Anesthesia Coding Alert

These 4 expert tips will keep your reimbursement on the right track.

No matter what type of practice you code for, at some point your group will have a physician temporarily out for longer than just a vacation. Whether it's several months for maternity leave, a sabbatical, or something else, the group might decide to hire a locum tenens (LT) physician to fill the gap. If so, remember four important things from our experts to make sure you don't miss any reimbursement opportunities.

Tip 1: Pay Attention to What LT Means

When you bill for an LT physician, "you are billing for a covering physician as if they were the regular physician," explains Laureen Jandroep, CPC, COC, CPC-I, CPPM, founder/CEO Certification Coaching Organization, LLC in Oceanville, New Jersey. "Medicare has certain parameters that need to be met in order to bill locum tenens, and many other insurance companies adopt similar policies."

The following advice is based on Medicare's LT guidelines. Other payers - even those that follow Medicare's LT concept - might have different rules when billing for substitute physicians. When reporting a substitute physician's services to a third-party payer, check out their guidelines to see if they differ from Medicare's at all.

Tip 2: Remember LTService Has a Time Limit

An LT physician can fill in for 60 continuous days starting with his first date of service, confirms Jill Young, CPC, CEDC, CIMC, of Young Medical Consulting LLC in East Lansing, Michigan.

Also, you can only use LT billing rules for physicians who are filling in for physicians on leave, says Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey. "The LT physician must be substituting for a physician within the practice and not a contractual employee/physician of the practice," she continues.

Tip 3: Keep Your NPIs and Modifiers Straight

When you're billing for an LT physician, you should report all of her services under the Medicare National Provider Identifier (NPI) number of the physician she's subbing for, says Young – not the LT's number.

So, if you hire Dr. Sub as an LT physician to fill in for Dr. Vacation, you'll bill all of Dr. Sub's services under Dr. Vacation's NPI.

Modifier alert:  When you're billing for an LT physician, be sure you always append modifier Q6 (Service furnished under a fee-for-time compensation arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area) to indicate that you are billing for an LT's services.

Tip 4: Keep Detailed Records of All LT Services

When it comes to documenting an LT's services, experts recommend that the practice keep a record of all the services the LT physician provides.

"A practice must keep a record of all the services an LT physician provides ... in case of an audit, and for compliance with Medicare billing and coding guidelines," says Brink.

Good idea:  In order to ensure you're documenting all an LT's services, you can go back and check the services by date, "since the regular physician would not be seeing/billing for any patients during this time," recommends Young.