Insurance Codes Focus on Complementary Care
A set of integrative health-care codes, known as ABC codes, are under review by the U.S. Department of Health and Human Services, in a process that will determine whether use of the codes will be mandatory when billing insurance companies for complementary care.

Mandatory use of ABC codes on insurance claims would mean widespread, standardized documentation of the use of complementary care, providing a body of information written in the "common language" of traditional medical codes.

According to Alternative Link, the Albuquerque, New Mexico-based company that created the codes, this detailed data could be used by researchers, practitioners, insurance companies and policymakers to improve national health care.

"Practitioners use codes for medical record-keeping, practice management and billing; health plans use codes for processing insurance claims and for designing and managing benefits," states the Web site of Alternative Link. "Researchers use codes to identify what care works best, [and] policymakers use codes to understand what is best for the nation and to make public policy decisions."

The medical codes currently mandated for insurance billing reflect the practice of allopathic medicine, with little in the way of integrative health care. For example, among the Current Procedural Terminology (CPT) codes developed by the American Medical Association, there is only one that represents massage therapy. That code, 97124, describes basic Swedish massage, with no specification whether a session consisted of craniosacral therapy, deep-tissue massage, Rolfing or some other form of bodywork.

"Older medical-code sets have significant gaps," states the Alternative Link Web site. "They do not adequately describe or reflect the care delivered by more than 3 million licensed health-care practitioners."

With more than 4,000 codes to describe various complementary health-care techniques - approximately 200 of them related to massage - ABC codes have been used voluntarily by practitioners, medical centers, insurance companies and health-plan providers since 1996, for purposes such as research, office management and manual commerce.

In January 2003 ABC codes were approved for use in electronic commerce, which is regulated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). More than 10,000 entities registered to use ABC codes in electronic commerce, and anyone doing business with a registered user may do so as well.

"ABC codes help the insurance industry to better manage care, claims and outcomes," said Synthia Molina, CEO of Alternative Link. "Each code is an accurate and precise description of the care provided."

However, some massage therapists argue that a handful of ABC codes are too descriptive, in that they single out trademarked descriptions of certain techniques, such as movement re-education and structural integration.

"My fear is that by isolating out everybody's trademarked technique that you're going to start paying differently based on the teacher," said Diana Thompson, L.M.P., author of Hands Heal: Communication, Documentation and Insurance Billing for Manual Therapists. "Instead of having a Feldenkrais code or an Alexander code, it should be a movement re-education code, with the different types listed beneath, stating 'including, but not limited to.'"

According to Melinna Giannini, founder and president of Alternative Link, trademarked codes are based on hours of training in a particular technique. "Alternative Link anticipates having codes for all modalities with documented training standards," she said.

The codes are developed through communication with complementary health-care schools, licensing and accreditation bodies, practitioners and subject-matter experts, said Molina.

Besides giving insurance companies a more accurate account of services rendered, according to Alternative Link, ABC codes also make it easier for individual practitioners and medical centers to keep detailed records of each client's history.

"ABC codes don't remove the need for S.O.A.P. notes, but they certainly decrease what you have to write," said Heidi Rothenberg, market-development director for Alternative Link and a former massage therapist.

The standardized, digital codes aim to simplify data collection for the purposes of research, analysis and reporting in the "common language" of traditional medical codes. They are the same number of characters as the traditional codes and fill the same slots on insurance forms.

"As [health-care providers] complete their insurance claims, they can capture data off the claims to determine what interventions have the best economic outcomes and the best patient health outcomes," said Molina.

In turn, that data can be used to improve benefit plans, provider contracting, national health policies and personal health-care decisions, she said.

"[ABC codes] provide a way to do the analysis that legitimizes the services and puts them on the same footing as conventional medicine," said James Sargent, executive vice president of Medimerge Health, a Massachusetts-based company that designs and manages integrative health plans. "This becomes the tool for getting companies to integrate complementary and alternative medicine as a routine part of their health plan."

By revealing the economic and health benefits of complementary care through the language of standardized codes, Alternative Link aims to make complementary care a regular component of most health plans, said Rothenberg.

"Over time, insurance companies will begin to pay on these services on a regular basis," she said. "Massage will begin to be a covered service, and people who have never before had access to wellness care will be covered."
- Brandi Schlossberg

More Table Talk                                                       See July/August 2004 Issue