Neurology & Pain Management Coding Alert

Question: We are looking to hire a locum tenens (LT) physician for a physician that’s going on an extended vacation. Can you offer some advice on how we should bill for the LT’s services that I can pass onto the billing department and others that bill/code for the LT?

Oklahoma Subscriber

Answer: When one of your full-time physicians goes on an extended vacation — or sabbatical or maternity leave — your practice might hire an LT to fill in for the missing physician.

Billing for the substitute physician’s services with Medicare — or payers who follow Medicare’s billing guidelines — can be tricky unless you have the proper guidance.

In short: A LT physician must be substituting for another physician. You can’t just bring in a LT as extra help for situations where your practice has an uptick in business.

There are three rules you must remember when you are billing for an LT physician:

1. Medicare ID billing number: Bill the LT’s services with the ID number of the physician he’s subbing for.

Example: Your practice hires an LT physician to fill in for Dr. X, who is on a teaching sabbatical. The LT physician performs a level-two E/M service for an established patient. 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 LT’s services under Dr. X’s Medicare ID number.

2. Modifiers: Remember to append modifier Q6 (Service furnished by a locum tenens physician) to 99212 in the above example. In fact, append Q6 whenever you code for a service that an LT physician provides.

Time limit: Medicare does place limits on the amount of time you can bill under LT rules. An LT can fill in for 60 continuous days starting with his first date of service. This period continues for up to 60 calendar days, with no breaks, even if the LT does not see patients on some of those days. In situations where the regular physician is going to be absent for more than 60 days, you’ll need to formulate an alternative plan for physician coverage and patient care.