Practice Management Alert

Question: My question is regarding a patient of ours who is deaf. She came to us for an evaluation for outpatient surgery; we are a specialist office. We are told that it is a law that we must provide an interpreter for her when she comes in our office for the visit. As we are checking into this, we are finding that an interpreter is not cheap, and actually, the interpreter's services are more than what we will get from the insurance company for the visit. Do we have to provide the interpreter?

Maryland Subscriber

Answer: You do need to provide an interpreter for this patient. Physicians are required to comply with the 1964 Civil Rights Act, as amended; Section 504 of the Rehabilitation Act of 1973; the Age Discrimination Act of 1975; the Omnibus Reconciliation Act of 1981; the Americans with Disabilities Act of 1990; and all other applicable federal and state laws that prohibit discrimination in the delivery of services on the basis of race,color, national origin, age, sex, handicap/disability, or religious beliefs.

The catch: Medicare and most other payers do not separately reimburse interpretive services. They usually consider interpretive services -incidental- to the rendered service, such as an office visit (99201-99205).

Code T1013 (Sign language or oral interpretive services, per 15 minutes) is not valid for Medicare, according to the 2009 Medicare Physician Fee Schedule, which assigns the code status I (Not valid for Medicare purposes). The majority of payers designate T1013 for use only by contracted non-medical vendors.

Some payers, such as Medicaid in some states, may pay for the interpreter's services. You should check with your individual payers to see what their policy is.

Best bet: Verify in writing how you should bill for an interpreter's services with each of your individual payers before coding. Also, Medicare and other payers may pay for extra time associated with using a translator, so check with your payer about this option.

Example: The Vermont Medical Society offers this tip on an FAQ on its Web site: -The only way to account for this extra time is to submit one of the prolonged services codes (99354-99355), which requires that the face-to-face time spent with the patient extend at least 30 minutes beyond the typical time associated with the appropriate CPT services. Note that Medicareand most other payers will not pay for the services of the translator even if they are willing to pay for the extra visit time associated with using a translator.-

Get help: The AMA offers suggestions for financing interpreter services in its brochure -Office Guide to Communicating With Limited English Proficient Patients.- Take a look online at www.amaassn.org/ama1/pub/upload/mm/433/lep_booklet.pdf.