Pediatric Coding Alert

Question: One of our physicians is taking some time off, and a temporary physician will take her place while she's gone. What code should I use to indicate that certain services were performed by the substitute physician?

Alabama Subscriber

Answer: The general rule, particularly for Medicare and private payers that follow Medicare payment guidelines, is to use modifier Q6 (Service furnished by a locum tenens physician) when billing for substitutes. Locum tenens reporting guidelines govern all services provided to Medicare patients by a substitute physician. The modifier simply tells the payer that a locum tenens physician provided the services -- a one-way exchange between physicians.

Rule of thumb: You must append modifier Q6 to every procedure code on a claim for a substitute physician. But remember, you should still send the bill out under the regular physician's name. For instance, when a substitute physician provides a level-two E/M for an established patient, you would bill 99212-Q6 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; straightforward medical decision-making) under your physician's National Provider Identifier (NPI).

Answers for You Be the Coder and Reader Questions were reviewed by Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.