Pulmonology Coding Alert

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

Dallas Subscriber

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

Documentation: For example, the NP is providing incident-to services based on Dr. A’s plan. Dr. B is the locum tenens pulmonologist 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 pulmonologist was present instead of Dr. A. The supervising pulmonologist is the locum who is a contracted member of your group, 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.