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Modifier AI

  1. Default Modifier AI
    Medical Coding Books
    Does anyone have any information about this modifier? I was told by a doctor that this modifier should be used by the primary care doctor when billing for an admission. Therefore the specialist could bill for an admission as well. This doesn't sound right.

  2. #2
    Default
    This is correct. The consultation codes have gone away for medicare as of Jan 1, 2010. Check out CMS website concerning consultation codes. In the CMS search engine type in consultation codes 2010 and you will get all the information you need. Just remember, for non-medicare, It will be carrier specific whether they will use consultation codes, including some medicaids. There are also several other threads on here concerning this topic. try the search engine at the top of the page.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  3. Default Follow Up question
    So, two doctors will be able to bill for a hospital admission for the same date of service?

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    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 A. Mitchell, MSPH, CPC-H

  5. Default Follow up question
    Both doctors will be using 99221, 99222 or 99223? Or would the consulting dr use 99231, 99232 or 99233? How can more than one doctor use the admission codes (99221-99223)?

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
    Default
    they will both use the 99221-99223 for their initial encounter with the patient. You will need to think of these as initial inpatient encounter codes with the AI modifier signifying admission.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Ellenville, New York
    Posts
    1,176
    Default One possible exception
    Quote Originally Posted by Ambs1997 View Post
    Both doctors will be using 99221, 99222 or 99223? Or would the consulting dr use 99231, 99232 or 99233? How can more than one doctor use the admission codes (99221-99223)?
    The consulting physician MAY be paid by using 99231-33 IF the service that he or she provides does not meet the criteria for 99221-23, since those require at least a detailed history and exam. Inpatient consults did not require that level for 99251 and 99252. Therefore, some carriers have advised to use the proper subsequent code instead of the initial code or the unlisted. This is one very confusing area of the change and will be addressed (hopefully) by CMS in the near future.

  8. #8
    Default A1 modifier
    I understand it to be, that the admitting physcian use the A1, as well as the physcian overseeing the patient's care if they aren't the same, if a hospitalist admits during the nite, then the PCP comes in to take over care, the A1 would be applied to the admission code and the subsequent inpt hospital charge, is this not correct?
    thanks

  9. #9
    Location
    North Carolina
    Posts
    3,126
    Default
    The modifier is AI (letter)...not A1 (one)

    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. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed. NOTE: The primary purpose of this modifier is to identify the principal physician of record on the initial hospital and nursing home visit codes. It is not necessary to reject claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or outpatient codes). Follow-up visits in the facility setting may be billed as subsequent hospital care visits and subsequent nursing facility care visits as is the current policy. In all cases, physicians shall bill the available code that most appropriately describes the level of the services provided.

    http://www.cms.hhs.gov/Transmittals/...ds/R1875CP.pdf

  10. Default
    I would like to know what would happen if the Admitting Physician forgets to use the AI modifier on their 99223 admit code. Will the consulting doctor's (using the same code) claim then be denied? How can the consulting physician be sure if the admitting doc is using the modifier or not?

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