Anesthesia Coding Alert

Question: We have a locum tenens physician providing medical direction for a few CRNAs while our anesthesiologist is on leave. When we bill the anesthesia modifiers for the locum, do I use the Q6 first and then the QK, or the QK first and then the Q6?

Connecticut Subscriber

Answer: Choose the appropriate anesthesia code for the procedure, then append the payment modifier QK in the first position (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) when the locums physician medically directs multiple concurrent cases. If he directs a single case, append modifier QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) instead. The second statistical/informational modifier should be Q6 (Services furnished by a locum tenens physician).

Refresher: Keep three important points in mind the next time you’re coding for locum tenens services:

• Bill the locum tenens physician’s work under your physician’s NPI.
• CMS has a 60-day time limit for using locum tenens physicians. If your physician will be gone longer than that, she should arrange for another physician to perform locum duties on her behalf after the 60-day mark.
• When you report locum tenens services, don’t confuse modifier Q6 with reciprocal billing modifier Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement). Reciprocal billing arrangements typically describe a two-way exchange between providers, which is not the same as a locum tenens arrangement.