Ophthalmology and Optometry Coding Alert

Question: We are planning to hire a locum tenens (LT) physician for an ophthalmologist that’s going on an extended vacation. Can you offer some advice on how we should bill for the LT’s services that I can pass onto the billing department and others that bill/code for the LT?

Answer: When one of your full-time physicians goes on an extended vacation — or sabbatical or maternity leave — your practice might hire an LT to fill in for the missing physician.

Billing for the substitute physician’s services with Medicare — or payers who follow Medicare’s billing guidelines — can be tricky unless you have the proper guidance.

In short: A LT physician must be substituting for another physician. You can’t just add an LT as extra help for situations where your practice has an uptick in business.

There are three rules you must remember when you are billing for an LT physician:

1. Medicare ID billing number: Bill the LT’s services with the ID number of the physician he’s subbing for.

Example: Your practice hires an LT physician to fill in for Dr. X, who is on a teaching sabbatical. The LT physician performs a level-two E/M service for an established patient. On the claim, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making) for the LT’s services under Dr. X’s Medicare ID number.

2. Modifiers: Remember to append modifier Q6 (Service furnished by a locum tenens physician) to 99212 in the above example. In fact, append Q6 whenever you code for a service that an LT physician provides.

3. Time limit: Medicare does place limits on the amount of time you can bill under LT rules. An LT can fill in for 60 continuous days starting with his first date of service.