Neurology & Pain Management Coding Alert

Follow these locum tenens rules to max out pay for ‘substitute.’

It’s getting warmer as summer approaches, and that means many staff members will be taking vacations — including physicians. When a physician takes an extended leave, the practice often hires a locum tenens (LT) physician to provide coverage.

Benefit: When you hire an LT physician, you can bill for her services under the absent physician’s name and Medicare identification number, still bringing money in to your practice even though your physician is away. Careful, though; one or two missteps when billing for LTs could make payers take notice. And not in a good way.

“Medicare has certain parameters that need to be met in order to bill locum tenens, and many other insurance companies adopt similar policies,” explains Laureen Jandroep, CPC, COC, CPC-I, CPPM, founder/CEO of Certification Coaching Organization, LLC, in Oceanville, N.J.

Dodge some of the speedbumps that might pop up when a physician takes leave by following these LT tenets.

LT Must Be Subbing For Another Physician

When you are billing for the locum, she must be filling in for another physician who has taken leave for some reason. You cannot hire temporary physicians as extra help and bill LT, confirms Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president of Healthcare Resource Management Inc. in Spring Lake, NJ.

“The locum tenens physician must be substituting for a physician within the practice, and cannot [be] a contractual employee of the practice,” she adds.

So if Dr. A goes on vacation and you hire Dr. B to take over her case load, you might bill LT for Dr. B’s services. If you hire Dr. B for two months to help out with an unexpected surge in new patients, you cannot bill LT.

Report All LT’s Services With Absent Physician’s ID

When billing for the LT’s services, you must be sure to bill under the name and Medicare ID of the absent physician, advises Jandroep. Further, you should append modifier Q6 (Service furnished by a locum tenens physician) to any code you are billing for the LT’s services.

An LT claim must also include the practice group’s National Provider Identifier (NPI), and the NPI of the physician the LT is subbing for.

Example: Dr. A is on leave, and Dr. B is the LT. Dr. B performs a level-two E/M service for an established patient with a plan of care in place for a tic caused by penicillin use. On the claim, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…) for the service with modifier Q6 appended to show that you are billing for a locum. File the claim under Dr. A’s name and NPI.

Avoid Payer Issues by Following LT Limit

LTs can’t fill in forever. Medicare stipulates that an LT physician can substitute for the same physician for 60 continuous days, starting with his first day of service, says Jandroep. Other payers that follow LT rules might have different time constraints, she continues.

“If coverage is needed for longer than 60 days, then the covering physician should be added to the group and their NPI number [should] be used instead of the regular physician’s,” explains Jandroep.

Make Recordkeeping a Priority for LT

When you are employing a locum tenens physician, you should “absolutely” keep a record of all the services the LT provides, Brink recommends.

Keeping this record is good practice “in case of an audit, and for compliance with Medicare billing and coding guidelines,” explains Brink.