Part B Insider (Multispecialty) Coding Alert

Reader Question:

Clarify Your LT Claims Concerns

Published on Mon Jun 20, 2016

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Question: One of the physicians in our practice will be out of the country for nine weeks this summer. In the last issue of Part B Insider, you mentioned that CMS allows only 60 continuous days per locum tenens (LT). If our physician only ends up being away 65 days, can we just keep the same LT for the last five days?

Florida Subscriber

Answer: No. CMS has a very strict policy regarding coverage by locum tenens (LT)—when they say 60 continuous days, they mean 60 continuous days starting immediately from the first day the LT provides care for patients of the regular physician.

However, your practice is welcome to contract another LT for the remaining five days or for as many days that lead up to another 60 continuous days in order to fill the regular physician’s absence. LT physicians do not replace regular physicians, but rather work primarily as interim substitutes for a regular physician on leave for either illness, pregnancy, vacation, continuing medical education, and sabbatical.

Exception to the rule. The only time this rule is waived is when the regular physician is called to active duty in the military. If this is the situation in which an LT is hired, an unlimited amount of days are allowed.

It’s critical to bill under the name and absent physician’s NPI number to avoid denials. You need to append modifier Q6 (Service furnished by a locum tenens physician) to any code you’re using to cover the LT’s care.

Documentation must be clear in LT situations, especially if you are using one LT for 60 continuous days, then hiring another LT for the next 60 days to cover your regular physician’s leave. As long as the LT is mentioned in the medical notes, the biller only need name the regular physician and his NPI to avoid denials.