Psychiatry Coding & Reimbursement Alert

Published on Wed Oct 14, 2015 PDF

Question: We are using a substitute psychiatrist to fill in for one of our psychiatrists who is taking maternity leave next month. I was told that we’re billing for this clinician under the absent psychiatrist’s Medicare ID. I’ve never billed for a substitute clinician before. Do I need to observe any specific coding/modifier rules for this clinician’s services?

Maryland Subscriber

Answer: You’ll need to know a couple of rules, and one specific modifier, in order to bill for substitute — aka locum tenens — physicians.

Check out this quick guidance on getting each locum claim right while your regular physician takes extended leave:

Billing: You should bill the locum’s services with the ID number of your psychiatrist for which he/ she is covering.  Let’s say Dr. X is taking leave, and Dr. Y is filling in for her. Dr. Y performs psychotherapy and medication management for an established patient who was under the care of Dr. X prior to his leave.

On the claim, you should report an appropriate psychotherapy code such as +90833 (Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service [List separately in addition to the code for primary procedure]) for the psychotherapy part of the service and an appropriate E/M code such as 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. …) for the encounter. You report these services under Dr. X’s National Provider Identifier (NPI) number.

Modifier: You should, then, attach modifier Q6 (Service furnished by a locum tenens physician) to 99213 and +90833 in the above example to let the payer know that the services were provided by the locum that was hired to take the place of your clinician. In fact, append Q6 whenever you code for a service that a locum provides.

Time limit: There is a time limit specified for reporting the locum’s services under your clinician’s NPI number. You should observe a 60-day time limit for your locum, starting with his/ her first day of service. Let’s say Dr. X goes on maternity leave September 1, 2015 and you hire a locum to fill in for her; the locum starts that same day and sees his first patient. You can bill the locum’s services under Dr. X’s NPI number until Oct. 30, 2015.