The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63491

Connie L. Koshewa, CPM, MPH, Department of Research & Code Development, Alternative Link, Inc, 6121 Indian School Rd. Suite 131, Albuquerque, NM 87110, 505-875-0001, connie.koshewa@alternativelink.com and Synthia L. Molina, MBA, Chief Executive Officer, Alternative Link, Inc., 6121 Indian School Rd, Suite 131, Albuquerque, NM 87110.

Abstract: Objective:

Develop a set of codes to standardize descriptions of integrative healthcare products and services and thereby support integrative healthcare research, management and commerce, and health policy decision making.

Methods:

A team of researchers used exploratory and case study methods, supplemented by subject matter expert reviews, to characterize over a dozen categories of integrative healthcare practices including several with energy and spirituality-based approaches to care.

The team then developed an alphabetic coding system that was compatible with the prevailing medical coding systems, data fields, software and Internet applications, and healthcare information systems.

For each term, the team assigned a representative five-character alphabetic code string.

For each practitioner type, the team assigned a two-character alphanumeric code.

More than 4,200 integrative healthcare interventions were coded to create a comprehensive set of codes of value in research projects, management processes and business transactions.

Results:

The code set, called ABC codes, is being evaluated in a nationwide demonstration project in support of late stage review as a national standard by the U.S. Department of Health and Human Services.

The codes have been incorporated into one major software application for claims adjudication and in use in government, community and academic demonstration projects.

Conclusion:

The ABC code set fills critical gaps in the nation’s HIPAA code sets and the national health information infrastructure (NHII). The codes will provide a more complete and accurate picture of U.S. healthcare in support of health policy decision making.

Learning Objectives:

At the conclusion of the session, the participant in this session will have gained knowledge in:
• how gaps in the HIPAA code sets have led medical and health policymakers to erroneous policy decisions;
• why these gaps compromise healthcare research, management and commerce for the integrative healthcare increasingly demanded by today's consumers;
• how the combination of ABC codes and the grandfathered HIPAA code sets supports healthcare insurance benefit plan design, managed care and provider contracting, utilization and clinical practice management, claims processing, outcomes research and actuarial analyses; and
• why the combination of code sets is likely to measurably improve public health, industry and business efficiencies and performance, and socioeconomic development.

Keywords: Alternative Medicine/Therapies, Public Health Research

Related Web page: www.alternativelink.com

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Alternative Link & the ABC codes and The Foundation for Integrative Healthcare (FIHC). DHHS approved the first exception to the HIPAA rules on January 16, 2003, which allows the ABC codes for integrative healthcare to be tested nationally.
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employed as Director of Research & Code Development by Alternative Link