Primary Care Coding Alert

Question: When each of our family physicians takes two weeks of vacation, another FP in town who isn't a member of our practice will fill in for them. Should I code differently when the substitute FP performs a service or procedure?

Maine Subscriber

Answer: You should submit the applicable E/M service and or procedure code under the regular FP's personal identification number (PIN) or group number. Append modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement) or -Q6 (Service furnished by a locum tenens physician) to the code to indicate that a substitute physician performed the service.

For instance, a substitute, locum tenens FP makes a scheduled follow-up visit to a nursing home resident with controlled dementia, hypertension and diabetes. During the visit, the patient exhibits flu symptoms. The FP performs an expanded problem-focused interval history, an expanded problem-focused interval examination and moderate-complexity medical decision-making.

You should report 99312-Q6 (Subsequent nursing facility care, per day, for the evaluation and management of a new or established patient ...) using the regular FP's PIN or group number.