Pulmonology Coding Alert

Effective communication is essential between health care providers and their patients. A patient who is hearing-impaired may present a challenge to effective communication. The Americans with Disabilities Act (ADA) requires that physicians provide a sign-language interpreter for complex office visits if a patient requests one. And, there are ethical ways to recover the cost of using an interpreter.

According to the guidelines of the Registry of Interpreters for the Deaf (RID), a national membership organization for interpreters and transliterators, An interpreter should be present in all situations in which the information to be exchanged requires effective communication, such as taking a medical history, explaining tests, procedures and diagnoses, planning treatment, providing discharge instructions and scheduling follow-up care.

Who Pays for Interpreter Services?

Melanie Witt, RN, CPC, former program manager with the Department of Coding and Nomenclature, American College of Obstetricians and Gynecologists, says that in most instances the services of an interpreter during a patient encounter become part of your overhead cost.

You cannot bill an evaluation and management (E/M) service for the services of an interpreter. Witt says billing for an interpreters services using ICD9 Code V40.1 (problems with communication) is a common error. If
you bill for an interpreters services using V40.1, you imply that you are billing for a communication problem with the interpreter.

The best approach, Witt advises, is to establish everything up front with your carrier before the patient ever visits the office. Dont wait until after the fact. Arrange before the visit how to bill it, and you can
avoid a lot of problems. You should call your carrier before the patients visit to your office and ask for the carriers reimbursement policy and procedure on interpreter services.

Some companies that provide managed-care services have an interpreter available; some carriers actually have an interpreter on staff who will meet with the hearing-impaired patient and the physician; and some carriers establish a direct payment with an interpreter. In many instances, preferred physician options and indemnities leave it up to the provider to determine how to proceed with obtaining interpreter services. In any case, if a deaf patient requests this [auxiliary] service, it must be provided.

Billing Options

If the patient encounter is long, Witt suggests another approach is to use prolonged visit codes. At a 99215-level visit (office or other outpatient visit for the evaluation and management of an established patient which requires at least two of three key components) instead of the usual time it took for you to conduct the patient [...]