Principal Physician of Record

Instructions

This modifier distinguishes the Principal Physician who oversees patient's care when performing evaluation and management (E/M) services and is only appended to an appropriate E/M code by that physician. It is imperative, so that other specialties may bill their claims for the same E/M code and not receive denials.

Correct Use

• Append to initial/subsequent E/M codes only
  • 99221 - 99223 (Hospital-Initial)
  • 99231 - 99233 (Hospital-Subsequent)
  • 99291 (Critical Care)
  • 99304 - 99306 (SNF-Initial)
  • 99307 - 99310 (SNF-Subsequent)
• Only principal physician of record appends to E/M code

Incorrect Use

• Inappropriate for another physician to append (primary or specialty)

Claim Coding Example

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6
• CMS Change Request (CR) 6740