Medical billing codes have been devised for two reasons: as tools for the settlement of claims for compensation dependent on the codes' ability to communicate information pertaining to diagnostic and therapeutic procedures, and for clear outcome data related to the analysis of efficacy of treatment as well as measures of cost-effectiveness for underwriters.

For over 35 years, the Current Procedural Terminology codes (CPT™) have dominated medical billing code sets for conventional medicine. The CPT™ codes, published by the AMA since 1963, "were developed in response to demands of physicians and agencies for a uniform system of terminology and coding to be used in the reporting of diagnostic procedures and treatment," according to an article on CPT™ in JAMA , May 4, 1970. The system has continued to grow and evolve, becoming the basis for e-business in conventional medicine.

The altruistic tone of this 1970 JAMA article, written when the AMA's new system was in its infancy, and its impact on healthcare seems appropriate and sincere. The writer even invites input from the medical community: "Suggestions for the development of future editions of CPT™ will be appreciated by AMA, including new terms and special arrangements. Indeed, a constant flow of stimulating information and recommendations will keep CPT™ current and vitalized."

This year the first complete system of medical billing codes for complementary and alternative medicine has emerged as a result of the efforts of Jo Melinna Giannini and her staff at Alternative Link. This new service affords the full integration of CAM in the healthcare system after decades of struggle in this area.

The origins of Ms. Giannini's idea for this world-changing project lie in a personal health experience: "In 1992 I developed a very painful kidney problem which started as water retention and discomfort. By May of 1994 the situation had escalated to inability to void fluids, mental confusion, constant pain, and depression. I had had three rounds of tests that included sonograms, cystoscopy, and x-ray flow tests. No diagnosis was ever formulated in all that time. But I was given five rounds of penicillin. I kept getting sicker and sicker. Finally, a friend recommended that I try an alternative M.D., in Roswell, New Mexico. Within two weeks, I had lost 14 pounds of fluid, had gained control of my problem, and felt better than I had in over two years. The holistic practitioner had made me responsible for my own care and I felt empowered versus helpless. Her entire course of treatment, including herbs, injections, follow-ups, and adjustment of dosages was less than $500.00. The previous two years had cost my insurance company $15,000. They happily paid for the tests, doctors, and drugs that did not improve my condition, but were unwilling to pay for alternative treatments."

"The idea dawned on me that if alternative treatments were reimbursable by insurance companies, this was the answer to the health care crisis. Codes equal pay was the way it danced in my head. Since that time, the people and support have come together, resulting in the ABC™ coding system."

Alternative Link was founded in 1996 by Ms. Giannini. Since then, she and her company have developed the ABC™ codes, exclusively for CAM. Simultaneously, this privately-owned company has developed software to support alternative healthcare billing, reimbursement, and office management functions. They have produced a database system (CAM-net™) that is compatible with existing mainstream healthcare systems and facilitates third-party reimbursement decisions for CAM.

The ABC™ billing codes and the CAM-net™ database system have the ability to resolve a host of thorny issues for CAM business. The ABC codes were not designed to replace any existing billing system, but to fill in all the content gaps that exist in current billing methods for CAM modalities. The ABC™ codes provide accurate description of the patient encounter with CAM practitioners of 13 different modalities.

Correct and accurate CAM billing codes and claims support equal reimbursement and legal compliance. Correct and accurate CAM billing codes lead to outcome data, critical to the future of integrated medicine. This level of data capture will show payers actual costs and outcomes by provider type. Without such data, premiums for CAM cannot be set, underwriters cannot develop CAM policies, and meaningful comparisons cannot be made between CAM and allopathic medicine.

Physicians using more and more CAM procedures and products are concerned about their billing methods complying with HIPAA (Health Insurance Portability and Accountability Act) mandating that a "coding must accurately reflect the actual patient encounter." The urgency for compliance is highlighted by civic and criminal penalties for billing misrepresentation, intentional or otherwise, under the HIPAA laws.

The disciplines that CAM-net™ links with the state-by-state scope of practice laws include but are not limited to acupuncture, holistic medicine, massage therapy, homeopathy, naturopathy, ayurvedic medicine, chiropractic, and midwifery. The Nursing Intervention Classification (NIC) codes, Home Health Care codes, and the OMAHA community nursing codes have also been incorporated into this system to meet state compliance laws.

Relative Value Units have been assigned that tie Alternative Link's coded services to conventional pricing (similar to pricing mechanisms attached to CPT™).

CAM-net™ was built to plug-in to existing health care software, and supplies all legal and educational support for payers, providers, and stakeholders, throughout health care.

The approximately 4300 codes include codes for the prescribing, dispensing, and compounding of homeopathic remedies, herbs, and botanicals. Alternative Link has coded over 1300 homeopathic remedies, over 345 Oriental herbs and botanicals, and 228 Western herb and botanicals. They are also now inviting private companies to enter product coding into the system . . .

Alternative Link's system has been voted into the American National Standards Institute Implementation Guide for Electronic Standards (ANSI) and accepted into the National Library of Medicine's Unified Medical Language System. Of the codes sets being considered for an additional Level One National Standard code set, Alternative Link's compilation is the only system offering CAM codes and billable nursing services.

According to John Weeks, distinguished spokesperson for CAM business and publisher/editor for The Integrator , "We need to move CAM out of economic and philosophical quarantine. This requires a deeper belief within health care (already held by the patient) that CAM can not only serve the patient but can create a better health care system. The use of Alternative Link's CAM codes assures greater value for integrated medicine than most managed care executives and others in decision-making positions could know."