AI modifier

KoBee

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Is it safe to say, AI modifier should only be applied when there is multiple providers using CPT 99221-23 on same day or it doesn't matter if different days?


first day = consulting provider = admits pt = 99222
second day = hospitalist = going to over see pts care = 99222

this is different days, no other providers saw the pt one first day or second day, should the hospitalist still append AI modifier? or no, because no other provider billed a 99222 on that day? or yes, still apply it because it will tell medicare who will be overseeing the pt.
 

thomas7331

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Per CMS instructions: "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." There's no mention here that it would only apply to visits performed on the same date - I would use it for the principal MD's initial visit regardless of when or whether other physicians are billing.

It's not clear from your example which provider would use the modifier - in my experience, when a consulting/specialist provider admits the patient, then they are the attending/principal physician and they would then have to request a hospitalist consultation to manage any secondary conditions that are outside their scope (in which case the hospitalist is actually acting as a consultant to the specialist). If that's the situation, then the specialist would use the AI modifier and not the hospitalist.
 
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