CODING & DOCUMENTATION

 

Fam Pract Manag. 2018 Jan-Feb;25(1):33.

Author disclosure: no relevant financial affiliations disclosed.

RECIPROCAL BILLING DURING EXTENDED ABSENCES

Q

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?

A

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

Q

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)?

A

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

ABOUT THE AUTHOR

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Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM....

Author disclosure: no relevant financial affiliations disclosed.

Reviewed by the FPM Coding & Documentation Review Panel.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.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.

 
 

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