The autocoder can score ERAS (Enhanced Recovery After Surgery) quality measures while it codes an anesthesia case. This is an optional extraction. It is disabled by default, and your organization enables it. The measures do not change the codes or the modifiers on the claim.

## What the autocoder scores

The extraction reads the full clinical record. It prefers the comprehensive anesthesia report, and falls back to all available notes. The autocoder scores 13 measures:

| Measure | What it looks for |
|---|---|
| PONV prophylaxis | An antiemetic to prevent nausea and vomiting. |
| Prophylactic antibiotics | Antibiotics inside the window before incision. |
| NMB reversal | Blockade reversal with documented twitch recovery. |
| Active warming | Warming, or normothermia near the anesthesia end. |
| Multimodal analgesia | Two or more non-opioid analgesic classes. |
| IV fluid in range | IV crystalloid inside the goal-directed range. |
| No routine benzodiazepines in elderly | Benzodiazepines avoided at age 65 or more. |
| Fasting compliant | NPO per the documented fasting intervals. |
| Preoperative carbohydrate beverage | A clear carbohydrate drink before surgery. |
| A1c screening | A documented HbA1c value or screening. |
| Preoperative risk assessment | A formal assessment, for example ASA class. |
| Postoperative weight gain | Postoperative weight versus the baseline. |
| Fluid balance | Fluid management inside the documented range. |

Each measure returns met, unmet, or excluded. Excluded means the measure does not apply to the case, or the record does not document it. Each measure carries a plain-language description of its criteria.

## Neuromuscular blockade reversal

A documented twitch recovery count scores this measure as met when the record also documents a reversal agent. The autocoder records the reversal agent, whether the monitoring was quantitative, and the train-of-four ratio. Use those values for a strict MIPS numerator.

## Configuration

Your facility configuration controls this feature through the `th_eras` supplemental extraction. The same configuration controls whether each measure carries its supporting evidence text. Contact your Hank representative to enable ERAS measures or to change the evidence option.

## How this reaches you

What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, the measure results travel with the case for quality reporting, and they do not change coding. Organizations that consume the coding API directly decide in their own workflow which results reach their quality reporting team, who reviews them, and when a claim is released.