Wiki Modifier Q5 - Our office hired 2 new physicians

[cmw04170128@yahoo.com]

Our office hired 2 new physicians which are not yet credentialed with our insurance companies. We are in process of getting them credentialed but until we do,
Is it appropriate to use modifier Q5 for the patients currently being treated by our credentialed doctor?
Thank you
CMW

 

[mcnaryk]

Q5 modifier

If the patients are being treated by your credentialed doctor, then you should be billing using the credentialed doctor's own NPI and credentials, without a modifier. Q5 is reciprocal billing-where 2 doctors of different groups/specialties agree to see patients for the other for vacation or medical leave-I would not use it simply because a new physician is not credentialed yet. In a perfect world, no patients would be scheduled until all credentialing was complete, but I know from experience that does not always happen. If the new doctors see patients, you should bill under their own name/number. Hopefully the credentials come in within timely filing limits (and the effective date is retro-active to capture all charges) and you can refile. If not, you have to write those off-it's not the patient's fault that they were scheduled to see an uncredentialed physician. I hope this helps!!

 

[cmw04170128@yahoo.com]

Q5

Yes, thank you very much for your reply.