Pulmonology Coding Alert

This is MD, not PA or CRNA, territoryA locum tenens physician may be temporarily added to your practice, but if you don't keep proper documentation, the headaches may last long after he leaves.Billing for a locum tenens' services is fairly straightforward, experts say. You have to append modifier Q6 (Service furnished by a locum tenens physician) to all of the temporary doctor's claims and bill under the National Provider Identifier (NPI) of the physician the locum is replacing. Also, you should include the temporary doctor's NPI in box 23 on the CMS-1500 billing form.Timing is everything: You can bill for a locum tenens physician for 60 continuous days. If the locum leaves your practice for a time and then comes back, the 60-day clock starts again.Keep Copies of the Locum's ClaimsThe tricky part: Medicare requires you to maintain a separate record of all the claims you submitted for the locum tenens physician. There are a few ways to do this.You can make an extra copy of each of the locum's claims and keep the copies in a separate paper file for the locum tenens, or you can use your computer system to track the locum tenens. The computer system at Einstein Healthcare Network in Philadelphia allows billing staff to look up the NPI listed in box 23 of the billing form, says coding specialist Christine Endes. "This way, we can reference it at any time," she adds.New numbers: Endes and her colleagues also assigned different numbers internally to locum tenens physicians, for tracking purposes. Normally, if staffers type in a physician's NPI, the computer will print out a bill under that doctor's name, but typing in a special number for the locum tenens produces a bill with the absent doctor's name and modifier Q6 attached -- and it adds the locum's NPI to box 23.Don't Trip Over Similar ModifiersWhen you report locum tenens services, don't confuse modifier Q6 with reciprocal billing (modifier Q5, Service furnished by a substitute physician under a reciprocal billing arrangement). You use modifier Q5, for example, when your physician arranges with another doctor to cover each other's patients on weekends.In this situation, Doctor A will see Doctor B's patients and bill under Doctor B's NPI using modifier Q5. The physicians don't exchange any money because the services even out over time.Stick With True Locums SituationsMany coders agree that people only have trouble with locum tenens when they try to use locum tenens billing for a couple of situations it wasn't designed for:1. A newly hired physician who isn't credentialed yet. You can't bill for a locum tenens unless one of your regular physicians is really away.2. A physician assistant (PA) or certified registered nurse anesthetist (CRNA) [...]