Alternative Billing Concepts (ABC) Codes ABC Codes
Latest version of terminology standard available through UMLS 2009 Original Publication 2000
ABC Codes do not include an implicit information model and were designed for computerized documentation and measurement of non-physician and alternative medicine health services. They allow health care disciplines not reimbursed using standard billing codes to submit health care claims (ABC Coding Solutions). They consist of five-digit HIPAA compliant alpha codes with both a short description and an expanded definition.
Process for Updating/Publishing Standard ABC Coding Solutions (formerly Alternative Link Incorporated) publishes ABC Codes. User inputs and practitioner requests have prompted updates and refinements of existing code that are needed to supplement codes on standard CMS 1500 claim. The initial code manual was available in 2000. Regular publications occurred in 2015 and 2016; however, between 2010 and 2015, there was a publishing gap due financial issues.
Usage/Activity The codes are used to supplement Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Level II codes on standard Centers for Medicare and Medicaid Services (CMS)-1500 paper claims and ANSI ASC X12N 837P standard electronic claims when filing to health insurers (Association A. M.) (Medicare Billing: 837p and Form CMS-1500, 2012). ABC Codes have not been widely adopted and are not considered valid billing codes by Medicare.
In the absence of data from specific users, the table below illustrates different health care areas that the codes could support.
Challenges
Identifying Challenges and Opportunities within Standard Nursing Terminologies 20
ABC Code Support Areas Clinical Nurse Specialist (all specialties) Clinical Social Worker Doctor of Chiropractic Doctor of Oriental Medicine Doctor of Osteopathy (holistic) Holistic Nurse/Marriage and Family
Therapist Massage Therapist Midwife (Certified and Lay) Medical Doctor (holistic, all specialties) Naprapath Naturopathic Doctor
Nurse Midwife (all specialties) Nurse Practitioner (all specialties) Nutritionist Occupational Therapists Physical Therapists Professional Counselor Reflexologist Registered Dietician Registered Nurse (all specialties) Spiritual Advisor/Pastor/Priest (all faiths) Spiritual Nurse (all faiths)
Challenges ABC Codes are not mapped to SNOMED CT or LOINC. Interfacing with SNOMED CT lacked source of financial support, an issue echoed by other terminology owners. In addition, ABC codes do not represent clinical concepts, as they are oriented to the revenue cycle.
Opportunities ABC Codes represent services supplied by non-traditional providers, including nurse practitioners and other advanced practice nurses, outside of current valid billing codes; they offer a potential avenue for billing for these services. Today, most insurance companies and Medicare will not reimburse for these services.
C. Minimum Data Sets The general concept of a Uniform Minimum Health Data Set (UMHDS) can be defined as “a minimum set of items [or elements] of information with uniform definitions and categories, concerning a specific aspect or dimension of the health care system, which meets the essential needs of multiple data users” (Werley, Devine, Zorn, Ryan, & Westra, 1991). A minimum data set typically is organized around a specific type of data in order to support data sharing, comparison and analyses. Possible values for each data element must be determined, such as lists of agreed terminology. ANA recognizes two minimum data sets: the Nursing Minimum Data Set (NMDS) and the Nursing Management Minimum Data Set (NMMDS).