Support the Adoption of
ABC Codes

I designed alternative billing concept (ABC) codes to fill gaps in national code sets and developed the company’s system that ties codes to state scope-of-practice and training regulations by state and practitioner type. My company, ABC Coding Solutions, created an online claims application to offer a systematic way for massage therapists to reduce paperwork, increase coding accuracy and avoid fraudulent billing.

In 2003 ABC codes were granted the first exception to the Health Insurance Portability and Account­ability Act (HIPAA) by former Health and Human Services (HHS) Secretary Tommy Thompson. This action allowed ABC codes to be used in electronic transactions until October 2006. HHS denied further use of ABC codes last September by failing to name them a permanent national standard, making them ineligible for use in electronic transactions.

While ABC codes can be used for paper claims submissions, the industry is moving to electronic claims. Think snail mail vs. e-mail. Without ABC codes being named a permanent electronic standard, it is unlikely insurers/payers will incorporate massage therapy into plan benefits or pay appropriate fees, even when massage is allowed. Massage therapists are now in the same boat with more than 3 million other licensed practitioners who lack sufficient codes to participate as equal business partners with conventional doctors in health-care reimbursement. It is time for change.

ABC codes are designed to provide information to result in appropriate fees for care. For example, there is one Current Procedural Terminology (CPT) code for massage (97124) and only 14 other vague codes for other therapeutic procedures. The CPT codes do not have the detail needed to differentiate a basic chair massage from Rolfing. Within the ABC coding system, there are six codes for body-mind work, 31 codes for bodywork, 10 codes for energy work and 32 codes for massage, all designed to assure appropriate reimbursement and outcomes tracking. While many massage therapists starting up a practice might only need a few ABC codes, additional ABC codes are available as massage therapists continue their training and expand their practices. ABC codes are essential to assure reimbursement reflects skill and training.

The decision to exclude ABC codes under HIPAA was the result of a government review of two cost-benefit reports submitted by the developers of ABC codes. The review, conducted by HHS, misstated several key facts about ABC codes that ended up in a report to the secretary of HHS.

First, reviewers indicated that ABC codes are limited to de­scribing alternative medicine procedures. In fact, ABC codes support billing and documentation for more than 3 million licensed caregivers, including massage therapists, nurses, chiropractors, nutritionists and many others.

Government reviewers also cited a lack of empirical data on the cost-benefits of using ABC codes. In fact, compelling empirical data was submitted. HHS approved adoption of a code set that it developed with 3-M, which is slated to be used in hospitals nationwide. The data that supported this decision was based on several hundred simulated claim transactions. Data from more than 500,000 real claim transactions was submitted by the ABC code developers at a net annual savings of more than $2 million and documented by Alaska Medicaid.

A double standard in the HHS review of ABC codes is damaging to the nation—and it keeps your practice at the fringes of health care.

Government reviewers claimed that the adoption of ABC codes was not supported by the health-care industry. In fact, support for ABC codes included: Alaska Medicaid; a New Mexico Medicare HMO and PPO network; a national PPO alliance with more than 70,000 nonphysician health practitioners accessed by more than 400 insurance payers; the American Nurses Association, representing more than 2.7 million nurses; the American Massage Therapy Association; Associated Bodywork and Massage Professionals; the World Chiropractic Alliance; Midwives of North America; the National Association of Clinical Nurse Specialists; several national and state acupuncture associations; four U.S. senators; and several other legislators.

Senator Trent Lott voiced his objections to the 1983 HHS contract with the American Medical Association and said this contract created a “statutory monopoly.” U.S. Rep. Dan Burton said in 2006, “I believe that ABC codes, and other similar code sets, have significant potential to revolutionize the American health-care system. I am also confident that an independent review of these codes will bear this out.”

Members of Congress need to know massage therapists object to the government’s reliance on a physician trade organization regulating massage coding and reimbursement. The government’s historical reliance on the AMA’s codes limits you to seeing clients who can ­afford to pay cash for your care and tends to restrain your trade and the trade of other qualified health-care practitioners.

The AMA recently denied a request for new massage-assessment codes in CPT. By rejecting this request, massage therapists continue to lack a means to report the services they are legally authorized and trained to provide. The lack of massage-therapy codes exposes massage therapists to billing fraud and fails to provide a means to correctly report care. There are 11 massage-assessment codes in the ABC code set, which are listed by new or existing clients, time and location.

So, there you have the one-two punch: The government denies use of ABC codes in electronic transactions and continues to rely on the AMA to develop coding for massage therapists and a majority of other licensed caregivers—who outnumber physicians 5 to 1. With these two actions, 80 percent of licensed practitioners in the U.S. are either paid in cash, excluded from mainstream health-care reimbursement or forced to work for physicians in order to make a living.

In reality, the one CPT code for massage has not helped promote your profession. The value of ABC codes to massage therapists is simple, yet profound. ABC codes allow massage therapists to accurately document care and receive appropriate reimbursement. When ABC codes are fully adopted, outcomes data will emerge identifying the massage-therapy interventions that offer cost-effective and safe alternatives to medical treatments.

You can help reverse the HHS decision by contacting your members of Congress and telling them that ABC codes should be named a permanent national code set under HIPAA. Please contact ABC Coding Solutions at publicrelations@abccodes.com with the subject line titled “Congress.” We will be happy to assist you in finding your Congressional members and providing you with additional information.

Melinna Giannini is CEO and founder of ABC Coding Solutions (formerly Alternative Link, www.alternativelink.com). She has worked in health insurance since the 1980s. She is an expert on contracting, billing and practice management related to integrative health care. She speaks frequently at national conventions, testifies before health-related government committees and writes articles for leading health-care publications.