Internal Medicine Coding Alert

Avoid unnecessary stress this holiday season if you report reciprocal billing arrangements or locum tenens services for your internist. Keep this clip-and-save checklist handy as a quick reference tool for appending modifiers -Q5 and -Q6.
 
1. Remember that reciprocal billing allows a physician to submit claims and receive Medicare payments when he has arranged for a substitute physician to provide services on an occasional, reciprocal basis.
 
2. To appropriately report services performed under a reciprocal billing agreement, use modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement).
 
3. Locum tenens also allows the internist to receive payment for services another physician performs. But a locum tenens physician cannot work for another practice, and your physician cannot restrict the locum's services to your office.
 
4. The regular physician pays a locum on a per-diem or fee-for-time basis.
 
5. When reporting locum tenens physician services, attach modifier -Q6 (Service furnished by a locum tenens physician) to the appropriate code.
 
6. Medicare will not pay for reciprocal billing or locum tenens services for more than 60 continuous days.
 
7. To use both -Q5 and -Q6, your internist must be unavailable to provide services. This means that your physician should be out of the office while the substitute physician provides services.
 
8. The Medicare patient must have arranged to receive your physician's services.

9. You cannot report either -Q5 or -Q6 if your internist bills for services under a practice group number. But you may use the modifiers if your internist works for a group practice but bills as an independent physician.