The U.S. Department of Health and Human Services (HHS) has approved a demonstration project to test a new series of codes for billing complementary and alternative medicine and nursing services. The project allows for the testing of advanced billing concept ("ABC") codes in transactions related to the Health Insurance Portability and Accountability Act. If approved, the new codes will fill a variety of gaps in the current health care coding system, and may ultimately lead to improvements in the management and delivery of health care in the U.S.¹

The ABC codes were first developed in 1996 as a joint venture between the Foundation for Integrative Health Care (FIHC), an organization that "identifies and advocates the health-promoting and cost-effective practices of alternative medicine, nursing and other integrative healthcare professionals"; and Alternative Link, a health care information and consulting organization. The codes provide representations of alternative medicine, nursing and other integrative health care practices, consisting of a five-alphabetic-character field that describes particular health care services and supplies, followed by an optional two-character alphanumeric modifier that describes the type of licensed health care practitioner(s) who delivers that particular service or supply.

The ABC codes, approximately 4,200 of which have been developed to date, have gained the support of a diverse group of health care organizations, including the American Massage Therapy Association (AMTA) and the Associated Bodywork and Massage Professionals (ABMP). The codes are designed to fill the gaps in the American Medical Association's Current Procedural Terminology (CPT) codes and other areas of the Healthcare Common Procedure Coding System (HCPCS), by describing certain integrative health care practices and practitioners more accurately. Currently, many services offered by CAM practitioners are not listed in the CPT codes, or do not conform with descriptions of those services. This is particularly true for massage therapists. However, this situation may be resolved independently of the ABC codes, with the approval of new CPT codes by the AMA's CPT Editorial Panel.²

In the demonstration project, the ABC codes will be used as a supplement to the existing health care coding system, and will be evaluated in relation to 10 objectives Congress originally mandated for the HIPAA code sets.

In a statement on its Web site, Alternative Link notes that the ABC codes "offer design, development and oversight improvements that deliver superior functionality and support areas of healthcare subject to widely varying state laws - improvements not available in the HIPAA code sets but essential to assuring the legality and appropriate representation of integrative healthcare practices."³

Testing will be conducted in three-month increments for up to two years. Testing will continue until the occurrence of one of the following events, whichever comes first: proof of a widespread and favorable (or unfavorable) cost-benefit ratio for ABC codes; the Department of Health and Human Services naming (or rejecting) ABC codes as a HIPAA standard; or a project deadline of Oct. 14, 2005.

Synthia Molina, chief executive officer of Alternative Link, cautioned that the demonstration project will test the viability of ABC codes in HIPAA transactions only, and that there is no definitive timetable for when - or even if - the codes will gain the support of the insurance industry. Nevertheless, she asserted that testing the codes would lead to "major improvements in the national health information infrastructure."¹

Participants Wanted

To determine the effectiveness of the ABC codes, all HIPAA-covered entities, trading partners and their business associates are invited to participate in the demonstration project. To take part in the project, Alternative Link has created an online application at www.alternativelink.com/ali/DemoPro/DemoPro.asp. The Centers for Medicare and Medicaid Services has requested that all parties wishing to use ABC codes for HIPAA transactions sign up before March 16, 2003. For more information, contact Alternative Link at 505-875-0001, or the Foundation for Integrative Healthcare at 505-710-7390.

References

1. Dunkleberger C. Testing of ABC codes approved for complementary and alternative medicine and nursing. Internet Wire, Feb. 3, 2003.
2. Are massage CPT codes on the horizon? Massage Today December 2002.
3. The limitations of the older HIPAA code sets. www.alternativelink.com/ali/DemoPro/ABCtested.asp.