Wiki Coding based on time when using interpreter

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Pam Warren

Pam Warren

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Hi, I'd like to hear some feedback and maybe some direction with regards to regulatory guidance surrounding an question that was posed to me recently.

I'm in a geographical area where there is a large ethnic population of non-English speaking patients. Typically, when they are seen by the physicians, they require an interpreter, and this back and forth that takes place in order for the provider to communicate and insure understanding for treatment, etc, takes a great deal of additional time. Since this extra time involves counseling and coordination of care, is medically necessary and constitutes more than half of their face-to-face time, providers are wanting to code these visits based on time.

We do know that in cases where interpretors are necessary to comply with ADA (deaf or otherwise disabled patients), we cannot pass along extra cost of providing the service to the patient, and in my mind that would include coding based on that additional time. However, would it be inappropriate to apply that rationale to patients who need an interpreter for non-disability reasons?

I'm curious as to what everyone thinks about this...is it wrong to bill based on time when providers have to use extra time for counseling because of language barriers? Are we discriminating because of their inability to speak English? Or is it unfair for the provider to have to use the additional time without reimbursement? I haven't ever seen anything that addresses this, but welcome comments and/or regulatory guidance to help out! Thanks and have a good day. Pam
 
Pam I do not have much experience in this issue, although we have encountered it infrequently, and from my understanding it is part of practice expense and no, the dr. could not use that as a consideration in billing time based. My own opinion is that I do not think this is fair to the provider. Perhaps in the near future a new CPT code could be crafted that might account for these issues that would render the add'l revenue the doctors deserve. In a perfect world, wouldn't it be nice if patients would seek out physicians who spoke their language? On the other hand it would be great if physician's office staff had employees that were adept in bi and ti-lingual skills, but regardless any of these would still cut into the bottom profit margin. Or, as unpopular as this may sound, perhaps the patient could be charged for this extra service rather than have the doctors have to incur the cost? Just my first thoughts, and I find this an extremely interesting thread. Hope those more knowledgable will submit their input so that we can all learn.

Thanks for helping us out when we have questions. It's only fair and proper that your thread also be addressed!
 
I appreciate it, Suzanne. Our compliance officer weighed in on this, and according to her, billing the additional time for translation services when a patient is non-English speaking would definitely be discrimination based on ethnicity. So we're going to adopt an internal coding policy that disallows this, but I agree that it does impact the bottom line, but it also depends on the physician and how easily they're able to adapt to the use of the interpreter. Thanks for your response.
 
I have a question I hope someone can answer. Can we bill an insurance company for the time that an interpretor is in with the pt. Or do we pay the Interpretor's orginization for their time here. We recieved an invoice from the organization that provided the service, and they are requesting payment from us. Ive never dealt with this before and neither has my Supervisor. Pt was deaf. I know we cant bill the pt.
 
I have a copy of a great article that discusses the background and puts into layman's terms the concepts of discrimination for LEP (Limited English Proficiency) but I can't find the original source. Too long to post here, PM me if you'd like me to email it to you. Otherwise here's a relevant section of the OCR Title VI:

Section 601 of Title VI of the Civil Rights Act of 1964,42 U.S.c. Section 2000d ~
~. states: "No person in the United States shall on the ground of race, color or national
origin~ be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity receiving Federal financial assistance."
Regulations implementing Title VI, provide in part at 45 C.F.R. Section 80.3 (b):
"(1) A recipient under any program to which this part applies may not, directly or through
contractual or other arrangements, on ground of race, color, or national origin:
(i) Deny an individual any service, financial aid, or other benefit provided under the
program;
(ii) Provide any service, financial aid, or other benefit to an individual which is different, or
is provided in a different manner, from that provided to others under the program;
(2) A recipient, in determining the types of services, financial aid, or other benefits, or
facilities which will be provided under any such program or the class of individuals to whom,
or the situations in which such services, financial aid or other benefits, or facilities will be
provided ... may not directly, or through contractual or other arrangements, utilize criteria or
methods of administration which have the effect of subjecting individuals to discrimination,
because of their race, color or national origin, or have the effect of defeating or substantially
impairing accomplishment of the objectives of the program with respect to individuals of a
particular, race, color or national origin." (emphasis added).


http://www.hhs.gov/ocr/civilrights/resources/laws/revisedlep.html
 
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