Pulmonology Coding Alert

Get what you deserve with these 2 modifiers The pulmonologist's choice of a locum physician or a reciprocal billing arrangement when he takes vacation or calls in sick determines whether you should attach modifiers -Q5 or -Q6 to the appropriate procedure and service codes. Choose Between Reciprocal and Locum Billing Reciprocal billing allows a physician to submit claims and receive Medicare payments when he has arranged for a substitute physician's services. To report this arrangement, attach -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement).
 
Locum tenens also allows pulmonologists to receive payment for services another physician performs, but a locum tenens physician cannot work for another practice, and your physician cannot restrict the locum's services to your office. Also, your pulmonologist pays a locum on a per-diem or fee-for-time basis, says Jeff Berman, MD, FCCP, executive director of the Florida Pulmonary Society in Boca Raton.
 
When a locum performs a service or procedure, use modifier -Q6 (Service furnished by a locum tenens physician), Berman says.
 
Take a look at two locum tenens scenarios and the expert coding advice that follows to help you apply the Q modifiers correctly:
 
Scenario One. Your practice hires a locum tenens pulmonologist for 90 days as your practice searches for candidates to fill a vacant position. The locum physician performs a bronchoscopy (31622, Bronchoscopy [rigid or flexible]; diagnostic, with or without cell washing [separate procedure]) to inspect a patient's lung. After finding a lesion, the physician takes a biopsy (31625, ... with biopsy) of the lesion.
 
Coding Advice: Many pulmonology coders and pulmonologists mistakenly believe a practice cannot hire a locum physician or use modifier -Q6 for a locum's services if the substitute physician works for a pulmonologist who has left the practice.
 
But you could attach modifier -Q6 to 31625, although you would not separately report 31622, which the National Correct Coding Initiative bundles into the biopsy code. Medicare, however, doesn't allow you to use modifier -Q6 if the locum physician performed the bronchoscopic biopsy after his or her 60th day working for your practice.
 
Therefore, if the locum administered the bronchoscopy with biopsy (31625) on the 61st day of service, you could not use -Q6.
 
Scenario Two. While on vacation, a pulmonologist in your group practice arranges for another pulmonologist in the same practice to treat a patient for excessive fluid in the pleural space (511.1, Pleurisy; with effusion, with mention of a bacterial cause other than tuberculosis). The substitute physician performs an office consult (99244, ... for a new or established [...]