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Family Practice Coding Alert

Reader Question:

Additional Time With Disabled Patients

Question: Our practice sees two patients who are hearing- and speech-impaired. Are there codes we can use to represent the additional time spent with these patients to accommodate their communication needs?
llinois Subscriber  
Answer: There are no codes to reflect this additional time. And since the extra time is not directly related to counseling the patient but rather the accommodation of a disability, it cannot be used to justify a higher level of E/M service.
Most coding professionals recommend that family physicians view this situation as part of doing business. FPs are obligated by the Americans With Disabilities Act (ADA) not to discriminate against individuals with disabilities, but to provide reasonable accommodations, e.g., an interpreter to help the patient understand the risks and benefits of various treatments, and to ensure they are able to participate in the informed-consent process.
However, the ADA also clearly states that these accommodations must not create an unfair burden on the practice. In a large hospital system where hearing-impaired patients may be seen regularly, the cost of accommodation may be small. But for a solo practitioner, it may be a big problem. The ADA does not require any business to spend more money or go out of business  providing services that cost more than the revenues.
If hiring an interpreter is a hardship, practices should investigate other avenues of accommodation. Perhaps a family member could accompany the patient to interpret the discussion, or pertinent information could be provided in writing.