Primary Care Coding Alert

Question: Our family physician is taking a month-long vacation. Another physician will be substituting for her, but we are not sure if we should use reciprocal billing or locum tenens. What's the difference between the two? Michigan Subscriber Answer: Reciprocal billing is when the physician submits claims and receives Medicare payments that he or she has arranged for a substitute physician to provide on an occasional, reciprocal basis. Your vacationing FP can be reimbursed if four requirements are met:

The FP must be unavailable to provide the visit services.
The Medicare patient must have arranged to receive or seek to receive the visit services from the FP.
The substitute physician must not provide the visit services to Medicare patients over a continuous period of more than 60 days.
The FP must attach modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement) to the procedure code. If you are in a group practice that submits claims under the group's name, reciprocal billing does not apply to you. It does apply if you are a member of a group whose physicians bill in their own names, because Medicare treats them as independent physicians. Locum tenens also allows your practice to get paid in your FP's absence, but the substitute physician cannot be another practice employee and his patient services cannot be restricted to your office. The locum tenens physician is paid on a per-diem or fee-for-time basis. The requirements are the same as those for reciprocal billing arrangements, except you report modifier -Q6 (Service furnished by a locum tenens physician) instead of -Q5. Many practices bill locum tenens while they are waiting for a new physician to become credentialed.

For more information on Medicare's requirements for reciprocal billing and locum tenens, see sections 3060.6 and 3060.7 of the Medicare Carriers Manual, available online at http://www.hcfa.gov/pubforms/14_car/ 3b3060.htm#_3060_6.