Ophthalmology and Optometry Coding Alert

Question: We have never submitted a claim for a locum tenens (LT) physician, but we recently hired an LT physician to fill in for an ophthalmologist who is on maternity leave. How do I code for her if she performs a level-three E/M visit for an established patient?

Codify Subscriber

Answer: An LT physician must be substituting for another physician. In other words, you can't hire an LT as "extra help" if your practice experiences a temporary surge in business. Bill the LT's services with the ID number of the physician for whom he is subbing. Medicare does place limits on the amount of time you can bill under LT rules. A locum tenens doctor can fill in for 60 continuous days starting with his first date of service.

You'll code for the substitute physician's services with Medicare - or payers who follow Medicare's billing and coding guidelines - under LT rules and regulations. On the claim, report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity...) with modifier Q6 (Service furnished by a locum tenens physician) appended to 99213 to show that an LT provided the service. In fact, append Q6 whenever you code for a service that an LT physician provides.