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Modifier AI

A

Ambs1997

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Does anyone have any information about this modifier? I was told by a doctor that this modifier should be used by the primary care doctor when billing for an admission. Therefore the specialist could bill for an admission as well. This doesn't sound right.
 
This is correct. The consultation codes have gone away for medicare as of Jan 1, 2010. Check out CMS website concerning consultation codes. In the CMS search engine type in consultation codes 2010 and you will get all the information you need. Just remember, for non-medicare, It will be carrier specific whether they will use consultation codes, including some medicaids. There are also several other threads on here concerning this topic. try the search engine at the top of the page.
 
Follow Up question

So, two doctors will be able to bill for a hospital admission for the same date of service?
 
no ... one physician will bill for the admission with an initial code plus the AI modifier, the consultant will bill for the initial visit they have with the patient with no modifier. It is just that they will be using the same codes. We must think of these codes as initial inpatient visit codes and the AI modifier will indicate this as an admission visit.
 
Follow up question

Both doctors will be using 99221, 99222 or 99223? Or would the consulting dr use 99231, 99232 or 99233? How can more than one doctor use the admission codes (99221-99223)?
 
they will both use the 99221-99223 for their initial encounter with the patient. You will need to think of these as initial inpatient encounter codes with the AI modifier signifying admission.
 
One possible exception

Ambs1997 said:
Both doctors will be using 99221, 99222 or 99223? Or would the consulting dr use 99231, 99232 or 99233? How can more than one doctor use the admission codes (99221-99223)?
Click to expand...

The consulting physician MAY be paid by using 99231-33 IF the service that he or she provides does not meet the criteria for 99221-23, since those require at least a detailed history and exam. Inpatient consults did not require that level for 99251 and 99252. Therefore, some carriers have advised to use the proper subsequent code instead of the initial code or the unlisted. This is one very confusing area of the change and will be addressed (hopefully) by CMS in the near future.
 
A1 modifier

I understand it to be, that the admitting physcian use the A1, as well as the physcian overseeing the patient's care if they aren't the same, if a hospitalist admits during the nite, then the PCP comes in to take over care, the A1 would be applied to the admission code and the subsequent inpt hospital charge, is this not correct?
thanks
 
The modifier is AI (letter)...not A1 (one)

Modifier “-AI,” defined as “Principal Physician of Record,” shall be used by the admitting or attending physician who oversees the patient's care, as distinct from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier “-AI” in addition to the initial visit code. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed. NOTE: The primary purpose of this modifier is to identify the principal physician of record on the initial hospital and nursing home visit codes. It is not necessary to reject claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or outpatient codes). Follow-up visits in the facility setting may be billed as subsequent hospital care visits and subsequent nursing facility care visits as is the current policy. In all cases, physicians shall bill the available code that most appropriately describes the level of the services provided.

http://www.cms.hhs.gov/Transmittals/Downloads/R1875CP.pdf
 
I would like to know what would happen if the Admitting Physician forgets to use the AI modifier on their 99223 admit code. Will the consulting doctor's (using the same code) claim then be denied? How can the consulting physician be sure if the admitting doc is using the modifier or not?
 
This will probably be a question for your carrier. I attended a meeting last week and our Medicare reps stated that, for now, our claims will not be held for payment. However, a policy would be enforced, in the future, for lack of the A1 modifier.
 
AI reimbursement

mitchellde said:
no ... one physician will bill for the admission with an initial code plus the AI modifier, the consultant will bill for the initial visit they have with the patient with no modifier. It is just that they will be using the same codes. We must think of these codes as initial inpatient visit codes and the AI modifier will indicate this as an admission visit.
Click to expand...

Debra: Do you know if there any additional financial reimbursement with the AI or what makes the identifying modifier necessary?
 
The AI from what I have read is necessary to identify the principle physician of record. Why use it?..... To keep from have an issue with duplicate claims when the consultant bills and possibly for audit purposes, the presence of the AI will make the documentation requirements different. This is my opinion/assumption
 
We are a small rural CAH which most of the time will not have any consults. Should we use the AI modifier on all of our intial inpatient claims?

Thanks,
Lynne
 
Thank you, Rebecca. We had a lively debate in our office over who was actually the "attending" physician and when to use AI. Your link was especially helpful. Let's just say it made me a "gracious" winner. ;-)
 
CMS has modifier AI and the AMA CPT 2011 professional edition has A1 as the modifier for Principal Physicain of Record. Which modifier is correct?:confused:
 
So, does this mean that a NPP (in this case a PA) bill for an Initial hospital admission with modifier AI?

Example: Patient seen and admitted by PA, but hospital record and facesheet note a different MD as the admitting doctor, but does not bill admission.
 
We have been told by our Medicare carrier that they will pay whether the admitting uses the AI or not. Depending on the patient's problems, you could have 6 different physicians with different specialties billing for 99221-99223.
 
AI modifier

Our office sees alot denials because the admitting physicain does not use the AI modifier. What can we do to appeal with Medicare? We have no control over what another physician bills. We are being penalized for smething another physicain is not doing.
:confused:
 
We had to contact the requesting (admitting) physician's coder/billers as they need to send in a corrected claim. Time consuming and frustrating I know, but our MCR carrier wouldn't help us.
 
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