Optometry Coding & Billing Alert

Published on Thu Jan 18, 2007 PDF

Modifier Q6 a must for substitutes

When one of your optometrists takes a leave of absence and the practice hires a substitute OD to fill in, you must take extra coding steps on Medicare claims to ensure payment for the sub's services.

Why? When your practice employs a substitute or locum tenens optometrist, Medicare wants to see specific modifiers on claims. Further, your practice must observe time limits for locum tenens doctors. Otherwise, Medicare won't pay for their services.

(Note: Private insurers that follow Medicare coding and billing guidelines will also expect you to observe locum tenens rules for substitute providers.)

There are a number of instances in which your optometry practice might employ a locum tenens doctor, 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 practice another doctor's services. "A locum tenens cannot be used to provide additional help. The locum tenens doctor must always be used as a replacement who substitutes for a specific physician," Hammer says.

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 OD. This lets the Medicare carrier know that you are coding for a locum tenens doctor. "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.

- The locum tenens physician must perform all services in the absentee optometrist's office. "Any hospital services would be billed through the absentee (optometrist-s) office as well," Hammer says.

- When a locum tenens OD works for your practice, the absentee OD must keep on file a record of each service provided by the substitute in his absence. Keep this information on hand in case the carrier wants to view it.

- All services the locum tenens doctor renders must be billed to Medicare under the billing ID of the regular doctor. "Since locum tenens physicians are not directly contracted with Medicare for the care of those patients, all claims need to be filed under the absentee physician's name and number," says Chris Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, PMCC-approved instructor for The Coding Source in Oregon.

Another important rule to remember for locum tenens doctors is that they cannot fill in forever. "For Medicare, the maximum is no longer than 60 continuous days starting with the first date of services provided by the locum tenens doctor," Hammer says.