D.C.s to help test new ABC insurance codes

Ever since the American Medical Association, working with the American Chiropractic Association, established the Current Procedural Terminology (CPT) codes, they have caused problems for chiropractors and other non-medical providers. 

The lack of codes specifically denoting non-medical procedures such as chiropractic spinal adjustments created a gap that left thousands of alternative health services improperly coded. This also made it impossible to have head-to-head comparisons of the economic and health outcomes between medical and non-medical care. Without specific codes dealing with chiropractic or other alternative care services, there was no way to use the codes to show that chiropractic was more effective or cost-efficient than medical treatment.

The U.S. Department of Health and Human Services (HHS) recently authorized a test of a proposed modification to the coding standards for the nation's healthcare transactions. This action sets the stage for future authorization of Advanced Billing Concept (ABC) codes for products and services delivered by integrative healthcare practitioners.

The approval by HHS marks the culmination of a six-year effort by Alternative Link and, more recently, The Foundation for Integrative Healthcare (FIHC) to plug a gap in the Healthcare Common Procedure Coding System (HCPCS).

The World Chiropractic Alliance supported the efforts of Alternative Link and FIHC to develop these codes and will work closely with them to ensure they are adopted. In a letter to Tommy G. Thompson, Secretary of Health and Human Services, sent in Oct. 2002, the World Chiropractic Alliance noted that, "Chiropractic finds such codes essential for public health and safety, as well as for responsible healthcare cost oversight."

The letter went on to explain that, "In many areas of care, non-medical approaches cost less and result in better outcomes. There is an abundance of studies to demonstrate this. Many were presented to the White House Commission on CAM Policy over the past two years. Chiropractic was one of the many professions to participate in this dialogue Y We cannot improve access, quality and cost management if we cannot measure what works and does not work."

Veronica Gutierrez, D.C., a member of the Board of Directors of the World Chiropractic Alliance, was the only chiropractor to serve on that Commission.

The WCA also noted that, "The AMA has not (because it cannot) adequately code an area of service for which it is diametrically philosophically opposed both in training and consciousness."

The decision by Thompson's department to authorize the testing of the new ABC codes was "is a huge step toward measuring and comparing the quality and cost-effectiveness of different approaches to healthcare," said Melinna Giannini, coding expert and board member of the FIHC. "Codes developed by the Centers for Medicare and Medicaid Services and the American Medical Association have left unanswered questions about integrative healthcare. With this approval, comes real promise that health policymakers will soon be able to draw from a new body of more complete and accurate data. It makes possible a more rational approach to research, management and commerce in healthcare."

Giannini added that, "Testing and standardization of coding for integrative healthcare, made possible by the HHS approval, will help improve healthcare quality and efficiencies by highlighting best practices among all approaches to care, not just among physician-directed and disease-based models of care."

The approval creates an exception to the current HIPAA (Health Insurance Portability and Accountability Act) regulations that originally led to the naming of HCPCS as a national standard.

Doctors were cautioned that the approval is for the testing of ABC codes in HIPAA transactions and that no one could state definitively when the codes would be supported by widespread insurance reimbursement.

Still, Molina predicted that the code testing "will lead to major improvements in the national health information infrastructure, as well as health insurance benefit plan design, managed care and provider contracting, utilization management, clinical practice management, claims processing, outcomes research and actuarial analyses."

The WCA encourages all doctors to participate in this test program. Applications must be filed by March 14, 2003 . Visit the Alternative Link website  for an online version of the application. 

For more background on the issue of CPT codes for the chiropractic profession, see:

"Memos reveal ACA, AMA share CPT code goals," The Chiropractic Journal, August 1996

"ACA makes code deal with AMA; ICA president says chiropractic was 'sold out to medics'," The Chiropractic Journal, December 1996

"CPT codes and the Trojan horse" by Dr. Jeffrey Shay, The Chiropractic Journal, August 2002