Otolaryngology Coding Alert

You can avoid unnecessary stress this holiday season when you report reciprocal billing arrangements or locum tenens services for your allergist. Keep this clip-and-save checklist handy for quick how-to advice on applying modifiers -Q5 and -Q6.

1. Remember that reciprocal billing allows a physician to submit claims and receive Medicare payments that he or she has arranged for a substitute physician to provide on an occasional, reciprocal basis.
 
2. To appropriately report services a physician performs under a reciprocal billing agreement, use modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement).
 
3. Locum tenens also allows your allergist 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, use modifier -Q6 (Service furnished by a locum tenens physician).
 
6. Medicare will not pay for reciprocal billing or locum tenens services for more than 60 continuous days.
 
7. To use modifiers -Q5 and -Q6, your allergist 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 allergist bills for services under a practice group number. But you may use the modifiers if your allergist works for a group practice but bills as an independent physician.