Pulmonology Coding Alert

Question: When you report locum tenens (stand-in physician) services,should you add modifier Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement) to the report?

Ohio Subscriber

Answer: When you report locum tenens services, dont confuse modifier Q6 (Service furnished by a locum tenens physician) with reciprocal billing modifier Q5. Reciprocal billing arrangements typically describe a two-way exchange between providers. For example, your pulmonologist and another pulmonologist agree to see each others patients on alternating weekends and agree to a reciprocal billing agreement. These services would fall under modifier Q5. In these situations, the doctor who owns the patients, not necessarily the one who saw them at those visits, bills out the provided services under his national provider identifier (NPI) and appends modifier Q5 to indicate he really did not see the patient. The physicians dont exchange any money because the services should even out over time.

By comparison, locum tenens describes a one-way exchange between providers. Your pulmonologist would retain a substitute pulmonologist to take over the practice for such reasons as illness, pregnancy, vacation, or continuing medical education. The substitute pulmonologist generally is paid a fixed amount per diem or similar for-time basis. To report the locum tenens services,you would append modifier Q6 to all of the temporary pulmonologists claims and bill under your pulmonologists (who the locum is replacing) NPI.Medicare will only allow a locum tenens to provide services to Medicare patients for a 60-day continuous period.

--Answers to You Be the Coder and Reader Questions were reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.