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locum tenens

  1. Default locum tenens
    Medical Coding Books
    I understand that to bill LT, among several other things, the regular physician is unavailable to provide the visit services, this LT cannot be billed for a continuous period over 60 days, charges must include Q6 modifier. Here is our potential scenario (I am researching just in case the docs really want to go this route): our anesthesia group is looking to use LT to cover call from 7 pm to 7 am and some weekends. I say it's not LT because this "LT" would not be taking the place of someone on vacation, sick, etc., but covering because the regular staff would prefer not being on call so often. One doc says he is "unavailable" and that meets the criteria. I think it means we need to hire someone else. This would not be a temporary situation. Also - if the LT works just Sundays, how does that apply to the continuous time? If I understand Chapter 12 of the Part B Manual, there are starting and ending times for the main physician's absence and that time period is the "continuous period" for the LT coverage. One last issue - what is the difference between Q5 and Q6?

  2. #2
    Q5 is reciprocal billing arrangement. This is more what your providers want, I think you may be on the right track with just hiring someone else though.

    page 65 is where it starts talking about reciprocal billing.

    It sounds like they are just wanting to supplement service without having to take on additional hours. Which is not what the locum tenens or reciprocal billing policies are meant for.

    Continuous time is exactly that, 60 consecutive calendar days, not business days or days worked. It would start over every time the regular physician came back then left again. So your locum works 60 days and your regular doctor comes back on day 61 then is off again on day 62, the 60 days for a locum starts over again at that point.

    Hopefully this is helpful and not confusing,

    Laura, CPC, CEMC

  3. #3
    North Carolina
    The Use of Locum Tenens for Short Term Coverage

    Q: Could a practice hire a locum tenens physician to cover for the regular physician on their weekly days off?

    A: This situation does not match the locum tenens provision. The locum tenens arrangement is distinct from a temporary coverage situation, when one physician fills in for another for brief periods of time, such as after hours, weekends, vacations, and the like. Generally, the locum tenens physician has temporary contractor status. The arrangement cannot be a permanent employment situation in which the substitute "rotates" by covering for physicians on their weekly days off. This, in effect would constitute permanent employment and the application of the locum tenens rules in scenarios for which they were not designed. Whereas a provider's days off are a regularly recurring event without limit, the need for a "fill-in" physician exceeds the 60 day limit inherent to locum tenens. Therefore, a practice could not hire a "fill-in" physician to cover other doctors' days off and bill the services under the locum tenens provision.

    See CMS Publication 100-4, Chapter One, Section 30.2.10-11 for specifics on locum tenens through the following link:

  4. Default
    Thanks for the helpful information!

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