Neurosurgery Coding Alert

Remember: Your practice cannot hire a LT as "extra help."

Coding conundrum: One of the neurosurgeons in your group is expecting a baby, so she will be taking maternity leave. Until this neurosurgeon returns from maternity leave, your practice will turn her patient load over to a locum tenens (LT) physician.

Locum tenens defined: In the medical field, you can bring in a LT physician to temporarily replace another physician who cannot be in the office for some reason such as vacation, illness, or maternity leave.

There are special rules you must follow if your neurosurgery practice uses a LT. Review the following FAQs to make sure you follow these rules to protect your reimbursement.

FAQ #1: Which Positions Can You Bill a LT for?

Answer 1: Practices may try to use a locum for other employees, but this is not a correct practice. You can only use LT when substituting for a physician (medical doctor (MD) or doctor of osteopathic medicine (DO)).

"One of the biggest problems I see is when practices try to bring in a locum tenens for a nurse practitioner or a PA (physician assistant) who is going to be gone," says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AAPC Fellow, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Florida. "A locum tenens can be used as a replacement for a physician; not for anyone else."

Takeaway: Never use a LT in place of anyone other than a physician.

FAQ #2: What Modifiers Should You Append to LT Services?

Answer 2: You must append modifier Q6 (Service furnished under a fee-for-time compensation arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area) to any code for services the locum provides.

When you bill a LT physician's services, you bill them under the physician he is replacing for that time period. Modifier Q6 tells the payer that the LT physician is practicing medicine on behalf of the original physician, who is not available to see patients. This also indicates that the situation is temporary. The modifier protects your physician in the event of an audit, because obviously your original physician didn't perform those services - the locum did, according to Mac.

FAQ #3: Can We Hire LT as "Extra Help?"

Answer # 3: No, a LT provider can absolutely not be "hired" by the practice, says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

"The locum tenens physician is not an employee, and the practice pays a fee to the agency that employs the locum to come to the practice," Witt explains. "It is treated as a contractual arrangement."

Mac agrees, and points out that you cannot view locum tenens as "extra help" because in this situation, you must be temporarily replacing the physician. The original physician you are replacing cannot be seeing patients at the same time as the locum.

Remember: A LT physician usually has no practice of his own and moves from area to area as needed. The locum retains the status of an independent contractor, not an employee.