Cardiology Coding Alert

Question: Has Medicare released the modifier that the admitting physician is supposed to use?

Kentucky Subscriber

Answer: Yes, CMS did release the new modifier. The appropriate modifier is AI (Principal physician of record). Note that the modifier combines the letter "A" with the letter "I," not the number "1."

When to use AI: Because Medicare no longer accepts consult codes, Medicare instructs that "all physicians who provide an initial visit to a patient during hospital care shall report an initial hospital care code (99221-99223)" (Medicare Claims Processing Manual, Chapter 12, Section 30.6.9.1). The principal (admitting) physician -- the one who oversees the patient's care -- must append modifier AI to the initial hospital care code. So if the cardiologist oversees patient care, you should append AI. But if the cardiologist is called in to offer an opinion and another physician is overseeing the patient's care, the cardiologist should not append AI to his initial visit code.

You may read about the modifier in Transmittal 1875, CR 6740: www.cms.hhs.gov/transmittals/downloads/R1875CP.pdf.