Chiropractic Coding & Compliance Alert

Question: I own a small practice myself and had asked someone to look after the services for a short period in June while I was away. How do I code for this situation on the CMS 1500 form? Whose name and NPI would go in there? Mine or the fill-in doctor’s? Also, please clarify which modifier to use here - Q5 or Q6?

Texas Subscriber

Answer: A fill-in doctor works in lieu of the regular doctor, just for that short period. Therefore, most payers do not require the fill-in doctor to be credentialed with the plan. If you hire a doctor for short period, make sure the new joinee is already enrolled in order to submit claims. You may not use the services of a temporary doctor beyond a “locum tenens” of 60 days, says CMS.

As for the modifiers, use modifier Q6 (Services furnished by a locum tenens physician) when you have hired the physician from outside, and arrange to pay him on a per diem or fee-for-time basis.

You may use modifier Q5 (Services furnished by a substitute physician under a reciprocal billing arrangement) when your covering physician is a permanent employee of the practice, and you arrange for a reciprocal billing arrangement.

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