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AI modifier

  1. #1
    Question AI modifier
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    There was a medical conference last weekend and some of my physicans are telling me -- that the "AI" modifier is to be used EVERY time a medicare patient is being admitted.

    I thought the "AI" modifier was to be used only in the case of consults:
    Ex. Dr. Hyde admits a patient and is consulting Dr. Jekyll for diabetes management.

    Dr. Hyde - 99223 (AI)
    Dr. Jekyll - 99223

    I also searched on the CMS' website and it's stated under CONSULTS. Can someone please explain this? I am more confused now.

    Karen, CPC
    Physician Chart Auditor

  2. #2
    Location
    Glendale Geckcoders
    Posts
    8
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    Hi,
    It is true that everytime one of "your" physicians admits a "Medicare" patient you must use the AI modifier with procedure code 99223. This indicates to Medicare that your physician is the "Prinicpal Physician of Record".

    Nickie M.

  3. #3
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    AI modifer is defined as "Principal Physician of Record" and should only be used by the admitting/attending physician who oversees the patient's care for a medicare patient. The AI modifier should only be used one time during a patient's hospital admission on an initial hospital care code 99221-99223. Any other physicians that see the patient during the hospital stay would not use the AI modifier. Depending on the sufficiency of the documentation, if another physician is asked for consultation (for opinion, advice, etc) he may also charge an initial hospital care code 99221-99223, but would not use the AI modifier.

    I would have to agree that the AI modifer would be used at each inpatient admission as described above, how are you to know that other physicians will not be requested in as consultations.

    I use the AI modifier on each admit for a Medicare patient if my physician is the admitting/attending physician.

    I have different printouts of information if you would like me to tell you where to get it or I can fax it to you. My email is jcunningham@bromenn.org.

    I hope I have helped!
    Jennifer V. Cunningham, CPC, CIMC

  4. #4
    Location
    North Carolina
    Posts
    3,126
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    All physicians who provide an initial visit to a patient during hospital care shall report an initial hospital care code (99221-99223). The principal physician of record shall append modifier “-AI”, Principal Physician of Record, to the claim with the initial hospital care code. This modifier will identify the physician who oversees the patient's care from all other physicians who may be furnishing specialty care.

    Page 51

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

  5. #5
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    Quote Originally Posted by nmoreno View Post
    Hi,
    It is true that everytime one of "your" physicians admits a "Medicare" patient you must use the AI modifier with procedure code 99223. This indicates to Medicare that your physician is the "Prinicpal Physician of Record".

    Nickie M.
    Thanks Nickie

    Lets say a Medicare patient comes in today May 24, 2010 and is admitted by Dr. Apple (99223) . There is no consult at all. Patient is discharged May 30, 2010. The patient is again admitted June 12, 2010, Dr. Wolf (99223). Dr. Wolf calls for a consult for the patient's uncontrolled DM to Dr. Smith who bills a 99222.

    5/24/2010 - Dr. Apple 99223-AI
    6/12/2010 - Dr. Wolf 99222-AI
    6/12/2010 - Dr. Smith 99222

    Would this be correct? I'm just trying to understand.
    Karen, CPC
    Physician Chart Auditor

  6. #6
    Location
    Glendale Geckcoders
    Posts
    8
    Default
    That is correct, providing you are still referring to a "Medicare" patient.

  7. #7
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    Quote Originally Posted by nmoreno View Post
    That is correct, providing you are still referring to a "Medicare" patient.
    Yes, I am still referring to a Medicare patient.

    Thank you
    Karen, CPC
    Physician Chart Auditor

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