Modifier AI

Principal physician of record

Correct Use

  • Although may be appended by principal physician with all claims for Evaluation and Management (E/M) service(s); must append modifier, appropriately billed E/M code for level of service provided, to initial hospital and nursing home visits
    • This clearly identifies physician as principal physician who oversees patient's care, separately from all other providers who may be furnishing patient care
  • Properly document services and select level of CPT code that reflects the E/M service(s) provided
  • Provide results of evaluation to requesting physician

Note: If modifier is missing from initial hospital or nursing home visits of principal physician's claim, claims for other E/M services rendered on same date may not be paid

Appeal Option

  • Request Reopening to append missing modifier to claim

Resource

 

Last Updated Sep 27 , 2022