Some insurers[a] are making unreasonable demands regarding the application of modifier 93. Medical-legal providers use modifier 93 to bill for the extra time required to conduct an examination with a language interpreter. An important and necessary step, interpretation services ensure accurate communication between patient and doctor — but at the cost of valuable, reimbursable time.
According to provider advocates[b], certain insurers are wasting doctor’s valuable time by requiring redundant and unnecessary justifications for using this modifier.
Modifier 93 is the only way for a medical-legal doctor to obtain reimbursement for time spent on interpretation. Our recent guide identifies those circumstances, and explains exactly when and how to apply the modifier compliantly per CCR § 9795. In short, providers can apply modifier 93 to billing codes ML102 for Basic Comprehensive Medical-Legal Evaluations and ML103 for Complex Comprehensive Medical-Legal Evaluations.
Because ML102 and ML103— unlike the rest of the medical-legal billing codes in CCR § 9795— are not time-based, modifier 93 is necessary to account for time additional time the provider spent navigating language barriers. The CCR outlines the compliant application of the modifier thusly:
“-93 Interpreter needed at time of examination, or other circumstances which impair communication between the physician and the injured worker and significantly increase the time needed to conduct the examination. Requires a description of the circumstance and the increased time required for the examination as a result...”
Accordingly, there are two scenarios in which modifier 93 is applicable:
- When an interpreter is needed due to language barrier, or
- When “other circumstances impair communication.”
Common sense dictates that the requirement of a “description of the circumstance” refers to the “other circumstances” in the second scenario. According to Stephen J. Cattolica, Director of Government Relations for provider advocacy group California Society of Industrial Medicine and Surgery (CSIMS):
“Historic use and payment patterns have never required an explanation why the use of an interpreter causes more time...it is intrinsic to the definition. Any explanation has always been connected to those ‘other circumstances which impair communication between the physician and the injured worker[c][d]’”.
If a provider needs an interpreter, the circumstances are clearly implied, if not downright obvious: the patient doesn’t speak the same language as the physician.
According to Cattolica, the medical-legal provider should include the interpreter’s name and badge number in the medical-legal report when the evaluation requires interpreter services. This information should satisfy the need to justify use of modifier 93, and protects the provider in case of dispute. Insurers and their claims administrators[e] should need no further explanation or justification.
Nevertheless, some insurers reportedly deny payment for time spent on interpreter services when modifier 93 is applied without the superfluous description of circumstances. This is pointless payment friction for providers. Insisting on an explanation that an interpreter is needed to interpret is an exercise in time-wasting typical of a system rigged to make obtaining correct payment harder for providers.
When medical-legal providers receive an incorrect denial of payment for time spent on interpreter services, we recommend an immediate appeal. Providers should submit a Second Review, and consider using the following language in the “Reason” field of the DWC Form SBR-1:
Modifier 93 is applicable when either an interpreter is needed due to language barrier, or when “other circumstances impair communication.” As documented in medical-legal evaluation, an interpreter was required due to language barrier. Accordingly, per the Medical-Legal fee schedule, additional payment is due for services rendered. [f][g][h]
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Nevertheless, some insurers reportedly deny payment if the extra description of the circumstances is not additionally addressed when modifier 93 is applied to time spent on interpreter services.
[a]At least in the opener, "insurers" is the most effective shorthand for our message. We can always explain claims admins, TPAs, etc when and where we need to.
[b]I'm using the plural here, since you mentioned to Cattolica that he wasn't the first to bring this up to you.
[c]why not italicsized?
[d]Because it's a quote within a quote. The formal rules for block quotes actually require removing the quotation marks and not italicizing at all, but (like most blogs) we're making up our own rules for the sake of visual impact. If you feel strongly about it, I can italicize the quote-within-the-quote.
[e]Here, below the fold, we are free to indulge in the distinction between terms for MARY's sake.
[f]Please edit. We should give them something to pass onto their staff that is useful.
[g]Is "Reason" a field in the SBR 1 form? Is that why we're using quotations?
[h]Yes DWC Form SBR-1 (see screen shot below)
[i]Since Steve's email was to you personally, I think it would be best if one of us just reached out to get his permission to quote the email, in case he meant it to be off the record.
[j]agreed. Can you please contact him directly?