Urology Coding Alert

Be sure you know the difference between modifiers Q5 and Q6.

At some point your urologist will need time off, whether for vacation, maternity leave, or illness. Avoid unnecessary complications and delayed payments by knowing the ins and outs of locum tenens billing before you hire a substitute physician for your office. Keep this clip-and-save checklist handy for quick how-to advice on billing during your urologist’s absence.

1. Know What Reciprocal Billing Means. Remember that reciprocal billing allows an absent physician to submit claims and receive Medicare payments for services that have been arranged for a substitute physician to provide on an occasional, reciprocal basis.

2. Get to Know Modifier Q5. 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). The physician providing reciprocal services does not receive any payment from the absent physician or his office.

3. Nail Down Locum Tenens Specifics. Locum tenens allows your doctor 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. Consider Per-Diem Pay Requirements. The absent physician pays a locum tenens physician on a per-diem or fee-for-time basis.

5. Make Q6 Your Locum Tenens Go-to Modifier. When reporting locum tenens physician services, always use modifier Q6 (Service furnished by a locum tenens physician).

6. Keep Track of Days on Your Calendar. Medicare will not pay for reciprocal billing or locum tenens services for more than 60 continuous days, although reciprocal care is often for much shorter periods of time.

7. Make Sure Doc Isn’t On-Site. To use modifiers Q5 and Q6, your doctor must be unavailable to provide services. This means that your physician should be out of the office while the substitute physician provides services.

8. Keep Intent in Mind. The Medicare patient must have arranged or sought to receive your vacationing physician’s services.

9. Make Record-Keeping a Priority. The patient’s regular physician must maintain all of the substitute physician’s service on record, along with the substitute physician’s NPI number.

You can make an extra copy of each of the locum’s claims and keep the copies in a separate paper file for the locum tenens, or you can use your computer system to track the locum tenens services.

11. Know Your Payer. 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." Therefore, you must bill these payers using the name of the physician rendering the service.

12. Avoid Locum Tenens for NPPs. Locum tenens applies only to physicians – not to non-physician practitioners such as nurse midwives, nurse practitioners, or physician’s assistants.

13. Keep Modifiers Straight. Differentiate locum tenens from reciprocal billing. When you report locum tenens services, don’t confuse modifier Q6 with modifier Q5.

You use modifier Q5, for example, when your physician arranges with another doctor to cover each other’s patients on weekends. In this situation, Doctor A will see Doctor B’s patients and then Doctor B will bill under his NPI using modifier Q5. The physicians don’t exchange any money because the services eventually even out over time.