Pulmonology Coding Alert

Question: If our pulmonologist goes for a vacation and another pulmonologist from our own group provides services for his patients, whose name should be report for the claims?Ohio SubscriberAnswer: As per section 30.2.10 in the Medicare Claims Processing Manual (www.cms.gov/manuals/downloads/clm104c01.pdf), you can report your pulmonologist's (who is away on vacation) name for the claims. However, you must remember that there are several rules that need to be followed as is mentioned in the manual. Payment can be issued if the regular physician arranges a substitute physician to furnish services on an occasional reciprocal basis in the following circumstances: The regular physician is unavailable to provide services;The Medicare patient arranged or seeks services from the regular physician;The substitute physician is certified with the Medicare Part B carrier, is not employed by the regular physician, and has his/her own practice;The substitute physician services occur over a continuous period < 60 days; andModifier [...]