Orthopedic Coding Alert

Question: Can we code for a nonphysician practitioner’s (NPP) service with a locum tenens modifier? He is filling in for one of our NPPs who is on medical leave following surgery.

Texas Subscriber

Answer: No, you cannot report 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) for a CRNA’s service.

Here’s why:  Modifier Q6 was originally designed to represent locum tenens (or substitute) services of one physician for another. You can also now report modifier Q6 for a substitute physical therapist in certain situations, but you still cannot report Q6 for an NPP.

Keep these tips in mind when filing claims that do qualify for modifier Q6:

• Append modifier Q6 to every procedure code on a claim for the locum tenens physician.
• The cap for a locum tenens physician’s services is 60 days.
• Send the bill out under the regular physician's name and National Provider Identifier (NPI).
• Use modifier Q6 when reporting locum tenens services to Medicare. Check other payment guidelines for locum tenens policies before submitting claims. Medicare payment rules typically apply to Medicaid, and some private payers also follow Medicare guidelines.

Final note: Modifier Q6 has no effect on payment.