Wiki intial visit versus subsequent visit for IP

[coder1]

Good Afternoon Coding world,


After viewing many posts on here, claims are being denied with or without AI modifer for inital visit. Our practice are using the subsequent codes for the first time patient are seen so our claims will not be denied. Claims are being denied because more than one doctor perform the intial visit from the same specialty. There is no way to know if the same specialty seen the patient. Wound care is not a specialty category for Medicare.


I want to know if this ok..Does Medicare require for specialty to use intial visit?

 

[mfanning]

According to Medicare, modifier AI is informational only and will not effect reimbursement.

Check out MLN Matters artile SE1010, which was recently published by CMS. It is basically a Q&A on all this crazy consult business.

 

[mkj2486]

Why can't you get the patient's chart to see who saw the patient? I do not understand why "there is no way to know if the same specialty (saw) the patient". Even if you do not know the specialty of every doctor at your facility, there has to be a way to find it out.

 

[mitchellde]

According to Medicare, modifier AI is informational only and will not effect reimbursement.

Check out MLN Matters artile SE1010, which was recently published by CMS. It is basically a Q&A on all this crazy consult business.

They may say that it is informational only, however they also indicated early on that if the admitting physician failed to use the AI modifier then this would potentialy hold up claims processing for consulted physicians.
In fact this is exactly what has been happening to so many that have billed out consults, not all mind you but a significant number are being denied due to no AI having been submitted by the admitting doc.
So I tend to believe it is more than merely informational.