ED Coding and Reimbursement Alert

When the regular doctor is out, follow these rules when coding for the replacement physician When one of your physicians takes a leave of absence and the ED hires a substitute physician to fill in, you must take extra coding steps on Medicare claims to ensure payment for the sub's services.

Why? When your ED employs a substitute, or locum tenens, physician, Medicare wants to see specific modifiers on claims. Further, your ED must observe time limits for locum tenens doctors. Otherwise, Medicare won't pay for their services. You Can't Hire Locum Tenens Doctor as Extra Staff There are a number of instances in which your ED might employ a locum tenens physician, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.

For example, you might need a substitute if one of your regular doctors:

- goes on vacation.

- has an illness that requires extended recovery time.

- goes on maternity or family health leave.

- takes a leave in order to attend continuing medical education sessions. 

Caveat: Remember that these substitutes cannot be hired to give your ED staff another doctor's services. -A locum tenens cannot be used to provide additional help, such as staffing for another operating room. The locum tenens doctor must always be used as a replacement who substitutes for a specific physician,- Hammer says.
 
Remember Q6 on All Locum Tenens Claims Coding for locum tenens involves several extra steps in order to file an acceptable claim, Hammer says.

Here's a quick primer on the basic rules of locum tenens for Medicare providers:

- You must attach modifier Q6 (Service furnished by a locum tenens physician) to all codes for procedures performed by the substitute physician. This lets the Medicare carrier know that you are coding for a locum tenens physician. -Enter modifier Q6 to the procedure code in item 24d of the CMS-1500 claim form or in the corresponding field for electronic claim submissions,- Hammer says.

Without the modifier, you-ll likely receive a denial for the claim.

Suppose one of your ED physicians goes on maternity leave. Your locum tenens physician provides a Medicare patient with level-two E/M service and a control of a simple nasal hemorrhage.

On the claim, attach modifier Q6 to the E/M code (99282, Emergency department visit for the E/M of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem- focused examination; and medical decision-making of low complexity) and to the nosebleed treatment code (30901, Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) to show that a locum tenens doctor provided the services.

- The locum tenens physician must perform all services in the absentee physician's office. -Any hospital services would be billed through the absentee physician's office as well,- [...]