Technically, the AI modifier is for information purposes only. If the admitting fails to append the modifier, both physicians should still get paid. Your physician is billing his/her initial hospital visit and should be paid accordingly. After all, you submitted your claim correctly. In my opinion, it's the admitting physician that should receive a denial IF a denial is going to be issued. With that being said, we do not live in a perfect world so you may need to appeal/place a call to the carrier to re-open the claim for reconsideration. You can also refer them to the MLN bulletin...
Q. Do admitting physicians still get paid if they do not report the modifier “-AI?”
A. Yes, the use of the modifier is for informational purposes only.
Although this address' the admitting physician, the same should apply to your physician.
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