Ob-Gyn Coding Alert

Find out when to apply modifier AI.

You know Medicare won’t reimburse consultation codes, but that doesn’t mean private payers won’t.

Read the following four E/M and consultation coding questions and determine how you would answer them before you turn to page 6 for the answers.

Question 1: Consult ‘Replacement Codes’

Your ob-gyn documents a traditional consultation service for a Medicare ob-gyn patient. How should you report this?

Question 2: Do Unlisted Codes Apply?

When a specialist sees a Medicare patient in the hospital at the request of another physician and you know it’s a service that would bill as a consult for a private payer, should you report an unlisted E/M code (99499) for the service, rather than billing an inpatient E/M visit code?

Question 3: Who Bills the AI Modifier?

If your physician sees a non-Medicare patient in the hospital at the request of the patient’s attending physician, should you append modifier AI (Principal physician of record) to your claims? And in what scenarios is modifier AI appropriate for Medicare payers?

Question 4: Are Level Transfers Appropriate?

Suppose your documentation would have supported a level-three outpatient consultation (99243) per AMA CPT^® guidelines for a private payer. Can you simply bill a level-three outpatient visit (99213) for a Medicare patient? Or are level transfers not acceptable?

Think your answers are right on the money? Turn to page 6 to determine whether your coding accuracy is right on target.

Think you know the answers? Click here to know the Answers.