We want to clarify a Blue Cross^® Blue Shield^® of Arizona (BCBSAZ) billing requirement for inpatient and observation encounters. When submitting a professional claim for the admitting provider, use the “AI” modifier for the first inpatient/observation encounter (procedure codes 99221-99223).

Background

We sent information last fall about setting up your billing system with the following guidelines:

Admitting physician of record: Use codes 99221-99223 (for first inpatient/observation encounter) or 99231-99233 (for subsequent inpatient/observation encounters).

Physicians other than the admitting physician: Use consultation codes 99251-99255 (for first inpatient/observation encounter) or 99231-99233 (for subsequent inpatient/observation encounters).

What is changing this month

For the admitting physician of record only: Use the AI modifier (with codes 99221-99223) for the first inpatient/observation encounter. This modifier clearly identifies the admitting provider.

BCBSAZ will be reviewing some previously denied claims (since November 2022) and making adjustments to pay claims if the modifier was properly billed.

If you have questions about this update, contact your provider liaison. For more information about inpatient/observation visit codes, refer to your AMA/CPT^® book or digital coding tools.

In This Issue

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May news: Executive summary

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Inpatient care: Notification and authorization updates

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Billing clarification: Inpatient and observation visits

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Include the rendering provider for "clean" claims

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Behavioral health inpatient discharge and follow-up

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BCBSAZ fee schedule updates

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