Radiology Coding Alert

You can avoid unnecessary stress during physician vacations when you report reciprocal billing arrangements or locum tenens services for your radiologist. Keep this clip-and-save checklist handy for quick how-to advice on applying modifiers -Q5 and -Q6.

 1. Remember that reciprocal billing allows a physician to submit claims and receive Medicare payments for services that he has arranged for a substitute physician to provide on an occasional, reciprocal basis.
 
 2. To appropriately report services a physician performs under a reciprocal billing agreement, use modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement).
 
 3. Locum tenens also allows your radiologist to receive payment for services another physician performs. But a locum tenens physician cannot work for another practice, and your physician cannot restrict the locum's services to your office.
 
 4. The regular physician pays a locum tenens physician on a per-diem or fee-for-time basis.
 
 5. When reporting locum tenens physician services, always use modifier -Q6 (Service furnished by a locum tenens physician).
 
 6. Medicare will not pay for reciprocal billing or locum tenens services for more than 60 continuous days.
 
 7. To use modifiers -Q5 and -Q6, your radiologist must be unavailable to provide services. This means that your physician should be out of the office while the substitute physician provides services.
 
 8. The Medicare patient must have arranged or seeks to receive your physician's services.
 
 9. You cannot report either -Q5 or -Q6 if your radiologist bills for services under a group practice number. You can, however, use the modifiers if your radiologist works for a group practice but bills as an independent physician.

 10. The patient's regular physician must maintain all of the substitute physician's service on record, along with the substitute physician's physician ID number.

 11. Locum tenens applies only to Medicare. Most other payers (such as TRICARE, managed care, traditional indemnity insurance, etc.) do not recognize the locum tenens guidelines or reimburse for "substitute physicians," so you must bill these insurers using the name of the physician who rendered the service.