Cardiology Coding Alert

Cardiologists may be unable to see patients for several reasons, including vacation, illness and pregnancy. In such cases, many physicians, particularly those in solo practices, hire substitute physicians, commonly known as locum tenens physicians, or simply locums.

A locum does not have a practice of his or her own, moving instead from practice to practice. The cardiologist pays the locum a fixed per-diem amount as an independent contractor and bills for the service as though it were personally provided. Many physicians confuse locum tenens billing scenarios with reciprocal billing. There are, however, two main differences, according to guidelines in section 3060.7 of the Medicare Carriers Manual (MCM):

1. Locum tenens are paid on a per-diem rate. In a reciprocal arrangement, each physician continues to bill all services to his or her own patients. 2. Locum tenens arrangements are identified by appending HCPCS modifier -Q6 (Service furnished by a locum tenens physician), whereas the reciprocal billing arrangement is indicated with modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement). Note: Reciprocal billing guidelines are in section 3060.6 (immediately preceding locum tenens) of the MCM. Section 3060.7 contains additional locum tenens guidelines. Cardiologists who retain locums can obtain payment from Medicare for covered services if: The regular physician is unavailable to provide the visit services. The Medicare beneficiary has arranged or seeks to receive services from the regular physician. The locum is an independent contractor, not an employee of the practice, and is paid for services on a per-diem or similar fee-for-time basis. The substitute physician does not provide the visit services to Medicare patients over a continuous period of longer than 60 days. Note: The MCM states that when the CMS-1500 claim form is revised, "provision will be made to identify the substitute physician by entering his/her unique physician identification number (UPIN) upon request." Any postoperative services provided by the cardiologist in a global period after the patient has had surgery should not be identified on the claim as substitution services, notes Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C. "You should use modifier -55 (Postoperative management only) with the appropriate procedure code for the post-op care during the global period if the surgeon performs intraoperative care only," Callaway says. The surgeon who performed the procedure should be contacted to ensure modifier -54 (Surgical care only) was appended for the intraoperative portion. Unusual Scenarios In a locum tenens arrangement, two physicians operate under the same name (not just the same practice ID number). As a result, some unusual coding scenarios may arise. Scenario A. A cardiologist leaves practice A and joins practice B. Practice A hires a locum tenens for [...]