General Surgery Coding Alert

Question: We have a surgeon who left our practice, and we’re wondering if we can still use his services “on call” under a locum tenens arrangement. Could you please explain the rules on this point?

AAPC Forum Participant

Answer: No. You should reserve locum tenens for providers who are intending to return to work.

The Medicare Claims Processing Manual Chapter 1 discusses how locum tenens can be used:

“A ‘continuous period of covered visit services’ begins with the first day on which the substitute physician or physical therapist provides covered visit services to Medicare Part B patients of the regular physician or physical therapist and ends with the last day the substitute physician or physical therapist provides services to such patients before the regular physician or physical therapist returns to work (emphasis added).

This period continues without interruption on days on which no covered visit services are provided to patients on behalf of the regular physician or are furnished by some other substitute physician on behalf of the regular physician. A new period of covered visit services can begin after the regular physician has returned to work.