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Consult-observation

Annie Posted Fri 06th of October, 2017 13:19:33 PM
If a medicare patient is in observation and another doctor is consulted does the admitting doctor still need to use an AI even if the consulting doctor is using 99203 e/m code. Or do you use AI modifier only for Inpatient Initial visit.
SuperCoder Answered Mon 09th of October, 2017 08:28:38 AM

Hi, 

AI modifier can be used with admission inaptient/ observation Initial Visit. The AI modifier is to be used by the admitting or attending physician only. If the consulting doctor is using 99203 E/M code then no need to append modifier AI with observation admission code. 

However, claims that include the “-AI” modifier on codes other than the initial hospital and nursing home visit codes (i.e., subsequent care codes or outpatient codes) will not be rejected and returned to the physician or provider.

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.

 

 

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