Oncology & Hematology Coding Alert

Question: In what situations should we use modifier -Q5?

Tennessee Subscriber

Answer: If another oncologist covers for a patient's regular oncologist, the designated attending physician may submit a claim for the substituting physician's services under reciprocal billing.
 
In that case, you would attach -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement) to the appropriate procedure or E/M code. For example, if your oncologist scheduled a patient for chemotherapy administration (96410, ... infusion technique, up to one hour), the substitute physician may conduct his or her own brief exam and check the patient's history. Although the substitute oncologist provided face-to-face care, your oncologist may still bill for the chemo services. In that case, you would report 96410-Q5 and 99212-Q5 (Office or other outpatient visit for the evaluation and management of an established patient ...).
 
Remember that to report -Q5 you have to meet certain CMS requirements: The regular physician cannot provide the visit services, the Medicare patient arranges or plans to receive services from the regular physician, and the substitute physician doesn't provide the visit services to Medicare patients over a continuous period of longer than 60 days.