Thursday, September 23, 2010

Modifier AI Fact Sheet




Definition:

AI Modifier : Principal Physician of Record

Appropriate Usage:

• To identify the admitting or attending physician who oversees the patient’s care while in an inpatient or nursing facility setting
• Appended to the initial inpatient hospital visit procedure code
• Appended to the initial nursing facility procedure code
• Valid for services January 1, 2010 and after

Inappropriate Usage:

• Appended to procedure codes other than the initial inpatient visit or initial nursing facility care services
• Appended by physicians other than the attending or admitting physician who oversees the patient’s care
• Appended to services dated December 31, 2009 and before

Additional Information

Note: Medicare will allow services when a provider uses this modifier incorrectly on an office or other outpatient service. Medicare will allow services when someone other than the principal physician of record uses this modifier. Medicare can allow services provided by a physician called in to see the patient even though the principal physician of record does not append this modifier to his/her claim or he/she has not yet submitted the claim to Medicare.

Documentation:

The patient’s medical record indicates the physician overseeing the patient’s care in an inpatient
or nursing facility setting.

Unassigned Claim:

The use of the modifier does not change the processing of unassigned claims.

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