AI Modifier Used To Report Attending Physician Status
Medicare has formally adopted AI as the modifier to be used as an addendum to the admission code by the attending physician when the patient is admitted to the hospital. This is a different modifier than was previously reported.
CMS has issued an MedLearn Matters Bulletin on how to bill now that consulting codes have been eliminated. This very important bulletin may be downloaded at:
At the Chicago meeting attendees were told that without a modifier, patient records would need to be reviewed prior to payment. Although this seems a burdensome requirement on CMS that will likely not materialize, it may. Therefore, specialists should be very sure that the attending physicians that refer to them are aware of the need to use the AI modifier.
Be certain that your billing staff knows when you are consulting and when you are attending so that they may appropriately use the modifier.
If you do not know the insurance of the patient, provide your billing staff with alternate coding for admissions v. consultations. The levels of service are not a direct crossover.
For example, a level 3 admission code (99223) typically takes 70 minutes and requires a comprehensive history and exam and medical decision making of high complexity. A level 3 consultation code (99253) typically takes 55 minutes and requires only a detailed history and examination and medical decision making of low complexity.
Since you are ultimately liable for the level of service you bill, this is a decision best made by you.
Be sure your documentation supports the levels for which you bill.
REMEMBER: NOT ALL PAYORS ARE ELIMINATING CONSULTING CODES.