Radiology Coding Alert

2 scenarios show you how to report stand-in services and get paid  When your radiologist takes a vacation and asks another radiologist to fill in, modifiers -Q5 and -Q6 are the keys to recouping reimbursement for the substitute physician's services. Distinguish Reciprocal Billing From Locum Tenens "Locum tenens" physicians generally do not have practices of their own, but instead move from practice to practice, filling in for other physicians. Your radiologist pays the locum tenens physician a fixed per-diem amount as an independent contractor. Your practice, in turn, bills for the service as if your physician personally performed the service.
 
Many physicians confuse locum tenens billing with reciprocal billing, but don't use these terms inter-changeably. According to guidelines in section 3060.7 of the Medicare Carriers Manual (MCM), two main differences distinguish these scenarios:
 
1. Locum tenens physicians are paid on a per-diem rate. In a reciprocal arrangement, each physician continues to bill all services to his or her own patients.
 
2. Locum tenens arrangements are identified by appending HCPCS Codes modifier -Q6 (Service furnished by a locum tenens physician), whereas you should indicate a reciprocal billing arrangement with modifier -Q5 (Service furnished by a substitute physician under a reciprocal billing arrangement).
 
According to the MCM, Medicare will reimburse physicians who retain locums for covered services after meeting the following criteria:
  The regular physician is unavailable to provide the visit services.
  The Medicare beneficiary has arranged or seeks to receive services from the regular physician.
  The locum is an independent contractor, not an employee of the practice, and you pay him for services on a per-diem or similar fee-for-time basis.
  The substitute physician does not provide the visit services to Medicare patients over a continuous period of longer than 60 days.   Test Yourself: Locum Tenens or Not? Take a look at these two scenarios and the expert coding advice that follows to help you determine when the -Q modifiers may not be the best choice. Scenario 1: Every Wednesday, your radiology group has an increase in patients when several of the hospital clinics schedule their patients for diagnostic studies. You recently hired a part-time radiologist to help out on Wednesdays and Thursdays, and you plan to bill him as a locum tenens. You intend to report him as substituting for your group's chairman (the chairman does not now practice, so this won't impact productivity for the group's other physicians). Coding Advice: Unfortunately, this is not a true locum tenens situation. If the practice's chairman were a practicing physician who is absent on Wednesdays and therefore cannot perform the imaging services, [...]