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What is Medical Billing and Coding - Modifier AI?

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. It is not necessary to reject 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). Follow-up visits in the facility setting may be billed as subsequent hospital care visits and
subsequent nursing facility care visits as is the current policy. In all cases, physicians shall bill
the available code that most appropriately describes the level of the services provided.

What it means is that, if your physician or surgeon is the admitting provider, you have to append
the Modifier AI for the E/M codes. This new guidelines was made effective as of January 1, 2010
when the Medicare Part B ceased to recognize the consult codes.

Modifier AI is applicable in the nursing facility (99304-99306) and inpatient hospital setting
(99221–99223)









Because of this change, these codes may be billed several times in a day by different providers
who are involved with the patient's care as for "Initial Encounter/Visit". But there will be only ONE
admitting physician. This admitting physician will then append the Modifier AI to indicate as
"Principal Physician of Record" or simply, the "admitting physician".

Read More on the guidelines from CMS
HERE.

Reference: Current Procedural Code for 2011, CPT Changes for 2011.


"CPT is owned by the American Medical Association."