Part B Insider (Multispecialty) Coding Alert

Published on Wed Apr 27, 2011 PDF

Question: The inside cover of my CPT® manual shows modifier A1 (letter A, number 1) for principal physician. Our office manager told me that I was supposed to bill this as modifier AI (letter A, letter I). Which is correct?

Missouri Subscriber

Answer: Modifier AI (letter A, letter I) is appropriate for "Principal physician of record." Printing A1 was an error, as indicated in the AMA's "Corrections in CPT® 2011" document at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managingyour-practice/coding-billing-insurance/cpt/about-cpt/errata.page. The most recent update, as of printing time, was April 12, 2011.

You should also take note of the correction to the note under +99356 (Prolonged physician service in the inpatient setting, requiring unit/floor time beyond the usual service; first hour). CPT® currently indicates that 99356 should be used "in conjunction with 99221-99233, 99251-99255, 99304-99310, 90822, 90829." However, that code list was printed in error. Instead, it should say that 99356 should be used along "with 99221-99223, 99231-99233, 99251-99255, 99304-99310, 90822, 90829."

You'll be revising that note "to split out the range," the CPT® errata indicates, "as the subsequent observation codes (99224-99226) should not be included in the range of codes."

Check the Corrections document regularly for updates at the AMA Web site, at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/errata.page.