AI modifier clarification

michiboo

Networker
Messages
98
Best answers
0
We are having some confusion here at our office to when it is appropriate add AI modifier when patient is admitted with in same day and sees two different providers.

Medicare patient:

Sees ER provider and ER provider calls in the hospitalist to consult patient, hospitalist admits patient all within the same day.
Example: 99222-AI

or

Sees ER provider on Monday and ER provider calls in the hospitalist to consult patient, hospitalist consults and admits patient on Tuesday.
Example: 99222 (no AI)

or

Hospitalist consults and admits patient, hospitalist calls cardiologist to consult patient and cardiologist see patient on the same day.
Example: 99222-AI


are these examples correct?? help :/
 

thomas7331

True Blue
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2,139
Best answers
3
I think you're making this a little bit too complicated. The AI modifier was created when Medicare stopped accepting consultation codes in order to have a way to distinguish the initial hospital visit of the admitting physician from the initial visits of consulting physicians. So the AI modifier will be used once per admission, on the initial visit, by the provider who is actually admitting the patient. All other specialists who are called to consult on that patient during that stay will just bill an initial visit with no modifier. It does not matter whether these are on the same day or on different dates. So if the hospitalist is admitting the patient, then the hospitalist will use modifier AI on their initial/admitting E&M service.
 
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