General Surgery Coding Alert

Question: One of our physicians will be out of the office for an extended period, and a fill-in physician will be taking her place. How will this affect our coding?


New York Subscriber


Answer: Follow these expert tips on billing using locum tenens to keep your office in compliance. 1. Don't confuse Q6 and Q5: Locum tenens providers are physicians temporarily taking another physician's place because of illness, pregnancy, vacation time or continuing medical education (they cannot fill in at a practice for more than 60 consecutive days). HCPCS allows you to easily distinguish these services by appending modifier Q6 (Service furnished by a locum tenens physician) to the CPT procedure code for whatever services the locum provides. Modifier Q6 is different from modifier Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement), which you shouldn't use for locum tenens billing. 2. Properly fill out the claim: To bill for locum tenens, create the bill under the doctor they are filling in for, but include modifier Q6 on all procedures and place the locum UPIN in box 23 on the claim. You should place the locum tenens physician's National Provider Identifier (NPI) or Unique Physician Identification Number (UPIN) in block 23 on the CMS-1500 form, and the NPI/PIN for your doctor who is absent goes in 33 and 24K (as it normally does). The carrier will pay the doctor who is absent but will be able to reference which doctor really performed the procedure. Careful: Some carriers follow Medicare guidelines for locum tenens, but others have their own guidelines for fill-in-physician billing, so check first when using Q6 on a non-Medicare claim. 3. Avoid logistical pitfalls: Watch out for the following cautions when billing for locum tenens services: Your physician must pay the locum tenens physician for services on a per-diem or similar fee-for-time basis for when he's filling in. Also, locum tenens allows your physician to receive payment for services another physician performs, but your physician cannot restrict the locum's services to your office.