sign in sign up
<<
Home , Acupressure, Alternative medicine, Craniosacral therapy, Energy medicine, Manual therapy, Moxibustion

compliance

Coding Complementary and Alternative

BY CINDY PARMAN, CPC, CPC-H, RCC

ancer patients are typically treated part of standard medical care.3 The NCI , Livingston-Wheeler therapy, with approaches ranging from provides the following additional Revici treatment, and dietary C and radiotherapy to definitions: supplements. chemotherapy or immunotherapy. However, • Standard medical care is medicine that is 2. medicine. Techniques that involve millions of patients every year seek practiced by licensed and/or registered the use of energy fields. Examples include additional options from a menu of professionals. Some standard , , , complementary and medical care practitioners are also , pulsed fields, magnetic (CAM).1 According to a January 2018 article practitioners of CAM. fields, electromagnetic, and/or alternat- in JAMA ,1 patients may feel that • Alternative medicine is treatment used ing current or direct current fields. conventional healthcare too often leaves instead of standard medical treatment. 3. Manipulative and body-based practices. with little time and attention to • Complementary medicine includes Manual techniques that are used to commit to all of the areas in which patients treatments that are used along with manipulate or move one or more parts of require support. In contrast, practitioners standard medical treatments but are not the body. Examples include various specializing in complementary and considered to be standard of practice. techniques, exercise programs, alternative medicine schedule dedicated • Integrative medicine is a total approach oriental massage, Swedish massage, intervals focused on the patient’s priorities. to medical care that combines standard , , Pilates, People have used complementary and medicine with CAM practices that are myotherapy, , neural alternative medicine for thousands of years demonstrated to be safe and effective. therapy, hippotherapy, , and/or in pursuit of health and well-being.2 This approach treats the patient’s mind, . However, because rigorous clinical trials for body, and spirit. 4. Mind–body medicine. Techniques CAM have not been completed, designed to enhance the mind’s capacity the safety and effectiveness of these The Office of Cancer Complementary and to affect bodily function and symptoms. treatments remain uncertain. For example, Alternative Medicine is a division of the NCI Examples include biofeedback, hypno- there is limited information relating to the in the Division of Cancer Treatment and therapy, , relaxation therapy, correct dose and toxicity of some natural Diagnosis. This office is responsible for NCI’s , mental , Gerson therapy, remedies or to interactions of natural research agenda in complementary and spiritual healing, , light and products with prescription medications. alternative medicine as it relates to cancer therapy, and/or therapies that use The National Center for Complementary prevention, diagnosis, treatment, and creative outlets such as art, music, or and Integrative Health, a division of the symptom management.4 There are several dance. National Institutes of Health, is the federal different types of CAM that include but may 5. Whole medicine systems. Medicine based government’s leading agency for scientific not be limited to the following: on theory and practice. Examples include research on the diverse medical and 1. Biologically based practices. Substances , , ­, healthcare systems, practices, and products that are found in nature and used for diet and traditional Indian medicine such as that are not generally considered part of or nutrition. Examples include . conventional medicine. According to the products, vitamins, creams, ointments, Di Many of these treatments are profiled inThe National Cancer Institute (NCI), complemen- Bella cancer therapy, bioidentical Journal of Alternative and Complementary tary and alternative medicine is the term for compounded hormone therapy, Greek Medicine, a peer-reviewed journal providing medical products and practices that are not cancer cure, Kelly’s nutritional–metabolic scientific research for the evaluation and

OI | July–August 2018 | accc-cancer.org 9 integration of complementary and alterna- “medically necessary for properly selected set under the Portability tive medicine into mainstream medical members, subject to applicable benefit plan and Accountability Act. practice. Journal coverage includes botanical limitations and exclusions.” In addition, this ABC codes fill in the missing gaps found in medicine, acupuncture and traditional policy lists over two pages of alternative traditional code sets and can be used in Chinese medicine, mind–body medicine, medicine interventions that are considered practice management, nutrition and dietary supplements, experimental and/or investigational. This keeping, and other administrative activi- integrative health, yoga, Ayurveda, payer notes that the of alternative ties.10 It is important to recognize that ­naturopathy, homeopathy, , gong, medicine therapies is generally unproven, though these codes may not contribute to massage therapy, , with some shown to be ineffective or even reimbursement, they are valuable for neurostimulation, integrative , harmful. tracking time and work effort, generating and comparative effectiveness. United Healthcare publishes a Coverage reports for individual staff member Summary, which states, “Complementary Insurance Coverage productivity and overall management of and alternative medicine is not a covered patient and work flow. According to the , benefit,” although some members may be insurance companies will generally not cover There are nearly 4,200 ABC codes that eligible for acupuncture reimbursement.8 treatments that have not been proven to be describe approximately 1.4 billion episodes BlueCross BlueShield of Tennessee has helpful for the illness or symptoms experi- of alternative medicine, including herbal also a published CAM policy that states that enced by the patient.5 As with many other medicine, massage therapy, naturopathy, these alternative and complementary services, it will probably be necessary to , Ayurvedic medicine, homeopa- treatments are considered to be investiga- 11 review the individual insurer’s policy. For thy, care, and midwifery. Each ABC tional.9 Due primarily to the lack of insurance example, HealthNet states, “The Plan code consists of a string of five alphabetic coverage, Americans spend approximately considers complementary and alternative characters organized in a hierarchical $33 billion dollars annually out of pocket for medicine to NOT be medically necessary, structure that groups similar products, except as specified in the member’s benefit CAM treatments and products. remedies, treatments, and supplies together. ® document.”6 The Aetna policy provides the Cancer programs generally utilize CPT This five-character code is followed by a following coverage information7: procedure coding, International Classifica- two-character code that identifies the type of Aetna considers alternative medicine tion of , Tenth Revision, Clinical practitioner who performed the service interventions medically necessary if they are Modification diagnosis coding, and defined by the procedure code. For example, supported by adequate of safety Healthcare Common Procedure Coding the two-character code would identify and effectiveness in the peer-reviewed System Level II service and supply codes for practitioners such as acupuncturists, published . charge capture and billing purposes (see naturopaths, reflexologists, and other Table 1, page 11 and Table 2, page 12). Due to individuals who deliver complementary and According to its Complementary and the limited availability of codes for CAM, alternative medicine. Alternative Medicine policy, Aetna considers some services performed can be internally It is unlikely that all complementary and acupuncture, biofeedback, electrical tracked but do not have nationally recog- alternative medicine practices will have an stimulation, and chiropractic services to be nized billing codes. equal impact on cancer care. According to In addition to the code sets the NCI, cancer patients who are using or recognized for insurance billing, considering using complementary or there are ABC Codes that describe alternative therapy should talk to their healthcare interventions not healthcare professional. It is generally helpful included in other code sets (Table 3, if the attending writes a prescrip- page 12). These codes were tion for the alternative or complementary developed by Alternative Link therapy; then, if there is no insurance Incorporated in 1996, and in 2003 coverage, the patient may be able to use the Secretary of the U.S. Depart- medical savings plan dollars for the ment of Health and Human procedure or treatment. In addition, some Services approved a two-year healthcare plans require preauthorization to program of commercial use and ensure that the patient’s diagnosis meets evaluation. In September 2006 the requirements when coverage is available. U.S. Department of Health and Human Services denied further use Cindy Parman, CPC, CPC-H, RCC, is a principal of ABC codes because they were not at Coding Strategies, Inc., in Powder Springs, named a standard, designated code Ga.

10 accc-cancer.org | July–August 2018 | OI Table 1. CPT Procedure Codes for Complementary Medical ­Procedures

CODE DESCRIPTOR

Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the 90875 patient), with psychotherapy (e.g., insight oriented, behavior modifying or supporting psychotherapy); 30 minutes

Individual psychophysiological therapy incorporating biofeedback training by any modality (face-to-face with the 90876 ­patient), with psychotherapy (e.g., insight oriented, behavior modifying or supporting psychotherapy); 45 minutes

90880

90901 Biofeedback training by any modality

96900 Actinotherapy (ultraviolet light)

Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to deter- 96902 mine telogen and anagen counts or structural hair shaft abnormality

97014 Application of a modality to one or more areas; electrical stimulation (unattended)

Therapeutic procedure, one or more areas, each 15 minutes: massage, including effleurage, petrissage, and/or tapote- 97124 ment (stroking, compression, percussion)

Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or 97140 more regions, each 15 minutes

Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact 97810 with the patient

Acupuncture, one or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one 97811 contact with patient, with reinsertion of needle(s)

Acupuncture, one or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with 97813 the patient

Acupuncture, one or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one 97814 contact with the patient, with reinsertion of needle(s)

98940 Chiropractic manipulative treatment; spinal, one to two regions

98941 Chiropractic manipulative treatment; spinal, three to four regions

98942 Chiropractic manipulative treatment; spinal, five regions

98943 Chiropractic manipulative treatment; extraspinal, one or more regions

OI | July–August 2018 | accc-cancer.org 11 Table 2. Healthcare Common Procedure Coding System Level II Codes to Report and/or Track CAM Services Performed

CODE DESCRIPTOR Activity therapy such as music, dance, art, or play therapies not for recreation, relate to care and treatment of patient’s G0176 disabling mental health problems, per session (45 minutes or more) Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy G0283 plan of care M0075 Cellular therapy (the practice of injecting humans with foreign proteins) P2031 Hair analysis (excluding ) S8930 Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with patient S8940 Equestrian/hippotherapy, per session S9449 Weight management classes, nonphysician provider, per session S9451 Exercise classes, nonphysician provider, per session S9454 classes, nonphysician provider, per session T2036 Therapeutic camping, overnight, waiver; each session T2037 Therapeutic camping, day, waiver; each session

Table 3. Example of ABC Codes That Add Information to an Existing Procedure Code Descriptor

MEDICAL DESCRIPTION ABC CODE DESCRIPTION CODE 97124 Therapeutic massage CBBBC ™, 30 minutes 97124 Therapeutic massage CBEAB Craniosacral therapy, 15 minutes 97124 Therapeutic massage CBEAC Connective tissue massage, 15 minutes

References online at: cancer.org/treatment/treatments-and- online at: uhcprovider.com/content/dam/provider/ 1. West H. Complementary and alternative medicine side-effects/complementary-and-alternative- docs/public/policies/medadv-coverage-sum/ in cancer care. JAMA Oncol. 2018;4:139. medicine/complementary-and-alternative-methods- complementary-alternative-medicine.pdf. Last 2. National Institutes of Health. Complementary and-cancer/insurance-coverage-for-cam.html. Last accessed May 29, 2018. and alternative medicine. Available online at: report. accessed May 29, 2018. 9. BlueCross BlueShield. Complementary and nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=85. 6. HealthNet Plan. Complementary and alternative alternative medicine. Available online at: bcbst. medicine, including acupuncture treatment. Last accessed May 29, 2018. com/mpmanual/Complementary_and_Alternative_ 3. National Cancer Institute. Complementary and Available online at: bmchp.org/-/media/ Medicine.htm. Last accessed May 29, 2018. alternative medicine. Available online at: cancer.gov/ ecf59b7490646f0bb1463262594f34e.ashx. Last 10. Find-a-Code. ABC code sets. Available online at: about-cancer/treatment/cam. Last accessed May accessed May 29, 2018. indacode.com/medical-code-sets/abc-codes-set. 29, 2018. 7. AETNA. Complementary and alternative medicine. 4. Office of Cancer Complementary and Alternative Available online at: etna.com/cpb/medical/ html. Last accessed May 29, 2018. Medicine. Available online at: cam.cancer.gov/about_ data/300_399/0388.html. Last accessed May 29, 11. AAPC. Advanced contract billing codes. Available us/default.htm. Last accessed May 29, 2018. 2018. online at: aapc.com/medicalcodingglossary/ 5. American Cancer Society. Will my insurance cover 8. UnitedHealthcare. Coverage summary: advanced_contract_billing_codes(abc_codes).aspx. alternative and complementary therapies? Available complementary and alternative medicine. Available Last accessed May 29, 2018.

12 accc-cancer.org | July–August 2018 | OI