# Initial Inpatient visit



## krssy70 (Apr 12, 2010)

I have a scenerio that continues to be in question:

Pt is seen in ER and is admitted to our group of physicians, (or to the physician that is on call on that date).  The case is discussed at time of admission with one of our fellows, (as we are a teaching hospital). My question is, because we are unable to bill for the services rendered by the fellow on the day of admission, can we bill an initial inpatient visit even though it may be the day after the admission that the admitting provider sees the patient, or sometimes even the day after that?

Also, Medicare only, should we use the AI modifier?


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## AuntJoyce (Apr 12, 2010)

*Initial in-patient visit*

Hi Kristen,

I code for a group of hospitalists at a teaching hospital and there are times that the patient is admitted (for example) to the hospitalists service on January 1st and is seen by the fellow, housestaff, etc.  The hospitalist per se may speak with any of these docs but does not see the patient personally until January 2nd.  That is the date that you bill your hospitalists initial visit and yes, if it is Medicare and the patient is on their service, you get to append the AI modifier.

Hope this helps.

Joyce


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## cpccoder2008 (Apr 12, 2010)

I have the same question but need some documentation on what is correct. I would say bill the date of which the physician see's the patient and documents his H&P, even though it may be a different date than the admission. The medical records clearly state a different date therefore you should bill to that date. 

As far as the AI modifier. I recently attended a medicare seminar and clearly asked the speaker " Do we have to attach the AI modifier to _every _ medicare admit ? and was told no. It is informational only, no services should deny without it. You are suppose to attach the AI modifier only to the initial hospital visit of the principal physician of record. But if you don't and a consult is billed (99221-99223) neither will deny. 

Hope that clears up the AI but as far as the other issue i would love feedback myself.
Thanks


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## krssy70 (Apr 13, 2010)

Thank you Joyce, that was very helpful.

cpccoder:

As far as the AI modifer goes, what I seem to be hearing is that if the AI modifier is *not* utilized by the admitting provider on the initial hosp visit, then any services that are being rendered by any consulting physicians utilizing the initial hospital visit codes, are most definetly being denied. I am going to look for the forum where other fellow coders were running into this issue. 


Thanks,
Kristen


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## krssy70 (Apr 13, 2010)

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

Page 51. 

Section 30.6.10 elaborates on this further... 

This explains how the AI modifier should be used. Unfortunetly I could not locate the conversation regarding the denials that have been encountered due to the misuse of this modifier. sorry. 

I hope this helps,
Kristen


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## cpccoder2008 (Apr 14, 2010)

*No denials here*

We were not attaching the AI modifier from Jan 1 -Mar 15 (due to clarification of billing consults) and have not received denials on ANY of our claims. Both admit and consults are being paid using 99221-99223. I also attended a medicare seminar along with many teleconferences and specifically asked the question "If we didn't amend the AI modifier would the consults billed after be denied ?"  and she stated " NO, the AI was for informational purposes only". We are attaching the modifier now but before that, we weren't.


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