Medicare Compliance & Reimbursement

Modifier AI will denote the primary physician of record, now that consult coding is a thing of the past. Center for Medicare and Medicaid Services (CMS) will no longer reimburse you for consultations effective Jan. 1, 2010, but your physicians will still collect for initial inpatient visits -- even if they didn't admit the patient -- thanks to a new modifier. In the past, only the admitting physician reported initial hospital care codes (99221-99223), and specialists who saw the patient separately often billed inpatient consults. New way: Now that Medicare won't recognize the consult codes, multiple physicians may report initial hospital care during a patient's visit. Therefore, CMS released new modifier AI (Principal physician of record), which the admitting physician will append to the code for his initial visit with the patient. In black and white: "In the inpatient hospital setting and the nursing facility setting all physicians (and qualified nonphysicians [...]