Oncology & Hematology Coding Alert

Here's how to report stand-in services and get paid While the oncologist takes summer vacation, can he still get paid for chemotherapy treatments? Sure, if you know when and how to report modifiers -Q5 and -Q6. Reciprocal Billing or Locum Tenens? You Decide Reciprocal billing allows a physician to submit claims and receive Medicare payments when he has arranged for a substitute physician's services. To report this arrangement, append -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement). Locum tenens also allows the physician to receive payment for services another physician performs, but a locum tenens physician cannot work for another practice, and your physician cannot restrict the locum's services to your office. Also, the physician pays a locum on a per-diem or fee-for-time basis, says Jean Acevedo, CPC, LHRM, senior consultant, Acevedo Consulting Inc., Delray Beach, Fla. When a locum performs a service or procedure, attach modifier -Q6 (Service furnished by a locum tenens physician) to the appropriate code. Understand Both Modifiers Review these two locum tenens scenarios and the expert coding advice that follows to help you apply the -Q modifiers correctly:

Scenario one: Your practice hires a locum tenens oncologist for 90 days while your practice searches for candidates to fill a vacant position. On his first day, the locum tenens oncologist infuses chemotherapy for an hour (96410, Chemotherapy administration, intravenous; infusion technique, up to one hour). Coding advice: Many oncology coders and oncologists mistakenly believe a practice cannot hire a locum physician or use modifier -Q6 for a locum's services if the substitute physician works for an oncologist who has left the practice. But you could append modifier -Q6 to 96410 to inform Medicare that it should pay your physician for the locum's chemotherapy services.

However, Medicare doesn't allow you to use modifier -Q6 if the locum physician performed the procedure after his 60th day working for your practice, Acevedo says. Therefore, if the locum administered chemotherapy (96410) on the 61st day of service, you could not use -Q6. Scenario two: While on vacation, the oncologist in your group practice arranges for another oncologist in the same practice to see a patient for prolonged chemotherapy treatment. The substitute physician performs a prolonged infusion (96410, +96412, ... infusion technique, one to 8 hours, each additional hour [list separately in addition to code for primary procedure]). You report 96410, 96412-Q5, which means the substitute oncologist performed the infusion under a reciprocal agreement. Your billing specialist submits the claim under the group number.

Coding advice: The Medicare carrier will probably deny your claim because you cannot use reciprocal billing arrangements for services or procedures that a member of the same group provides. CMS rules state that [...]