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Thread: Admitting Doc not using AI modifier

  1. #1

    Default Admitting Doc not using AI modifier

    AAPC: Back to School
    Are there any options if the physician of record 99223 does not use the AI modifier and the consultant bills the same 99223 and the consultant does not get paid what options do we have if the admitting doc is not able to be contacted to correct his claim?

    Is my consultant out or are there circumstances with medicare that we can notify them this was for a consult as we billed correctly and deserve to get paid? Anyone with that issue?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    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.


    Page 9

  3. #3


    we are starting to get some denials with this scenerio. insurance stating already paid another MD for admit.

    Hopefully it will work itself out.
    Rachell Lindley, CPC
    Multispecialty Clinic Coding
    Internal Medicine
    General Surgery
    Family Medicine

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