USE OF A1 MODIFIER

by HEBA
(AZ)

I WORK FOR A HOSPITALIST WHO SEES PATIENTS AS WOUND CARE AS WELL AS FOLLOW UP. I'M CONFUSED IF I SHOULD USE THE A1 MODIFIER FOR HIS CONSULT CODE THAT WE SUB FOR 99223 PER NEW MEDICARE GUIDELINES. PLEASE EXPLAIN THE USE OF A1 MODIFIER IN AN EASY YO USE FORM.

I REALLY APPRECIATE YOUR HELP

Heba,

Sorry I'm not much help here - I haven't coded or billed for hospital settings in a while

Here's Medicare's explanation:



Here's what CMS says with regard to 99223:

"Modifier “-AI,” defined as “Principal Physician of Record,” shall 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. 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."

I'm really just restating the CMS info but I hope this provides some help/link or guidance as to Medicare's consult code changes.

Thanks,

Gina

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