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Consultation Codes-AI modifier

  1. Default Consultation Codes-AI modifier
    Clearnace Sale
    I know the admitting physician needs to put the AI modiifer on the initial hospital admit code and the consulting dr uses just initial hospital admit code. I have been told that the admitting dr does not have to put the AI modifier on unless the consulting dr sees the patient on the same day as the initial hospital admit. For example if the admitting dr admits on 01/01/10 and the consulting dr sees the patient on a different day 01/02/10, the modifier AI does not have to be used because it is not on the same day as the initial admit code. It that correct. It does not state that specifically in the instructions I have read. Please advise. Thanks

  2. #2
    North Carolina
    It is my understanding that the admitting physician will need to identify himself as the admitting physician...

    "The principal physician of record will append modifier “-AI” Principal Physician of Record, to the E/M code when billed. This modifier will identify the physician who oversees the patient's care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient will bill only the E/M code for the complexity level performed."
    Rebecca CPC, CPMA, CEMC

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  3. #3
    Swainsboro/Statesboro, GA
    Default Mm6740
    I haven't found any CMS regulations that address the date issue. I would have the principal physician use modifier AI regardless of the date of any other physicians.

    These are my thoughts after reading MM6740.
    Freda Brinson, CPC, COC, CEMC
    AAPC Swainsboro/Statesboro Chapter
    2017/2018 Secretary/Treasurer
    2016 Education Officer
    2014/2015 President
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

  4. Default Consultation codes
    Once again I have missed the boat - I need to speak to the billing people about this consultation change - I had heard and read some articles about this change - can someone send me the link about the guidelines - we are busy trying to hire new physicians and I have not been tracking the consultation code changes with the billing dept. I would greatly appreciate it if someone could forward me the link. I manage an ortho practice and we do a significant number of ortho consults.

    Did this have an effect on the office consultation codes - sorry I sound so dumb - but have doctors coming and going and our business mtgs have been jammed with interviews and checking out locations - I would like to stay on top of this - would really appreciate your help.


    Desperate Denise

  5. #5
    North Carolina
    Medicare no longer recognizes/pays for consultation codes...Hospital or provider based. Below is the offical link...
    Rebecca CPC, CPMA, CEMC

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    CLICK to give FREE mammograms!

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