Wiki AI modifier with Critical Care?

[debbie.buck10@gmail.com]

Does anyone know if we can use AI modifier when we are the addmitting Dr and it is Critical Care?

 

[em2177]

Correct Use of AI modifier:

Append to initial/subsequent E/M codes only
99221 ? 99223 (Hospital-Initial)
99231 ? 99233 (Hospital-Subsequent)
99291 (Critical Care)
99304 ? 99306 (SNF-Initial)
99307 ? 99310 (SNF-Subsequent)

Only principal physician of record appends to E/M code

 

[ny2scgirl]

Does anyone know if we can use AI modifier when we are the addmitting Dr and it is Critical Care?

I know this is an old thread, but I have been trying to answer this question myself. Based on my research the answer seems to be no. The AI modifier does not need to be appended to the admitting claim if critical care is used instead of 99221-99223.

 

[amyjph]

I know this is an old thread, but I have been trying to answer this question myself. Based on my research the answer seems to be no. The AI modifier does not need to be appended to the admitting claim if critical care is used instead of 99221-99223.

https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00161100

https://med.noridianmedicare.com/web/jeb/topics/modifiers/ai

Appropriate use​

Admitting physician appends to the initial inpatient hospital care evaluation and management service (99221-99223).
Admitting physician appends to the initial nursing facility evaluation and management service (99304-99306).

Inappropriate use​

Reported on procedures codes other than 99221-99223 and 99304-99306.

If you have a modifier question, if you google Modifier _XX__ fact sheet, usually something will come up from a MAC/CMS. Not saying this would necessarily apply for all payers, but it is helpful.