Wiki Ai modifier

[Jess1980]

I need some clarification. I know we use the AI modifier for:

To identify the admitting or attending physician who oversees the patient's care while in an inpatient or nursing facility setting

Appended to the initial inpatient hospital visit procedure code


My question is this. When I have a specialist going to the hospital for their consultation visit would the AI be appended when they are NOT the ones who admitted the patient. This is strictly a consult visit.

 

[Jill Barron]

No 'AI' modifier if strictly a consult. Just use 99221,2, or 3 with no modifier.

 

[Jess1980]

AI modifier

Thank you Jill for the help. I thought I was losing my mind on this one.

There is a billing company telling me I have to use the AI and 25 modifier on the consults. The GI doctor is seeing them strictly on a consult and then has inpatient visits 99231-99233 for the followup. They are attaching these modifiers to our claims. Is there anywhere I can find documentation stating this is not valid.

 

[sivagurulingam]

Modifier AI has need to assign only with 99221-99223 who admit the patient. If its the inpatient consult and medicare insurance means bill with inpatient initial visit without AI modifier and commercial means please bill with appropriate consult code.

 

[mitchellde]

Thank you Jill for the help. I thought I was losing my mind on this one.

There is a billing company telling me I have to use the AI and 25 modifier on the consults. The GI doctor is seeing them strictly on a consult and then has inpatient visits 99231-99233 for the followup. They are attaching these modifiers to our claims. Is there anywhere I can find documentation stating this is not valid.

From the Medicare manual on modifiers:

Evaluation and Management (E/M)
AI Principal Physician of Record: Effective for dates of service on or after January 1, 2010, modifier AI should be used by the admitting or attending physician who oversees the patient?s care, as distinct from other physicians who may be furnishing specialty care. The principal physician of record shall append modifier AI in addition to the initial visit code. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed.
Note: The primary purpose of this modifier is to identify the principal physician of record on the initial hospital and nursing home visit codes.
See the MNL Matters? article MM6740 for more information:
http://www.cms.gov/MLNMattersArticles/downloads/MM6740.pdf