08-25-2017, 05:52 AM | Community Wiki

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Modifier AI

  1. #11
    North Carolina
    Medical Coding Books
    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.

  2. Default AI reimbursement
    Quote Originally Posted by mitchellde View Post
    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.
    Debra: Do you know if there any additional financial reimbursement with the AI or what makes the identifying modifier necessary?

  3. #13
    Columbia, MO
    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

    Debra A. Mitchell, MSPH, CPC-H

  4. #14
    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?


  5. #15
    Default AI modifier
    Do we use the AI modifier on the OP admit charges 99218-99220

  6. #16
    Kansas City AAPC
    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. ;-)

  7. #17
    Default AI modifer
    The admitting physician bills the AI with the 99223, the consulting physician bills the 99223 with no AI

  8. #18
    North Carolina
    Thumbs up
    Quote Originally Posted by PamBorden View Post
    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. ;-)
    Happy to help!

  9. #19
    Beaverton, Oregon Chapter
    Default AI Modifier
    The AI modifier is only used for the admitting physician of a Medicare or Medicaid patient. Refer to cms.gov for updated guidelines.

  10. Default
    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?

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