Radiology Coding Alert

Answer: With the passage of the Americans with Disabilities Act, federal law established a provision that requires physicians to provide a sign language interpreter when requested by a patient for complex visits i.e., presurgical consent discussions. The physician is not allowed to charge a separate fee for the interpreter. When this has been tested in the courts, it has not been considered an undue burden to expect the practice to pick up this cost.

However, an office visit with a sign-language interpreter may require additional time. In situations like this, the radiologist should note in the medical record the duration of the visit. This provides the coder with the information necessary to assign the appropriate level office visit.

For example, if explaining the procedure, its likely outcomes and associated risks takes an extended period of time (i.e., 45 minutes), the practice may assign code CPT 99204 (office or other outpatient visit for the evaluation and management of a new patient [physicians typically spend 45 minutes face-to-face with patient and/or family]). Shorter visits would be assigned one of the following codes, based on duration and circumstances 99201, 99202, 99203 while a longer visit would be coded 99205.

Coders may use V40.1 (problems with communication [including speech]) as the last diagnosis code to support the higher level for the office visit.

Answer provided by Thomas A. Kent, CMM, Kent Medical Management in Dunkirk, Md.