CODING & DOCUMENTATION
Fam Pract Manag. 2018 Jan-Feb;25(1):33.
Author disclosure: no relevant financial affiliations disclosed.
- RECIPROCAL BILLING DURING EXTENDED ABSENCES
- ICD-10 CODING FOR ACCIDENTS WITHOUT INJURY
- REMOVAL OF IMPACTED CERUMEN
RECIPROCAL BILLING DURING EXTENDED ABSENCES
I have an agreement with another physician in my area to provide coverage for me when I am unavailable. Can we bill for services we provide to each other's patients?
Most Medicare and Medicaid plans will allow you to cover another physician's practice under an arrangement known as reciprocal billing. Private payers' policies may differ, so verify the policies of your most common payers before reporting reciprocal billing. Here is how it works:
The absent physician may bill as if he or she provided the service. He or she must be unavailable to provide the care, the patient must request the care, and the documentation of services provided must be maintained by the absent physician's practice. HCPCS modifier Q5, “Service furnished by a substitute physician under a reciprocal billing arrangement,” should be appended to all of the procedure codes reported.
A physician cannot provide services under a reciprocal billing agreement for a continuous period of longer than 60 days. Also note that patients cared for under a reciprocal billing agreement may not be considered new patients for coding purposes if they would be an established patient to the absent physician. For these reasons, many physicians do not use the reciprocal billing arrangement, instead choosing to treat all patients who would normally receive care from the absent physician as their own patients and coding accordingly.
ICD-10 CODING FOR ACCIDENTS WITHOUT INJURY
What is the appropriate ICD-10 code to report when a patient comes in for an evaluation following an accident and no injury is found (e.g., a patient concerned about a concussion after being hit by a ball)?
If any sign or symptom of illness or injury is present, you should submit the ICD-10 code for the sign or symptom. Alternatively, the ICD-10 manual includes observation codes that can be reported for a patient
WE WANT TO HEAR FROM YOU
Send questions and comments to firstname.lastname@example.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.
Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions