Fill In Doctor: Locum Tenens

by  Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
July 31st, 2014

It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” doctor. When completing the CMS 1500 claim form, do they use their doctor’s name and NPI, or do they use the name and NPI of the covering doctor who actually saw and treated the patient? And which modifier is correct, Q6 Services furnished by a locum tenens physician or Q5 Services furnished by a substitute physician under a reciprocal billing arrangement?

A substituting doctor is really just a proxy and functions as if the regular doctor were present. For most payers, the substitute physician does not need to be credentialed with the plan, but he or she must possess an unencumbered license in the same specialty. If the temporary doctor is hired on, then Medicare (and presumably most private plans) would require the new doctor to become enrolled before submitting claims. Temporary doctors may not be used indefinitely, CMS limits locum tenens to 60 days, and most other payers probably have similar guidelines.

If the fill-in doctor was hired from the outside, he or she should be paid a per diem or on a fee for time basis as an independent contractor and the –Q6 modifier would apply. “Locum tenens” is latin for “to hold the place of”, or more plainly, a “fill-in”. When the covering physician is a permanent part of the office (under the same tax ID), this may constitute a reciprocal billing arrangement, and the –Q5 modifier would apply.

To summarize:



References:

Fill In Doctor: Locum Tenens. (2014, July 31). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/fill-in-doctor-locum-tenens-1463.html

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