Health Information Management

Q&A: Reporting modifier -AI for hospice and palliative care

JustCoding News: Inpatient, May 12, 2010

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QUESTION: CMS recently eliminated the evaluation and management (E/M) physician consultation codes and added modifier -AI (principal physician of record). How do I assign this modifier with respect to hospice and palliative care?

ANSWER: Modifier -AI is used to identify the physician responsible for admitting a patient to a nursing facility or inpatient (acute care) facility. Coders should appended modifier -AI to only the first (or initial) inpatient hospital or nursing facility E/M code. Coders may also append modifier -AI for the attending physician who will oversee the patient’s care while in the nursing or inpatient facility. This is used to differentiate this physician from other specialists who might care for the patient during this stay.

According to Medicare, this modifier will not have any effect on reimbursement amount. MedLearn Matters article MM6740 states:

The principal physician of record will append modifier “-AI” Principal Physician of Record, to the E/M code when billed. This modifier will identify the physician who oversees the patient’s care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed.

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

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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