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TanBro

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I work for an OBGYN office in Iowa, it is required for us to have an interpreter service for our patients. My doctor and I were wondering if there is some kind of reimbursement on the visit while using an interpreter? We use a virtual interpreter. Can I use the time based E/M coding for this or is this just part of patient care that is not billable? These visits can be quite long. Any feedback is appreciated. Thanks in advance.
 
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You can't bill for the cost of the interpreter service. I've heard of some offices using something like Google Translate on an iPad, which doesn't incur a translator fee, and they've found it works well.

Tom Cheezum, OD, CPC, COPC
 
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Hi there, it's going to depend on the carrier. Medicaid covers interpreter services, but I don't know if a virtual interpreter counts.

For E/M visits, during the CPT/RBRVS Symposium in November an AMA official said that it is appropriate to include interpreter time when you code a visit based on time. Just don't count time that is not directly related to patient care, such as connecting with the translator. But again, you'll need to check each payer's policy.
 
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Cheezum51 said:
You can't bill for the cost of the interpreter service. I've heard of some offices using something like Google Translate on an iPad, which doesn't incur a translator fee, and they've found it works well.

Tom Cheezum, OD, CPC, COPC
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Thanks. But I'm talking visit wise. Example being a patient comes in and does not speak English, we get in contact with the interpreter, after exam/explaining/reviewing a 10 min visit has turned into 30. If we document this can I bill a higher E/M for time?
 
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jkyles said:
Hi there, it's going to depend on the carrier. Medicaid covers interpreter services, but I don't know if a virtual interpreter counts.

For E/M visits, during the CPT/RBRVS Symposium in November an AMA official said that it is appropriate to include interpreter time when you code a visit based on time. Just don't count time that is not directly related to patient care, such as connecting with the translator. But again, you'll need to check each payer's policy.
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Thankyou!! I will look into that.
 
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CBLENNIE said:
Aside from Medicaid and managed Medicaid you cannot charge a patient for interpreter services per Title VI of the Civil Rights act. Below is a quote from a previous post about billing for interpreter services posted on 12/01/23 in a post titled Spanish Interpreting services, linked here.

Also, under the ACA there are requirements for providing language services to limited English proficient (LEP) patients. Specifically, the ACA extends previous mandates and explicitly requires insurers and healthcare institutions to provide written translation and interpreting services for limited English proficiency individuals of qualifying language groups. These requirements are specific to at least the top 15 languages spoken by LEP individuals in the relevant state. According to the Guide to Developing A Language Access Plan there is a link to the list of the top 15 languages per state on the last page of the guide in the Appendix: Selected Resources There is a link for CMS Top 15 Non-English Languages by State.
If a patient speaks a language other than one of these 15 you may be able to charge for interpreter services but Medicare and commercial insurance companies are not going to pay for them.
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The quote above is from a response to a similar question posted under the title Modifier(s) for Use of Interpreter During Visit. You cannot charge the patient for the use of the interpreter or for services to translate documents into their primary language.

While you cannot bill for the use of the interpreter, the fact that the length of the visit is extended due to the process of interpreting the conversation, you may be able to include the time spent conversing with the patient via an interpreter towards to the total time for the visit if you are billing for E&M services that have a time component. Then you could consider coding these visits based on time if the provider is documenting the exact amount of time they personally spent on the date of the encounter providing care to the patient, both face-to-face and non-face-to-face. This may mean you end up billing for prolonged visits services in addition to 99205 or 99215 since they have a time component to them.

There is no time component to preventive E&Ms and in office procedures so there is no way to capture the additional expense to the practice for patients who require an interpreter, for those types of visits it is just part of the cost of doing business.

I'm not an expert on E&M coding so I don't know for sure if this is the case so, please check with someone you trust who can guide you on E&M coding based on time and whether the time added to the visit due to the use of the interpreter is appropriate or not.
 
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CBLENNIE said:
The quote above is from a response to a similar question posted under the title Modifier(s) for Use of Interpreter During Visit. You cannot charge the patient for the use of the interpreter or for services to translate documents into their primary language.

While you cannot bill for the use of the interpreter, the fact that the length of the visit is extended due to the process of interpreting the conversation, you may be able to include the time spent conversing with the patient via an interpreter towards to the total time for the visit if you are billing for E&M services that have a time component. Then you could consider coding these visits based on time if the provider is documenting the exact amount of time they personally spent on the date of the encounter providing care to the patient, both face-to-face and non-face-to-face. This may mean you end up billing for prolonged visits services in addition to 99205 or 99215 since they have a time component to them.

There is no time component to preventive E&Ms and in office procedures so there is no way to capture the additional expense to the practice for patients who require an interpreter, for those types of visits it is just part of the cost of doing business.

I'm not an expert on E&M coding so I don't know for sure if this is the case so, please check with someone you trust who can guide you on E&M coding based on time and whether the time added to the visit due to the use of the interpreter is appropriate or not.
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Thankyou so much!! This is great information.
 
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TanBro said:
Thanks. But I'm talking visit wise. Example being a patient comes in and does not speak English, we get in contact with the interpreter, after exam/explaining/reviewing a 10 min visit has turned into 30. If we document this can I bill a higher E/M for time?
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Yes, for level-based visits (except ED services) you always have the option to code based on time.
 
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This was another valuable discussion on it.

I think it's a good question to bring to the compliance and legal counsel for the practice.
My view is, if the time is documented, the requirements are met, all the other documentation requirements are met, I would be ok coding based on time. It takes longer! Isn't that the point of being able to count time for an E/M? It takes longer to communicate and to ensure that the information is being conveyed correctly and appropriately. I wish there was a SDOH ICD for language barriers, etc. It can also be higher risk. There is also a med/legal component especially if a family member is being used, etc.

This doesn't address the coding question, however it does highlight and have good information on the risks and complexity providers deal with when treating patients with a language barrier. It is higher risk in some scenarios and can lead to inequities.

If you search translator, and terms like that in the forums, there are some other good threads on it. Some are older than 2021 though. They all sort of say the same thing.
 
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