Pulmonology Coding Alert

Question: My multi-specialty group is using a locum tenens to fill in at the hospital while one of our pulmonologists is out, but we aren't sure how to bill it. How should I report these services?

New Mexico Subscriber

Answer: Append modifier Q6 (Service furnished by a locum tenens physician) whenever you code for a locum tenens physician who is working in the place of a full-time physician.
 
Modifier Q6 is one modifier you may not use often, but it's one that has specific rules you need to know. For example, you can't use this modifier for services performed when the group employs extra physicians during peak times, but only when the locum physician is replacing an absent physician.
 
If your practice is short-staffed, engage the short-term doctors as contracted physicians rather than locum tenens, and use the personal provider number of the short-term physician (which means you should retain a physician who is already credentialed with Medicare and with any plans from whom he'll be seeing patients).
 
You also shouldn't use Q6 to code for a new physician who's waiting for Medicare to activate his identification number.
 
Another rule to remember is that Medicare won't consider someone to be locum tenens if he works for more than 60 continuous days. If the physician will be working more than 60 continuous days -- for example, during your pulmonologist's maternity leave -- don't use Q6.
 
Instead: Report services under the providing physician's number. However, if the regular physician returns to work, the 60-day maximum period resets, and the substitute can bill locum tenens for another 60 days.
 
-- Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.