Wiki AI modifer usage

[coding4fun]

Hello everyone..... looking for some advise and insight on the usage for the AI modifier. Scenerio is that pt presents to the ER department and is admitted to the hospital by Dr A. Dr A decides that a consult is needed from a cardiologist and phones Dr B to consult. I fully understand that Dr A would charge the appropriate H&P code with the AI mod attached. Since this is a Medicare pt what code would Dr B charge? He cannot charge a consult code as Medicare does not accept those any longer. My employer is telling me that we would key in the proper consultation coding and our system would automatically convert to a H&P coding (99221-99223) without the AI mod. This does not sound like the correct billing so that I would get all of your opinions for this scenario.

Thanks for all insight

 

[mhstrauss]

Hello everyone..... looking for some advise and insight on the usage for the AI modifier. Scenerio is that pt presents to the ER department and is admitted to the hospital by Dr A. Dr A decides that a consult is needed from a cardiologist and phones Dr B to consult. I fully understand that Dr A would charge the appropriate H&P code with the AI mod attached. Since this is a Medicare pt what code would Dr B charge? He cannot charge a consult code as Medicare does not accept those any longer. My employer is telling me that we would key in the proper consultation coding and our system would automatically convert to a H&P coding (99221-99223) without the AI mod. This does not sound like the correct billing so that I would get all of your opinions for this scenario.

Thanks for all insight

The correct code for an inpatient consult on a Medicare patient is 99221-99223, without the AI modifier--you are correct about that. As far as your system converting a consult code (99251-99255) to an Initial visit code...I'm not sure I'd trust that. It's not a direct crosswalk; one set has 5 levels, the other has 3. The only way to guarantee the correct code goes on the claim is to code it, and bill it out correctly.

HTH!

 

[coding4fun]

AI modifier usage

Just making sure that I am understanding correctly. It is correct for Dr B to consult on this Medicare pt and bill 9922x services without the AI modifier. I have always been told (in previous jobs) that proper billing for this scenario would be applying the appropriate subsequent visit code series (99231-99233).

 

[mhstrauss]

Just making sure that I am understanding correctly. It is correct for Dr B to consult on this Medicare pt and bill 9922x services without the AI modifier. I have always been told (in previous jobs) that proper billing for this scenario would be applying the appropriate subsequent visit code series (99231-99233).

Yes, Dr. B will bill a 9922X code. The only scenario where a subsequent code would be appropriate would be if the level requirements for an initial inpatient code weren't met.

Here's a Q&A from CMS regarding using the Initial Inpatient codes (emphasis added by me); link from the site is below it:

Is CMS going to crosswalk the CPT consultation codes that are no
longer recognized to the E/M codes for each setting in which an E/M
service that could be described by a CPT consultation code can be
furnished?
A. No, providers must bill the E/M code (other than a CPT consultation code)
that describes the service they provide in order to be paid for the E/M
service furnished. The general guideline is that the provider should report
the most appropriate available code to bill Medicare for services that were
previously billed using the CPT consultation codes. For services that could
be described by inpatient consultation CPT codes, CMS has stated that
providers may bill the initial hospital care service CPT codes and the initial
nursing facility care CPT codes, where those codes appropriately describe
the level of service provided. When those codes do not apply, providers
should bill the E/M code that most closely describes the service provided.


https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/SE1010.pdf