Practice Management Alert

Question: We have to hire a locum tenens (LT) physician for one of our providers who is going on a humanitarian mission to the Middle East. We have interviewed several candidates, and will soon hire the LT. Can you offer some advice on how we should bill/code for the LT physician? We have never employed an LT before, so we’re a bit lost.

Michigan Subscriber

Answer: The first thing you should remember is that LT is a feature of Medicare and payers that follow Medicare’s guidance. Some private payers might have other ideas about how to bill and code for substitute physicians. When you are coding/billing a substitute physician’s services for a third-party payer, be sure to know how it wants you to proceed.

With that in mind, follow this advice for keeping compliant with coding or billing for an LT physician:

1. LT must be a sub: An LT physician must be substituting for another physician who is going to be absent for an extended period of time. The physician could be absent for a variety of reasons; pregnancy, vacation, sabbatical, personal illness, etc. Medicare is very clear on this point, however: You can’t just bring in a LT as extra help for situations where your practice has an uptick in business.

2. Medicare ID billing number: You should bill the LT’s services with the Medicare 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. 

3. 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.

4. 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. This period continues for up to 60 calendar days, with no breaks, even if the LT does not see patients on some of those days. In situations where the regular physician is going to be absent for more than 60 days, you’ll need to formulate an alternative plan for physician coverage and patient care.