Question Translator included in 2021 E/M Time?

jenarnold

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Hello Everyone,
In using time to calculate a level of service in 2021, are there any exceptions to how time is counted when a translator is necessary to communicate with the patient?

For example: A 47-year-old established Laotian-speaking male patient returns to the office with a new complaint of unilateral hearing loss. History obtained through the translator reveals that he had cold symptoms last week which seemed to resolve, but then he lost hearing in his left ear. It is not complete, but sounds are diminished. He has no other complaints. HEENT exam is negative. Patient is prescribed antibiotic drops for possible infection. This visit takes a total of 21 minutes including appropriate history, exam, assessment, medication explanation and communication via translator.

Using time to level the service, 21 minutes would qualify for 99213. Would 99213 still be appropriate even though some of that time was spent translating? I haven't been able to find anything specifically stating time does or doesn't include time spent with a patient that requires a translator.

Thanks in advance for your time.
 

csperoni

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While that exact scenario is not addressed, I think the intent is that is should be counted.
Per AMA https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
Physician/other qualified health care professional time includes the following activities, when performed:
▪preparing to see the patient (eg, review of tests)
▪obtaining and/or reviewing separately obtained history
▪performing a medically appropriate examination and/or evaluation
▪counseling and educating the patient/family/caregiver
▪ordering medications, tests, or procedures▪referring and communicating with other health care professionals (when not separately reported)
▪documenting clinical information in the electronic or other health record
▪independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
▪care coordination (not separately reported)
To me, this falls under obtaining history and counseling and educating patient. It just took some extra time for this specific patient due to translator. It was still provider time caring for patient and I would count it.
 

jenarnold

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While that exact scenario is not addressed, I think the intent is that is should be counted.
Per AMA https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf
Physician/other qualified health care professional time includes the following activities, when performed:
▪preparing to see the patient (eg, review of tests)
▪obtaining and/or reviewing separately obtained history
▪performing a medically appropriate examination and/or evaluation
▪counseling and educating the patient/family/caregiver
▪ordering medications, tests, or procedures▪referring and communicating with other health care professionals (when not separately reported)
▪documenting clinical information in the electronic or other health record
▪independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
▪care coordination (not separately reported)
To me, this falls under obtaining history and counseling and educating patient. It just took some extra time for this specific patient due to translator. It was still provider time caring for patient and I would count it.
Thanks for the response. I appreciate it.
 

Pam Brooks

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We are looking into this now. Assuming that additional time is required for translator services to be used (and this means a professional translator, not necessarily a family member who is speaking on behalf of the patient), there may be circumstances where non-English speaking patients are billed a higher E&M consistently, based on the use of a translator. According to the ACA, if you're a Medicare provider (receiving federal dollars), a patient who is covered by the Civil Rights Act may not have a higher cost share because of their country of origin (and thus, language barrier). Some payers will pay for translator services (Mainecare is one), so to include the translator time within total time would be considered double dipping. The challenge will be how to calculate what the visit time would have been without the translator, if in fact it's determined that the time spent with a translator is disadvantageous from a civil rights perspective.

Our CMS contractor indicated that translator time can be included (in an email to the rev cycle folks), but our compliance team is looking into whether this may not have been the best advice, based on the ACA and the Civil Rights Act. If anyone has definitive regulatory guidance, I'd be appreciative.
 

csperoni

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Without getting into all the legal aspects, my initial feeling is that patients using interpreters would not be consistently billed a higher E&M (at least not for my practice.)
If you take the original example, based on time, they are reaching 21 minutes for 99213. If you bill on MDM, I still get at least 99213.
#/complexity of problem: Acute uncomplicated illness - level 3
Data: minimal or none - level 2
Risk: Rx issued - level 4
So for the specific example given, whether or not you count the interpreter time is irrelevant.
 
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