# AI Modifier



## rhedges

Can AI modifier be used by admitting physician into observation status?

Thank You

Ranae Hedges, CPC


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## mitchellde

No observation is outpatient.  AI is used only for inpatient initial admission.


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## mitzfritz215

Where is A1 modifier?  I can't find it anywhere.  I saw where a billing company used it when the Doctor wrote Pt admitted to PCU, discussed with ER Physician and (new orders).


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## mitchellde

It is not A1 it is AI (eye), it is a HCPC II modifier created for usage starting 2010 and is used only by the admitting physician for initial level for admission to either inpatient hospital or nursing facitlity.


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## mitzfritz215

I found it - it's a HCPC modifier.  AI.  

Would you use it after 99223 if the Pt was admitted to PCU, discussed with ER Physician and (new orders).


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## mitchellde

If your provider was the admitting physician and the payer is Medicare or a payer that is following CMS policy with respect to consultations, then Yes you use the AI modifier.   The AI modifier is used so that when your provider requests a consult, the consultant can use an initial visit level and be reimbursed.


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## mitzfritz215

Would you use it twice upon admitting when it is written spoke to ER Physician x 2 - 99221 AI AI OR 2 units?


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## mitchellde

no.  You use the AI modifier on the initial level of an admission.  It is informational only, it identifies your provider as the initial admitting physician.  That is all it does.  If your provider then calls a physician in for a consult at any point in the admission, say on day 3 of the inpatient stay your physician feels a cardiologist is needed to help with answering some questions, then when the cardiologist comes in and sees the patient he will use an initial level as well (99221-99223) with no modifier, but for him to be reimbursed your provider would have had to have used the Ai modifier on his initital level when he admittied the paition.  It is not used or dependent on a phone call at all.  and you would never bill any E&M with more than 1 unit.  You simply append it once to your initital level to communiacat that you are the admitting provider.


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## mitzfritz215

ok thanks - I didn't think I could use 2 units for the e/m code.  That didn't sound right to me.  
So upon admitting the Pt, the doctor speaks twice to the ER Physician as the Pt was in the ER I only us AI once for the admitting date?  Not sure what the doctor wants me to do with writing it times 2.  So it doesn't matter how many times he speaks with the ER doctor I only code AI once?  Just want to make sure.  I just started coding his hospital rounds yesterday and have only been coding for 2 1/2 months.  Trying to make a good impression on the doctor and of course doing it correctly.


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## claboy6125

Does anyone have the effective date for this CPT Modifier AI?


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## mitchellde

Effective date for AI modifier was 01/01/10.  The conversations with the ER physician are part of the decision making component of his visit level and then only if documented.   The AI modifier is appended to the initial level to identify him as the admitting provider, any work performed to determine the level of service has no bearing on whether to use the AI or not.


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## kbarron

*A1 vs AI*

A1(one) was effective 1/1/10 for " the principal physician of record". This was for "consult" codes that Medicare does not recognize. AMA corrected this modifier to AI (eye) on the revised corrections document 6/28/11.


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