Psychiatry Coding & Reimbursement Alert

Question: One of our psychiatrists will be away for ten weeks. He has made locum tenens arrangements for another psychiatrist of our group to cover while he’s away. There already is a nurse practitioner who bills incident-to under the psychiatrist who will be away. How do we bill the NP’s services while the locum tenens psychiatrist is supervising?

Wisconsin Subscriber

Answer: Incident-to requirements state that the supervising psychiatrist doesn’t have to be the psychiatrist who is associated with the plan of service. Any psychiatrist can supervise, as long as the NP is acting as an extension of the plan created by your psychiatrist.

Documentation: For example, the NP is providing incident-to services based on Dr. A’s plan. Dr. B is the locum tenens psychiatrist during Dr. A’s absence. File the claim with Dr. A’s name and identification numbers, with modifier Q6 (Service furnished by a locum tenens physician) to indicate a locum tenens psychiatrist was present instead of Dr. A. The supervising psychiatrist is the locum, but his name won’t actually be included on the claim.

Note: Effective April 1, 2013, the NPI of the locum will also need to be included on the claim. See the one-time notification from CMS online at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1151OTN.pdf

Caution: CMS has a 60-day time limit for using locum tenens physicians. If your psychiatrist will be gone longer than that, he should arrange for another psychiatrist to perform locum duties on his behalf after the 60-day mark.