time-based E/M because of language barrier

[Rita Bartholomew]

Our hospital owns a practice which sees a number of refugees who cannot speak English. Because the use of a translator extends the time the patient is seen, the providers want to bill these visits at a 99215. Because this is a provider based entity, we do bill a higher level on the facility side when a translator is utilized, but is it appropriate for the professional side to use this extra time to justify a higher E/M?

[BEARDOG]

Time as the deciding factor for an EM code can only be utilized when more that 50% of the face to face time is used for counseling or coordination of care for the patient. I understand your problem as we have the same situation in our office and there should be some other way to consider that but other than getting a "point" for obtaining the history from someone other that the patient you really can't factor it in anywhere else,at least as far as I know.

[sullivak]

I agree with BearDOG. I don't think that the time it takes to have the information translated can count toward counseling or coordination of care. We do encounter this at the office ourselves and have never coded higher for this scenario, unless there was substantially extra counseling or coordination of care.