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AMA Ownership of the CPT Codes: Perspective from Executives at ABC Codes, the "Alternative Link" PDF Print E-mail
Written by John Weeks   

AMA Ownership of the CPT Codes: Perspective from Executives at ABC Codes, the "Alternative Link"

Summary: For those in the integrative practice movement for over a decade, the subject of coding cannot be considered without the thought of a new Mexico-based business originally known as Alternative Link, and its founder Melinna Giannini. This business declared early that understanding the value of these therapies and fields would require a coding set that appropriately reflected them. In a long and exacting labor, the firm developed the ABC Codes, morphed into ABC Coding Solutions and developing products for not just "CAM" but for nursing (where many also chaff at the CPT) and Dubai Healthcare City. I contacted Giannini for comment and an update. Here is the column she co-authored with Mathias Kaesebier, the firm's executive vice president. At risk with current CPT coding, they argue, are health reform initiatives relative to non-discrimination and comparative effectiveness research.
Prior articles in this series:

Send your comments to
for inclusion in a future Integrator.

Image
Would their coding set better position integrative medicine in reform?
The exploration of the double whammy of ownership of Current Procedural Technology (CPT) codes by one guild, the American Medical Association (AMA), and the roughly $70-million royalty the guild receives, led me to think of Melinna Giannini. In the late 1990s, Giannini and her associates at Alternative Link began development of an alternative coding set known as ABC Codes to better capture outcomes in complementary and alternative healthcare, integrative and nursing practices. I told Giannini that the Integrator would be very interested in a response or update, in the light of the AMA CPT discussion. Giannini and Alternative Link's executive vice president Mathias Kaesebier, a former CEO of the US division of Heel Inc, responded with this column. 

_______________________________

Significant Coding Issues in Key Health Reform Initiatives
Relative to Integrative Medicine


Melinna GIannini & Mathias Kaesebier
ABC Coding Solutions
Image
Melinna Giannini: ABC's visionary founder & CEO
"Thank you for inviting us to comment on the Integrator's article and blog concerning medical coding and the affect this has on millions of health professionals.


"First of all, we commend you for bringing this topic up at critical time in the healthcare industry.  Procedure codes and who controls them will affect the future of all health professions in the U.S.  We believe that ABC codes can level the playing field. 

"The role Integrative Medicine will play in the future will be impacted by two new healthcare reform measures that also relate to coding.  These are:

1. The non-discrimination clause in Section 2706 of the Patient's Rights and Affordable Health Care Reform Act (the Act) states:
"A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable State law."
2. The new law also focuses on identifying cost-effective options to existing medical care based on Comparative Effectiveness Research.
Image
Kaesabier: ABC's executive VP
"Here is why robust coding is essential to both measures:

1.    Non-discrimination: The main difficulties in implementing the non-discrimination clause are the variances in state scope of practice laws and the lack of procedure codes for Integrative Medicine. Without a coding infrastructure, gaining payment for services becomes cumbersome and expensive. Integrative Medicine will remain cumbersome and expensive to the insurance industry until such a coding infrastructure is in place.  The [insurance] industry will most likely lobby against this non-discrimination provision until a solution is found.  ABC codes are mapped to the medical codes required for billing and were designed to validate scope of practice rules as insurance claims are filed.s

2.    Comparative Effectiveness Research (CER) could potentially level the playing field for Integrative Medicine by identifying cost-effective treatment options to conventional medicine. Claims data will be used for CER to identify effective treatments in the future because it is plentiful and relatively inexpensive to mine.  However, Integrative Medicine lacks the robust metadata generated from codes as insurance claims are filed.  The data that is available for Integrative Medicine can provide cost comparisons to conventional medicine cannot indentify specific treatment patterns that work or don't work for a given diagnosis or diagnostic related group.  The mandated medical codes can be used for this purpose.
"Global vs. U.S. Politics: When a government does not limit use to the medical codes mandated in the U.S., ABC codes have proven effective.  For example, Dubai Healthcare City tested ABC codes in 2008 and subsequently mandated their use in claims filed by CAM and osteopathic providers in 2009.  In 2010, a Middle East insurance company agreed to process claims based on ABC codes. For more information, go to to this link.

   
 "We believe transferring ownership
of ABC codes to an organization
representing all health professions
would provide a counterweight to
the medical monopoly on coding."
 
    
"In 2003, when ABC codes were granted an exception under federal law to be tested in electronic healthcare claims, over 11,000 providers registered to be potential users of ABC codes.  We believe transferring ownership of ABC codes to an organization representing all health professions would provide a counterweight to the medical monopoly on coding.  We believe that such an organization either exists or could be formed and this organization could potentially buy or license ABC codes. Such an arrangement could also generate revenue from publishing and licensing to support Integrative Medicine. Transferring ownership of ABC codes to such an organization would benefit the entire U.S. healthcare system by reducing the cost of communications between providers and payers and identifying cost effective options to current care models. 

"We invite any interested party to contact us regarding this proposal. Please email  "

Most sincerely,

Melinna Giannini, CEO
Mathias Kaesebier, Executive Vice-President

ABC Coding Solutions (Alternative Link)
________________________________

Comment: The early debate over the ABC Codes versus the CPT broke over a worry over a kind of apartheid. Mightn't a separate coding set relegate "CAM" to a second class citizen status? The argument is reasonable, yet at the same time the case for an "alternative link" documentation system has never been stronger than it is today. Has subservience to the AMA's priorities allowed practitioners the ability to adequately document and make their case? How rational is it to leave such important decisions in the hand of a single guild, dedicated to limiting other professions, that has just 17% of MDs as members? Ludicrous.

Giannini and Kaesebier are right that coding will be a critical language of comparison under CER.
If what integrative practitioners do is not well-reflected in the codes used, we have garbage in, and garbage out. I like thinking about the ABC Codes being passed on to a set of interests who own them together, as the firm is willing to consider. Yet the idea that the AMA would allow anyone else to both break their monopoly and then benefit from a royalty for another set of codes is repelled by the history of power relations in US medicine. Unbelievable.

An ultimate code set will rightfully be a commons.  Yet, in my feelers to organizations that might take on the challenge of prying the AMA's fingers loose, such a commons appears to have the same likelihood of creation as does heaven on earth.

Send your comments to
for inclusion in a future Integrator.



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