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Marina Posted Thu 26th of February, 2015 12:30:19 PM

One of our physicians (who is contracted with Medicare) became ill on a certain date of service which lead to another physician (who is not contracted to Medicare) having to see his patient. I beleive there is a modifier that I can bill with this office visit so that we are paid by Medicare. Please help me by telling me which modifier is best to use for this incidient. Thank you

SuperCoder Answered Fri 27th of February, 2015 06:24:15 AM

Thank you for the query.

I think you are looking for GA modifier. This modifier indicates that an ABN (Advanced Beneficiary Notice) is on file and allows the provider to bill the patient if not covered by Medicare.

I hope this information will be helpful.

Marina Posted Thu 05th of March, 2015 13:05:39 PM

I was under the impresssion that Medicare will allow and pay on a claim when a non contracted physician has to treat a patient under the circumstances of an emergency when the contracted physician is not available. Is this not true?

SuperCoder Answered Fri 06th of March, 2015 23:53:18 PM

Yes this is correct, the Q6 modifier would more than likely apply in this situation. The Q6 modifier represents that the visit was covered by a locum tenens physician. See the attached link for addition guidelines for billing in this scenario.

Marina Posted Tue 10th of March, 2015 16:15:07 PM

Thank you. Do I bill using the contracted providers billing info with the Q6 modifier? Or do I use the treating physicians info?

SuperCoder Answered Wed 11th of March, 2015 08:07:29 AM

You should use the provider's information that is being covered. For example, Dr. Smith is having surgery and he will be out for three weeks. Dr. Harris has been brought in as a locum tenens to cover his patients; you should bill under Dr. Smith's information but append the modifier to each claim. Be sure to read over the billing guidelines and requirements to ensure that you qualify to bill this way.

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