case events only

Decide what happens when the case event timeline records a TEE placement and the packet contains no separate TEE procedure note.

- **Code it**: add TEE code 93313 with modifier 59 for NCCI unbundling, and raise a review alert. *Default*
- **Do not code it**: require a procedure note before the autocoder bills a TEE.

Alert severity: *Default: 5*

**What this changes**: if you code it, the claim carries a 93313 line with modifier 59 and a compliance alert. If you do not code it, no TEE charge appears. Conservative facilities turn this rule off. The rule is `tee_from_events_only`.

**Example**: a facility that codes a TEE from the events changes the alert to INFORMATIONAL at severity 7 to reduce the review queue volume.

### 4.3 Lines, drains, and airways notes

Decide what happens when a procedure appears only in an LDA-type note. These notes are often checklists or tracking forms.

- **Bill from LDA notes**: treat a procedure in an LDA note as billable.
- **Skip LDA notes**: do not bill a procedure that appears only in an LDA note. *Default*

**What this changes**: with LDA notes skipped, the autocoder moves these procedures to the bundled list. If the same procedure also appears in an anesthesia procedure note, the autocoder still bills it from that source. The rule is `lda_procedures`. It marks the procedure non-billable and raises an INFORMATIONAL alert at severity 1.

### 4.4 Same-stick central line access

Decide what happens when a Swan-Ganz catheter goes through a central line introducer at the same access site.

- **Bundle the central line**: remove the central line charge and bill the Swan-Ganz alone, per NCCI. *Default*
- **Bill both**: both the central line and the Swan-Ganz appear on the claim.

**What this changes**: the default removes the central line code, because the NCCI edits bundle it with a Swan-Ganz at the same site. Only the Swan-Ganz code reaches the payer. The rule is `same_stick_central_access`.

### 4.5 Duplicate procedures

Decide what happens when the same procedure appears in more than one note.

- **Bill once only**: remove the duplicates and keep the highest-confidence version. *Default*
- **Bill each instance**: keep every instance for a reviewer to judge.

**What this changes**: the default removes the duplicate procedure codes. One instance of each code reaches the payer. An INFORMATIONAL alert tells the reviewer that the autocoder found and removed duplicates. The rule is `duplicate_procedures`.

### 4.6 Failed or aborted procedures

Decide what happens when the documentation shows an attempted procedure that failed or was aborted.

- **Do not bill it**: remove the failed procedure from the claim. *Default*
- **Bill it and raise an alert**: keep the procedure on the claim and let a reviewer decide.

**What this changes**: the default removes the failed procedure code. The code appears in the bundled and non-billable list with the reason "procedure failed". The rule is `failed_procedures`.

### 4.7 NCCI bundles from the claim checking service

Decide what happens when the automated claim checking service finds an NCCI bundling edit.

- **Remove the bundled code**: accept the bundle and remove the code from the claim. *Default*
- **Keep both codes and raise an alert**: leave both codes on the claim for a reviewer.

**What this changes**: the default removes the bundled code, per the NCCI rule. The removed code appears in the bundled list with the specific edit reason. If you keep both codes, both reach the payer, and the payer may deny one. The rule is `claimcleaner_bundles`.

### 4.8 NCCI modifier preference, 59 or the X modifiers

CMS introduced the X modifiers XE, XS, XP, and XU as more specific replacements for modifier 59. Medicare prefers the X modifiers. Commercial payer acceptance varies.

- **Use modifier 59** for all NCCI distinct-procedure identification. *Default*
- **Use the X modifiers**: convert modifier 59 to the most specific X modifier for the claim structure.

**What this changes**: with the X modifiers on, the autocoder converts modifier 59 after the claim checking service validates the claim. XE marks a separate encounter, such as a return to the operating room. XS marks a separate structure, which is a different anatomic site. XU marks an unusual non-overlapping service, such as a TEE, a nerve block, or another add-on procedure. Modifier 59 remains the fallback when no specific X modifier applies. The setting is `ncciModifierPreference`, with the values `59` and `x_modifiers`.

**Example**: a facility contracted with Medicare Advantage plans that require the X modifiers selects `x_modifiers`. A facility with workers' compensation or commercial payers that reject the X modifiers keeps `59`.

### 4.8a Nerve block line-item diagnosis codes

This setting controls which diagnosis codes ride on a separately billed nerve-block line. By default the block line does not inherit every diagnosis coded elsewhere on the encounter. It carries its own post-op pain diagnosis only.

- **G89 codes only**: the block line carries its post-operative pain code, usually G89.18. *Default*
- **G89 plus site**: the block line also keeps the site-specific pain diagnosis for that block, such as a shoulder or knee pain M code with G89.18.
- **Copy all diagnoses**: the block line inherits every diagnosis on the encounter. This is the older behavior.

**What this changes**: the default keeps a clean, defensible diagnosis on the nerve-block line, and it stops unrelated encounter diagnoses from attaching to it. "G89 plus site" adds the anatomic pain code when your payers expect it. "Copy all diagnoses" restores the previous behavior. If a block line would carry no diagnosis at all, the autocoder raises a HARDSTOP alert for a coder, so no block line is ever billed without a diagnosis. The setting is `nerveBlockLineIcds`, with the values `g89_only`, `g89_plus_site`, and `copy_all`.

**Note**: the default changed in a recent release. Select `copy_all` if you want every diagnosis to copy onto your nerve-block lines.

### 4.9 Qualifying circumstance codes

The age-based qualifier 99100 applies to a patient under age 1 or age 70 and older. Choose one:

- **Always add it when it applies**: add 99100 from the patient age. *Default*
- **Add it and raise an alert for verification**.
- **Never add it automatically**: a coder adds 99100 by hand.

The emergency qualifier 99140 applies to an emergent case. Choose one:

- **Always add it when it applies**: add 99140 when the case is emergent. *Default*
- **Add it and raise an alert for verification**.
- **Never add it automatically**: a coder adds 99140 by hand.

**What this changes**: 99100 and 99140 appear as extra line items on the claim. Some payers reimburse them separately, and others bundle them. With "never add", these codes appear only when a coder adds them. The rules are `special_circumstances_99100` and `special_circumstances_99140`.

**Medicare gate, on by default**: when the primary payer is Medicare, the autocoder moves the qualifying circumstance codes 99100, 99116, 99135, and 99140 out of the billable line items into the bundled list. It also raises the INFORMATIONAL alert `medicare_qualifying_circumstances_bundled` at severity 1. Medicare bundles these codes into the base anesthesia code and does not pay them separately. So even with "always add when it applies", these codes are not billable on a Medicare claim by default.

**Decide this one deliberately.** The suppression raises an INFORMATIONAL alert only. Nothing errors. If your contracts have you billing qualifying circumstance codes to every payer, tell your Hank representative to set `qualifyingCircumstances.suppressForMedicare` to the boolean `false` before your build is deployed. Confirm the change on a test Medicare claim before go-live. Otherwise these codes stop appearing as billable on Medicare claims, and the only trace is that INFORMATIONAL alert plus the code in the bundled list.

**Do not use an empty `medicareBundledCodes` list to turn the gate off.** An empty list means "suppress nothing" only on recent builds. On an older production build, an empty list did the opposite and suppressed all four codes. Use `suppressForMedicare` set to `false`. It behaves the same way on every build.

**Example**: some facilities do not bill 99100, because their payers do not reimburse it.

### 4.10 OB case review

Choose how the autocoder treats every obstetric anesthesia case, which includes labor epidurals and cesarean deliveries.

- **Require review for all OB cases**: every OB case gets a review alert. *Default*
- **Code them automatically**: the autocoder treats OB cases like other cases.
- **Alert on high-risk cases only**: only an unusual OB case gets an alert.

**What this changes**: with review required, every OB case carries the HARDSTOP alert `ob_case_review` at severity 2 by default. OB cases often carry complex global-pay and fee-for-service considerations, so a coder should confirm them.

**Overnight OB cases**: some cases run past midnight. An epidural goes in late one evening and the cesarean delivery follows in the early hours of the next day. The autocoder uses the earliest date as the date of service, and it tells the coding step that the encounter spans midnight. For an overnight case it selects the CPT and ICD code set from the encounter end date. This behavior needs no configuration.

### 4.11 Cosmetic procedure detection

Choose what happens when the autocoder detects a cosmetic procedure in the surgical notes.

- **Raise a HARDSTOP alert**: a reviewer separates the covered portion from the cosmetic portion. *Default*
- **Raise a high-priority review alert** of another type.

**What this changes**: a cosmetic procedure usually needs split billing. One claim covers the medical portion, and the patient is responsible for the cosmetic portion. The HARDSTOP alert asks a coder to review the time allocation first. The rule is `cosmetic_procedure_split_billing`.

### 4.12 No primary anesthesia code found

Choose what happens when the autocoder cannot identify a primary anesthesia CPT code for the case.

- **Raise a HARDSTOP alert** for manual review. *Default*
- **Raise a review alert** of another type.

**What this changes**: without a primary anesthesia code, the claim carries no base units for the time calculation. This usually means a canceled case, a monitoring-only case, or insufficient documentation. The rule is `anes_no_cpt_code`.

### 4.13 Nerve block billed as time

Choose what happens when a nerve block is the primary anesthetic and the autocoder must bill it as time units instead of a flat fee.

- **Raise a FINANCIAL alert**: tell the coder that the reimbursement is lower than the flat fee. *Default*
- **Raise no alert**.

Alert severity: *Default: 5*

**What this changes**: CMS and ASRA guidance require a nerve block used as the primary anesthetic to bill under the ASA code with time units, not as a separate flat-fee procedure. The reimbursement is usually lower. A short block produces a fraction of one time unit, where the flat fee is worth several RVUs. The alert asks the coder to confirm the result. The rule is `nerve_block_billed_as_time`.

### 4.14 CPT codes that always need review

List the CPT codes that always need a review alert when they appear on a claim. Give your Hank representative each code and the reason for the review.

- Alert severity: *Default: 8*
- Alert type: HARDSTOP (*Default*), COMPLIANCE, or FINANCIAL.

**What this changes**: any claim with one of your listed codes carries a high-priority alert. A reviewer confirms the code. The rule is `required_code_review`.

### 4.15 Date of service more than 1 year old

Choose what happens when the date of service is more than 1 year in the past.

- **Raise a HARDSTOP alert** for a charge entry review. *Default*
- **Raise a review alert** of another type.
- **Raise no alert**.

**What this changes**: an old date of service usually means the case reached the autocoder in error, or the date contains a data entry mistake. The alert asks a person to confirm the date. The rule is `anes_dos_age_warning`.

### 4.16 Alerts on handwritten sources

Handwritten notes can read less accurately than typed notes. Choose the behavior for each key billing field taken from a handwritten source.

| Field | Options | Default severity |
|---|---|---|
| ASA physical status, P1 to P6 | HARDSTOP alert (*Default*), another alert type, or no alert | 6 |
| Emergent status for 99140 | HARDSTOP alert (*Default*), another alert type, or no alert | 6 |
| Anesthesia type: general, regional, or MAC | HARDSTOP alert (*Default*), another alert type, or no alert | 6 |

**What this changes**: a value read from a handwritten note can be inaccurate. The default HARDSTOP alert asks a reviewer to confirm the value. This prevents an incorrect ASA modifier, an incorrect emergency qualifier, and an incorrect anesthesia type. The rules are `handwritten_asa_source`, `handwritten_emergent_source`, and `handwritten_type_source`.

**Automatic corroboration**: the autocoder cross-checks a handwritten value against the typed and electronic sources first. If a typed note reports the same ASA status, emergent status, or anesthesia type, the autocoder suppresses the alert. The electronic source is the corroboration. These alerts fire only when a handwritten note is the sole source for the value. The same logic applies to the anesthesia start and end times. If the case event times or the staff times confirm the times on a handwritten form, the autocoder suppresses the handwritten-time alert.

### 4.17 Non-standard time source

Choose what happens when the anesthesia start and end times come from a source other than the standard case event timesheet.

- **Raise a FINANCIAL alert**: tell charge entry that the times came from a non-standard source. *Default*
- **Raise no alert**.

Alert severity: *Default: 3*

**What this changes**: the time units affect the reimbursement directly. Times from a procedure note or another non-standard source can be less accurate than the official case event timesheet. The alert asks charge entry to check the times. The rule is `anes_non_case_times_source`.

### 4.18 Neuraxial procedures without documented times

Choose what happens when the autocoder finds a neuraxial procedure, such as an epidural or a spinal, and the documentation carries no start and end times for it.

- **Raise an INFORMATIONAL alert**: tell the coder that the procedure may be billable for time units if the provider performed it outside the anesthesia time. *Default*
- **Raise no alert**.

**What this changes**: a neuraxial procedure performed outside the primary anesthesia time window can be separately billable for time units. A labor epidural placed hours before a cesarean delivery is one example. Without times the autocoder cannot calculate the time-based billing. The alert reminds the coder to check whether the times belong on the claim. The rule is `neuraxial_without_times`.

### 4.19 Combined upper and lower GI endoscopy, 00813

The autocoder combines upper endoscopy anesthesia code 00731 and lower endoscopy anesthesia code 00811 or 00812 into the combined code 00813 when it finds both in the same case.

This behavior is not configurable, because it follows standard coding practice. An INFORMATIONAL alert tells the reviewer about the combination.

**What this changes**: the combined code 00813 replaces both individual codes on the claim. 00813 usually carries more base units than 00731, 00811, or 00812 alone, so the reimbursement is usually higher. The autocoder keeps the rationale from both original codes in the claim details.

## Section 5: Discontinuous time

**Tier: ADVANCED**

Anesthesia time sometimes comes in separate segments. An epidural takes one short segment, and the cesarean delivery anesthesia takes a later segment. Choose how the gap time appears on the claim.

- **Add the gap time to the start of the first segment**: the combined time starts earlier to account for the total minutes. *Default*
- **Add the gap time to the end of the last segment**: the combined time ends later to account for the total minutes.
- **Keep the segments separate**: each segment appears as its own entry on the claim.

Choose whether the autocoder raises an alert for discontinuous times.

- **Yes**: tell the coder about the multiple segments. *Default*
- **No**.

Alert severity: *Default: 4*

**What this changes**: the autocoder always preserves the total minutes. This choice only changes how the minutes appear on the claim. For a total of 90 minutes across two segments, the first option shows 90 continuous minutes from an adjusted earlier start. The second option shows 90 minutes to a later end. "Separate" sends two time entries. Some billing systems cannot accept more than one time entry, so combining is the default. The rule is `discontinuous_times`.

## Section 6: Confidence thresholds

**Tier: ADVANCED**

The autocoder assigns a confidence score from 0 to 100 percent to every code it selects. The score states how certain the autocoder is that the code matches the documentation. A surgical note that clearly describes a knee arthroscopy can produce 95 percent confidence on code 29881. If the note is ambiguous about a diagnostic or a therapeutic arthroscopy, the confidence drops. The autocoder raises a review alert when the confidence falls below your threshold.

**The severity is fixed and you cannot configure it.** Only the threshold percentages are configurable, and only for the rows below. The severity column shows the value the autocoder emits, so you know what the reviewer sees.

| Code type | Default threshold | Alert severity (fixed) |
|---|---|---|
| Primary anesthesia codes, 00100 to 01999 | 85 percent | 7 |
| Surgical and procedure CPT codes | 80 percent | 7 |
| ICD diagnosis codes | 80 percent | 5 |
| Modifiers, such as LT, RT, and 59 | 80 percent | 7 |

**Thresholds you cannot set.** These rows appear in the configuration and nothing reads them. Leave them alone.

| Code type | Status | What applies instead |
|---|---|---|
| GI endoscopy anesthesia codes | Not implemented | The primary anesthesia threshold of 85 percent applies to every anesthesia code. |
| OB anesthesia codes | Not implemented | The primary anesthesia threshold of 85 percent applies. |
| Anesthesia procedures: lines, blocks, and airways | Not implemented | The surgical and procedure threshold of 80 percent applies. |
| Nerve block codes | Not implemented | The surgical and procedure threshold of 80 percent applies. |
| Start and end times | Not implemented | No confidence alert fires on the case times. |

**What this changes**: a code below your threshold still appears on the claim, and it carries a review alert. The alert tells the reviewer which code needs verification. A lower threshold produces fewer alerts and more risk that an incorrect code reaches the payer. A higher threshold produces more alerts and better accuracy.

**Note on the severity numbers**: some configuration files show a severity of 8 for anesthesia codes and 6 for ICD codes. Those values are inactive. The autocoder emits severity 7 for an anesthesia code and severity 5 for an ICD code. The only configurable severity in this area is the missing-note severity in Section 8.1.

## Section 7: Quality check toggles

**Tier: REQUIRED**

Turn each validation check on or off.

| Check | What it does | Default |
|---|---|---|
| Low confidence alerts | Raise an alert for a code below the confidence threshold. | On |
| Time validation | Verify that the start and end times are logical. The end follows the start, and the duration is under 24 hours. | On |
| Required note checks | Verify that the required note types are present. See Section 8. | On |
| Require a provider NPI | Raise a HARDSTOP alert when a provider NPI is missing. | Off |

**What this changes**: each check, when on, can raise an alert. A check that is off lets that type of problem pass silently, with no alert. With time validation off, for example, a claim proceeds even when the start time follows the end time. With the NPI check off, a claim proceeds with a blank provider NPI field.

**Four settings that look like toggles and are not.** These keys appear in the configuration and nothing reads them. Setting them does nothing. The right column states what controls the behavior instead.

| Setting that looks like a toggle | Status | What controls the behavior |
|---|---|---|
| Missing modifier checks | Not implemented | The modifier threshold in Section 6.1 covers modifier confidence. |
| Duplicate code detection | Not implemented | The bundling rules handle duplicate procedures. This key does not gate them. |
| LDA procedure hard stop | Not implemented | The `lda_procedures` rule handles a procedure from an LDA note. It marks the procedure non-billable and raises an INFORMATIONAL alert at severity 1. |
| Require insurance information | Not implemented | Insurance is already required through the required-field check in Section 8.2, as a HARDSTOP alert at severity 7. Turn it off there. |

**Example**: a facility whose documents make time extraction unreliable turns the time validation check off and verifies the times outside the autocoder.

## Section 8: Required documentation

**Tier: REQUIRED**

### 8.1 Required note types

Select the clinical note types that must be present for a complete claim. The choices are the anesthesia pre-operative note, the anesthesia intra-operative note, the anesthesia post-operative note, the staff times, the case event times, and the surgeon procedure note. Name any other note type your facility requires.

*Default: no required note types.*

**Note**: the required note check in Section 7 must be on for this section to take effect. With that check off, the autocoder ignores a missing note whatever you select here.

Missing note alert severity: *Default: 5*

**What this changes**: when a required note type is absent from the documentation, the claim carries a COMPLIANCE alert. This catches a package that reached the autocoder without a key note, such as the post-op note. The setting is `requiredNoteTypes`.

**Facility examples**:

- Standard direction requires the pre-operative note.
- CRNA independent and MD only require no notes.
- A teaching hospital requires the pre-operative, intra-operative, and post-operative notes.
- Some facilities require only the surgeon procedure note, or no notes at all.

### 8.2 Required patient fields

Select the patient information fields that must be present. Every field below is required by default except the two NPI fields.

| Field | Alert type | Alert severity | Reviewer | Required by default |
|---|---|---|---|---|
| Patient first and last name | HARDSTOP | 8 | Data entry | Yes |
| Patient date of birth | HARDSTOP | 8 | Data entry | Yes |
| Patient medical record number | FINANCIAL | 6 | Data entry | Yes |
| Date of service | HARDSTOP | 10 | Charge entry | Yes |
| At least one billable code | HARDSTOP | 10 | Coder | Yes |
| Insurance information | HARDSTOP | 7 | Data entry | Yes |
| Surgeon name | HARDSTOP | 8 | Data entry | Yes |
| Provider name on every line | HARDSTOP | 8 | Data entry | Yes |
| Provider role on every line | HARDSTOP | 6 | Charge entry | Yes |
| Provider title on every line | HARDSTOP | 5 | Charge entry | Yes |
| Provider NPI on every line | HARDSTOP | 8 | Charge entry | No |
| Surgeon NPI | HARDSTOP | 8 | Charge entry | No |

**What this changes**: a missing required field raises either a HARDSTOP alert or a FINANCIAL alert, as the table shows. The date of service and the billable code carry the highest default severity, because no valid claim exists without them.

**Note**: the autocoder first tries to fill a missing patient name, date of birth, medical record number, insurance, date of service, or surgeon name with an extra extraction pass. The alert fires only when the field is still missing after that pass.

## Section 9: Staff time merging

**Tier: RARE**

The same provider can appear in more than one note under different name formats. A timing sheet can carry an initial and a last name, and a procedure note can carry the full first name. The autocoder can merge these entries.

| Setting | Options | Default |
|---|---|---|
| Match a single-letter initial to a full first name. | Yes or No | Yes |
| Merge only when one entry has no documented times. This prevents a merge of two different people. | Yes or No | Yes |
| Require the same role to merge. An attending entry does not merge with a resident entry. | Yes or No | Yes |

**What this changes**: a merge produces one clean entry per provider on the claim. Without a merge, one person can appear as two providers, which produces an incorrect time allocation or an incorrect medical direction result. The two safeguards prevent a merge of two different people who share an initial and a last name. The setting is `staffTimeMerging`.

## Section 10: Paper form handling

**Tier: ADVANCED**

Choose how sensitive the autocoder is when it detects a handwritten document. The threshold is the share of the document that reads as handwriting.

- **0.5 percent**: very sensitive. Any handwriting triggers the special processing.
- **1.5 percent**: high sensitivity.
- **2.0 percent**: standard sensitivity. *Default*
- **4.0 percent**: less sensitive. Only a heavily handwritten form is detected.
- A custom percentage.

**What this changes**: the autocoder treats a handwritten document differently. It scores the confidence from the legibility of the handwriting, so legible handwriting can still score high. It also adds the verification alerts and the handwritten source alerts from Section 4.16. A lower threshold classifies more documents as handwritten, which produces more alerts. A higher threshold detects fewer documents, and more handwritten data is then treated as reliable electronic data.

A facility that wants every handwritten-only code routed to review, whatever the legibility, can enable `claimValidation.handwrittenForceConfidence33`. That setting sets the confidence to 33 on any code whose source notes are all handwritten.

**Example**: a facility whose providers add handwritten notes to electronic forms uses 4 percent, so only a fully handwritten document is detected.

## Section 11: Provider information

**Tier: REQUIRED**

A provider roster lets the autocoder match NPIs and detect provider types automatically. Send your Hank representative three rosters.

- **Anesthesia physicians**: the name, the title, and the NPI of each MD and DO.
- **CRNAs and AAs**: the name, the title, and the NPI of each provider.
- **Surgeons and referring physicians**: the name, the title and specialty, and the NPI of each physician.

**What this changes**: with a roster loaded, the autocoder matches a provider name in the clinical notes to that provider's NPI. The NPI then appears on the correct line items. Without a roster, the provider NPI field stays blank, and a reviewer adds it by hand. A blank NPI can cause a rejection when your payer requires one. The setting is `providerMappings`.

## Section 12: Custom coding instructions and encounter summary

**Tier: ADVANCED**

### 12.1 Custom coding instructions

You can add facility-specific instructions that change how the autocoder selects codes. Write them in plain English. The autocoder applies them directly to its coding instructions for the area you name.

You can supply a separate instruction set for each of these areas:

- Primary anesthesia codes, 00100 to 01999.
- Nerve block coding.
- All anesthesia procedures, such as lines, airways, and TEE.
- GI endoscopy anesthesia.
- OB anesthesia.
- Surgical procedures.

**What this changes**: a custom instruction changes which codes the autocoder selects. Keep each instruction specific and actionable.

**Examples from real facilities**:

| Area | Instruction | Effect |
|---|---|---|
| Nerve blocks | Never include ultrasound 76942 with unlisted nerve blocks 64450 and 64999. | 76942 never appears with 64450 or 64999 on a claim. |
| All procedures | Return only one 76937 when more than one appears. | A claim carries a maximum of one 76937. |
| Primary anesthesia | State the difference between an AICD and a pacemaker, 00530 and 00534. | The autocoder selects the correct code for a cardiac device. |

### 12.2 Document segmentation instructions

Send instructions if your documents carry unusual formatting that the autocoder must handle differently.

**Example**: an instruction can state that several separate surgeon procedure notes appear under one operative note heading, and that the autocoder must separate each one.

### 12.3 Extraction instructions

Send instructions if your provider names or other fields appear in an unusual format.

**Example**: an instruction can state that a staff name appears as the last name, a credential, the first name, and a credential, and that the autocoder must read the name correctly from that order.

### 12.4 Encounter summary

Choose whether the autocoder writes a plain-English summary of each encounter for the reviewer.

- **Yes**: write encounter summaries. *Default*
- **No**: skip encounter summaries.

Choose which procedures include a summary. The options are surgical procedures (*Default*) or all procedures.

**What this changes**: the summary appears with the claim in the review dashboard, so a reviewer understands the case quickly. If the summary step detects a concerning finding, it raises a HARDSTOP alert at severity 5 for a coder. The setting is `encounterSummarizerSettings`.

## Section 13: ICD code limiting

**Tier: RARE**

Choose the maximum number of ICD diagnosis codes on each line item. The options run from 1 to 8, or unlimited. *Default: 4*

Choose whether the autocoder raises an alert when it drops a code.

- **Yes**: raise an INFORMATIONAL alert that lists the dropped codes.
- **No**: drop the codes silently. *Default*

**What this changes**: if the autocoder finds 6 diagnosis codes and your limit is 4, the 4 most relevant codes appear on the claim. The autocoder ranks the codes by relevance to the procedure, and it lists the dropped codes in the claim details. Most payers accept 4 ICD codes per line, and some accept up to 12. The rule is `max_icd_per_line_item`.

## Section 14: E/M visit settings

**Tier: REQUIRED for E/M facilities**

These settings apply to a facility on the E/M specialty. That specialty covers office and outpatient visits 99202-99215, hospital inpatient and observation visits 99221-99239, and emergency department visits 99281-99285. An anesthesia-only facility can skip this section.

For an E/M visit, the autocoder reads the clinical note and extracts the documented medical decision-making and the total time. A deterministic engine then assigns the visit level. The autocoder never picks the level itself. When a chart could read as either an office or a hospital encounter, the autocoder decides the setting from the documentation. It uses a hospital, observation, or emergency department code only when the note states that setting. Otherwise it uses the office codes.

### 14.1 Qualifying encounter note

The autocoder codes an E/M visit only when the document package contains a qualifying encounter note. The default qualifying types are an office visit note, a history and physical, a progress note, and an emergency department summary.

| Setting | Default | Notes |
|---|---|---|
| Qualifying note types | Office visit note, history and physical, progress note, emergency department summary | The only supported action is a refusal when none is present. |

**What this changes**: a package with no qualifying encounter note produces a refusal with the HARDSTOP alert `eandm_qualifying_note_refusal`, not a coded claim. To change which note types qualify, give your Hank representative the complete replacement list. The setting is `qualifyingEncounterNotes`, and it replaces the list as a whole. It does not add to the defaults.

### 14.2 E/M policy elections

These elections control payer-specific and billing-policy behavior. Each one ships at a safe, conservative default. The only election implemented today is the modifier 25 aggressiveness. The others are reserved for a later release. If you turn one on now, the autocoder does not change the claim. It raises the COMPLIANCE alert `eandm_policy_election_not_implemented`, so your choice is visible and audited, and the behavior stays at the safe default until the feature ships.

| Election | Default | What it does today |
|---|---|---|
| Modifier 25 aggressiveness | Conservative | Conservative never adds modifier 25 to the E/M line. Standard adds modifier 25 when the documentation shows a procedure on the same day. Either way, a same-day E/M with a procedure always raises the alert `eandm_mod25_same_day_procedure`. The autocoder suppresses nothing. |
| Incident-to election | Off | Reserved for a later release. A non-default value raises a review alert and changes no billing. |
| Preventive and problem split posture | Preventive only | Reserved for a later release. A non-default value raises a review alert and changes no billing. |
| G2211 add-on policy | Off | Reserved for a later release. A non-default value raises a review alert and changes no billing. |
| Payer ruleset map | Empty | Reserved for a later release. A non-empty map raises a review alert and changes no billing. |

**What this changes**: leave every election at its default until your Hank representative confirms that a feature has shipped. Setting the modifier 25 aggressiveness to standard is the one change that alters the claim today. Every other non-default election appears as a review alert only. The setting is `emPolicy`.

## Section 15: Radiology settings

**Tier: ADVANCED**

This section applies to a facility on the Radiology specialty.

The autocoder codes interventional radiology procedures automatically. The autocoder codes a package that reads as a procedure with interventional-specific checks. Vascular access, embolization, drains, biopsies, ports, and filters are examples. A diagnostic read, such as a plain film or a CT or MRI interpretation, is unaffected.

| Option | What happens |
|---|---|
| Enabled (*Default*) | The autocoder codes an interventional radiology chart with interventional-specific checks. Interventional documentation checks raise review alerts where the documentation is incomplete. These checks cover the combined supervision-and-interpretation families, the ultrasound guidance elements, and the moderate sedation documentation. |
| Disabled | The autocoder refuses every interventional chart and sends it to your coders with the "interventional radiology not supported" review alert. This is the older behavior. |

**What this changes**: disabling the lane turns interventional coding off for the facility. The autocoder then codes nothing for an interventional chart. Diagnostic radiology coding continues either way. The setting is `irCoding`.

## Section 16: Post-op pain rounds

**Tier: ADVANCED**

**Caution.** Do not disable this lane without a discussion with your Hank representative. With the lane off, the autocoder codes the surgery again on every pain-round package. The surgery was already billed from its own surgery-day claim.

An acute pain service round is a visit on a day after surgery. The provider manages the patient's post-operative pain at that visit. Many facilities send the comprehensive record for the round. That record contains the original surgery documentation in the same package.

The autocoder reads the package and detects the round. It then codes the round visit, not the surgery. The detection is deterministic. It reads the note types and the wording of the record. No AI decision is involved. The extraction step collects the evidence, and a rules engine picks the code.

There are three possible outcomes.

| Outcome | When it applies | Payer rule |
|---|---|---|
| 01996, one unit | An epidural or subarachnoid catheter was in place. The provider managed it at the visit. The visit is on a day after the catheter placement. | A flat fee. No time units. One unit per day. |
| E/M 99231-99233 | A peripheral nerve catheter was infusing, or the patient had a single-dose neuraxial opioid. | A peripheral nerve catheter is not 01996. The visit levels as subsequent hospital care. |
| Nothing billable | The record supports no separate service. | A routine post-anesthesia follow-up is part of the anesthesia base units. |

When the signals are only partial, the autocoder does not code the round. It codes the package normally and raises the critical alert `postop_pain_round_ambiguous`. A person then decides which encounter the package represents.

### 16.1 Post-op pain rounds lane

| Option | What happens |
|---|---|
| Enabled (*Default*) | The autocoder detects a pain-round package and codes the round visit. It does not code the surgery in the package again. |
| Disabled | The autocoder codes every package as a normal anesthesia encounter. A pain-round package then produces a duplicate surgery claim, with no alert. |

**What this changes**: keep this lane enabled unless your Hank representative advises otherwise. Disabling it returns the older behavior. The setting is `postOpPainRounds`.

### 16.2 Pain rounds review gate

The review gate marks a pain-round claim for a person to check. The gate is off by default. Turn it on if you want a coder to validate this lane before the claims go out.

| Option | What happens |
|---|---|
| Off (*Default*) | The autocoder codes a clean pain round with no gate alert. The coding record stays available for audit. |
| On, scope "coded" | Every claim that the pain-rounds lane coded carries a HARDSTOP alert. |
| On, scope "detected" | The alert also applies to a claim that coded normally from a package with pain-round content. This is the wider setting. |

You also choose the alert severity, from 1 to 10. *Default: 7*

**What this changes**: each claim in scope carries the HARDSTOP alert `postop_pain_rounds_review_gate`. The autocoder suppresses nothing and changes no code. Use the "detected" scope for the widest safety net during your first weeks on the lane.

The ambiguous-package alert is separate from this gate. It always fires, whether the gate is on or off. You cannot turn it off.

## Appendix A: Practice type comparison

This table compares the four built-in practice types. Select the one closest to your staffing model, then change individual settings as you need.

| Setting | Standard direction | Teaching hospital | CRNA independent | MD only |
|---|---|---|---|---|
| Medical direction | Enabled | Enabled | Enabled, non-directed | Enabled, with HARDSTOP alerts |
| MD plus CRNA billing | Both, QK and QX | Both, QK and QX | CRNA only, QZ | HARDSTOP alert |
| MD plus AA billing | Both, QK and QX | Both, QK and QX | Both, QK and QX | HARDSTOP alert |
| MD with a resident | AA and GC teaching | AA and GC teaching | AA and GC teaching | AA and GC teaching |
| CRNA alone | QZ, non-directed | HARDSTOP alert | QZ, non-directed | HARDSTOP alert |
| AA alone | HARDSTOP alert | HARDSTOP alert | HARDSTOP alert | HARDSTOP alert |
| MD alone | AA, personally performed | AA, personally performed | AA, personally performed | AA, personally performed |
| Required notes | Pre-op | Pre-op, intra-op, post-op | None | None |
| Provider selection | Most time, all roles | Most time, all roles | Most time, all roles | Most time, attending only |
| All other settings | Base defaults | Base defaults | Base defaults | Base defaults |

**Key differences**: standard direction is the typical MD and CRNA group. A teaching hospital adds stricter controls, so a CRNA-alone case alerts and more notes are required. CRNA independent suits an opt-out state where CRNAs practice without MD direction. MD only suits a solo-MD practice, where a CRNA or AA in the data shows an extraction error.

## Appendix B: Frequent questions

**What if I leave everything at default?**

The autocoder works with sensible defaults. Medical direction is on, all 7 TEFRA requirements apply, the standard confidence thresholds apply, and the basic patient fields are required. Most facilities change only a few settings.

**Can I change settings after go-live?**

Yes. Your Hank representative can update your configuration at any time. A change takes effect on the next claim. It does not affect a claim already processed.

**What if the autocoder codes something wrong?**

Every code carries a confidence score. A low-confidence code raises a review alert, so a coder can verify it. You can also add a custom coding instruction, as Section 12 explains, to prevent a specific error. Report a systematic problem to your Hank representative, who can update the base coding rules.

**How does the autocoder handle a code it has not seen before?**

The autocoder works from the complete CPT and ICD code sets. It can select any valid code within its supported specialties. For an unusual or rare code the confidence score is often lower, which raises a review alert.

**What is the difference between a HARDSTOP alert and a COMPLIANCE alert?**

A HARDSTOP alert marks something missing or conflicting that a person must resolve. A COMPLIANCE alert marks a regulatory or audit concern for your compliance process. Read the alert reference for your specialty for the complete type reference.

**What happens when I disable an alert?**

The autocoder stops raising that alert. Nothing appears in your review queue for it. The underlying condition still exists, and the autocoder no longer surfaces it. Your configuration change is logged for audit.

**Can I suppress one alert at my facility without disabling it everywhere?**

Yes. Ask your Hank representative to add the alert id to `claimValidation.suppressedHreIds` in your facility configuration. A suppressed alert is downgraded to INFORMATIONAL, not removed. It still appears in the audit trail. The alert reference lists the id for each alert.

**How does the autocoder handle a case that spans midnight?**

The autocoder detects an overnight case and uses the earliest date as the date of service. If an epidural goes in late one evening and the cesarean delivery starts in the early hours of the next day, the date of service is the earlier day.

**Can two facilities in one organization use different settings?**

Yes. Each facility gets its own configuration. A facility setting overrides the base specialty default. One facility can use one set of rules while another uses a completely different set.

**What is an add-on-only code?**

Some codes, such as 99100 and 99140, are qualifying circumstance codes. They can appear only with a primary code. A claim with only these codes and no primary procedure is an error. The "at least one billable code" check excludes an add-on-only code when it decides whether the claim carries a valid primary service.

## How these alerts reach you

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.