Do massage therapists need more medical codes for describing and billing their services? Melinna Giannini thinks so. That’s why she and a group of nine have spent the last five years compiling more than 4,000 codes to be used by all complementary and alternative medicine (CAM) providers, including massage therapists, bodyworkers and somatic therapists.

Giannini, president and founder of Alternative Link, started her privately funded company to help fill a void she felt existed in medical coding for CAM therapies. It was both her insurance background and her personal experience with alternative health that convinced her CAM providers needed better tools for insurance reimbursement.

"Melinna quickly understood reimbursement was being hampered because providers could not communicate services to payers in a standard way," said Connie Koshewa, director of research at Alternative Link. "The CAM payment issue was even worse because the laws governing treatment were different in each state." In addition, Giannini’s prior experience dealing with the medical community helped open her eyes. After years of looking to the allopathic community for help diagnosing a long-term illness, she finally visited a holistically trained medical doctor. Within minutes, she had a diagnosis and a treatment plan; within months, she had her health restored. But all the while, her frustration was heightened.

"My insurance would pay the $15,000 in medical bills for inclusive diagnostic tests," said Giannini. "But they wouldn’t pay the $500 for the diagnosis and treatment that worked. That was my motivation." Giannini said she was given back control of her own health, something she believes everyone should be privileged to do.

Alternative Link's principals believe the timing is perfect for the new codes because of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 which demands standard communication between providers and payers by 2002. "Part of the bill is calling for standard code sets," said Koshewa. Another part of the regulation is that practitioners are required to accurately describe what they do. "Without proper codes, insurance carriers won’t reimburse," said Koshewa, "and there’s up to a $10,000 fine for improperly reporting services."

To create the new handbook of codes, scheduled to come under scrutiny by the Department of Health and Human Services within the next few months, Giannini's group contacted associations, national resources and certified schools around the country. Their guidelines for including provider types to the codes were consistent:

1. there must be licensure for the modality/service/therapy in at least one state;
2. there must be mechanism for national certification or accreditation; and
3. there must be a means for securing malpractice insurance for the licensed practitioner.

Giannini knows there will be some who disagree with the need for more codes. She also knows it will serve others well. For instance, chiropractors who are supplied only four codes under the American Medical Association's Certified Procedural Terminology (CPT) codes, will have access to hundreds of physical modality codes, including 28 specific chiropractic services under the Alternative Link program. Many have supported her efforts for CAM coding, including the American Nurses Association. She says it's just good sense. "Look at what's happened over the last 20 years. Although chiropractors are licensed in all states and are paid by insurance carriers, there is still no viable outcome information to promote wider use of their services. If you do not support having these codes become standard, you'll have the AMA controlling your medicine and the payment for your services," she said.

Giannini said the concept and need for codes is nothing new, especially in the world of e-commerce. "You can’t buy a sweater out of a catalog without a code," she said. "Codes are business tools, they're not anything magic." She went on to explain that until there are means to measure and standardize the way we talk about therapies, insurance companies won't cover CAM services. "They can't measure the exposure," she said.

While some traditional medical groups have opposed for Alternative Links' efforts, Giannini said the government has been very fair and understands that CAM practitioners may not be well-served by the current coding.

Giannini would like complementary care practitioners to speak up and let the government understand payment problems associated with current coding. "If you would like payers to reimburse you for what you actually do, it's time to lobby for this code set." To view directions for submitting comments on CAM codes to the Department of Health and Human Services, visit www.alternativelink.com/hipaa.