Pulmonology Coding Alert

Question: One of our pulmonologists is going out on sick leave and we are hiring a locum tenens (LT) physician to fill in. How do I code for her if she performs a level-three E/M visit for an established patient?

Codify Subscriber

Answer: If you're new to LT coding, you'll want modifier Q6 (Service furnished by a locum tenens physician) to be your friend.

The scoop: AnLTphysician 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. Bill theLT's services with the ID number of the physician for whom he is subbing. Medicare does place limits on the amount of time you can bill under LT rules. Alocum tenensdoctor can fill in for 60 continuous days starting with his first date of service.

You'll code for the substitute physician's services with Medicare - or payers who follow Medicare's billing and coding guidelines - underLT rules and regulations. On the claim, report 99213 (Office or other outpatient visit for 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 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.