Modifier Q6-Lifeprint denied

DHARRIS0286

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Lifeprint denied a claim for using the Q6 modifier with 99226. We can't figure out why. Were a hospitalist group all under the same tax ID but some of our doctors are not the insurance doctor and require a Q6. Why would it be denied for this?
 

DHARRIS0286

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Q6 Modifier Help

Lifeprint denied a claim for using the Q6 modifier with 99226. We can't figure out why. Were a hospitalist group all under the same tax ID amd some of our doctors require a Q6 modifer. We've never had this problem before. Why would it be denied for this?[/HELP Please
 

Nreed

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In order to submit charges for a physician utilizing the Q6 modifier, they truly must be a LOCUM TENEN who is filling in for your physician for whatever reason. (see below). You cannot use the Q6 modifier just because you are coding/billing for someone who is not your "insurance doctor". Please read the information below from Medicare regarding the proper requirements for utilizing that modfiier.

30.2.11 - Physician Payment Under Locum Tenens Arrangements - Claims Submitted to Carriers
(Rev.1335, Issued: 09-14-07, Effective: 05-23-07, Implementation: 10-01-07)
A. Background
It is a longstanding and widespread practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for the regular physician to bill and receive payment for the substitute physician’s services as though he/she performed them. The substitute physician generally has no practice of his/her own and moves from area to area as needed. The regular physician generally pays the substitute physician a fixed amount per diem, with the substitute physician having the status of an independent contractor rather than of an employee. These substitute physicians are generally called “locum tenens” physicians.
Section 125(b) of the Social Security Act Amendments of 1994 makes this procedure available on a permanent basis. Thus, beginning January 1, 1995, a regular physician may bill for the services of a locum tenens physicians. A regular physician is the physician that is normally scheduled to see a patient. Thus, a regular physician may include physician specialists (such as a cardiologist, oncologist, urologist, etc.).
B. Payment Procedure
A patient’s regular physician may submit the claim, and (if assignment is accepted) receive the Part B payment, for covered visit services (including emergency visits and related services) of a
locum tenens physician who is not an employee of the regular physician and whose services for patients of the regular physician are not restricted to the regular physician’s offices, if:
• The regular physician is unavailable to provide the visit services;
• The Medicare beneficiary has arranged or seeks to receive the visit services from the regular physician;
• The regular physician pays the locum tenens for his/her 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; and• The regular physician identifies the services as substitute physician services meeting the requirements of this section by entering HCPCS code modifier Q6 (service furnished by a locum tenens physician) after the procedure code. When Form CMS-1500 is next revised, provision will be made to identify the substitute physician by entering his/her unique physician identification number (UPIN) or NPI when required to the carrier upon request.
If the only substitution services a physician performs in connection with an operation are post-operative services furnished during the period covered by the global fee, these services need not be identified on the claim as substitution services.
The requirements for the submission of claims under reciprocal billing arrangements are the same for assigned and unassigned claims.
 
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