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Locum Tenens

  1. #1
    Daytona Beach, FL
    Default Locum Tenens
    Medical Coding Books
    I do coding for General Surgery and a Hospitalists group. We have a number of Locum Tenens covering for our Hospitalists group and now have a Locum Tenens covering for a surgeon who has been out on medical leave. Our billing company has informed us that Medicare is denying our Locum Tenens charges even though we have appended the Q6 modifier. They say that "the note written by the doctor must indicate that they are in fact a locum tenen providing the documented services". I have searched through Medicare documents and I can't find anywhere information about these documentation requirements - only the Q6 requirement.

    Can anyone give me what is required documentation for this to be paid and where I can find this in writing? I need proof that this is required to show to the doctors to get them to add this to their documentation. They don't want to do anymore work than they have to so I need to prove to them that this is required - if it is!

    Thanks for the help!
    Jodi Dibble, CPC

  2. #2
    Sioux Falls South Dakota

    I searched the Medicare IOM for the info on locum tenans billing - in 104-01, section 30.2.11, it says nothing about the medical documentation having to say that this is a substitute (locum) physician - that is supposed to be taken care of by using the Q6 modifier. It does say you have to furnish the locum tenans NPI upon request. Who is your MAC? Can you get a copy of the denial from them? Sometimes they misinterpret the denial reason.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Daytona Beach, FL
    Hi Cindy,

    Highmark is our MAC. I too could not find anything in regards to documentation requirements. I have been trying to get a copy of the EOB's from the billing company, which is like pulling teeth. They have them scanned on some system, which I am unable to get access to - so I have been waiting for our Revenue Cycle Coordinator to get them for me, but with the close of the month, she has not had time.

    What I have now been told by the billing company is that the charges were originally denied for "Medical Necessity" so they went ahead and sent copies of the notes to appeal and they are saying that Highmark is now denying the appeal because the notes do not state that they are done by a Locum. The original denial reason does not make sense as these patients have had other days paid during the same stay by the same Locum, let alone the denial of the appeal because of documentation! So, until I can see these EOB's and probably call Highmark myself, I guess I will not get a true answer to this issue!

    Thanks Cindy for your help - it is greatly appreciated!
    Jodi Dibble, CPC

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