Otolaryngology Coding Alert

Question: Our otolaryngology practice recently hired a locum tenens (LT) physician to fill in for a physician who is on a university teaching sabbatical. I’ve never coded for an LT physician. Notes indicate that she recently performed a level-three evaluation and management (E/M) service for an established patient. How do I code this scenario?

Massachusetts Subscriber

Answer: You’ll code for the substitute physician’s services with Medicare — or payers who follow Medicare’s billing and coding guidelines — under LT rules and regulations. On the claim, report 99213 (Office or other outpatient visitfor the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity) with modifier Q6 (Service furnished by a locum tenens physician) appended to 99213 to show that an LT provided the service. In fact, append Q6 whenever you code for a service that an LT physician provides.

In short: An LT physician must be substituting for another physician. In other words, you can’t hire an LT as “extra help” if your practice experiences a temporary surge in business.

You should also remember these rules when you are billing for an LT physician:

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

Example: Your practice hires an LT physician to fill in for Dr. X. TheLTphysician 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.

Time limit: Medicare does place limits on the amount of time you can bill under LT rules. An LT physician doctor can fill in for 60 continuous days, starting with his first date of service. Medicare also requires that the LT physician have a contract to provide the LT services for the stated period.

Example: Dr. Y goes on teaching sabbatical January 1, 2017, and you hire an LT physician to fill in for Dr. Y. The LT performs his first service for a patient on January 3, 2017.

In this example, the LT physician can bill under Dr. Y’s Medicare ID until March 3, 2017; 60 days after the initial service he provides.

Refer to Medicare’s rules for LT physicians at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c01.pdf.