The American Medical Association owns CPT codes used to bill for conventional medical treatments. These codes are the insurance industry standards to bill and process medical claims by payers (insurance, managed care Medicare, and Medicaid, etc). Claims payments systems (including managed care negotiations with providers) depend on this coding system to:

1. Match charges with treatments
2. Translate costs into statistics
3. Identify costs
4. Underwrite health insurance policies
5. Track patient outcomes, and
6. Patient utilization.

As alternative medicine is brought into mainstream medicine, alternative providers attempt to use these codes, but their claims are not understood by the payers because accurate descriptions of the services they perform do not exist in the current procedural terminology (CPT).

"Dummy Billing Codes" or codes designed by individual payers to cope with alternative treatment exist with a few carriers that offer benefits for alternative medicine. State Medicaid and worker's compensation codes have been created to cope with acupuncture and naturopathy. In these instances, description of services or treatments originate from the payer instead of from schools or associations of alternative medicine. In no way do these codes account for all the services performed in the office of an alternative provider. Since no independent system exists to cope with the need for the exchange of information is this field of health care, an integrated system was created to describe all of alternative healthcare in a logical and uniform way.

The American Medical Association has a distinct conflict of interest in creating codes for alternative medicine. Their mission is to encode treatments used by conventional medical doctors for use in the allopathic medical care systems.

Alternative health care benefits cannot be added by the existing payer systems, Medicare, and Medicaid until the descriptions of treatments performed by alternative practitioners is put into a standardized vocabulary, identified with training standards, and given corresponding codes with relative value units. Further, the information must be able to be translated into each states' licensing and "scope of practice" to be useful to the payers. Finally alternative codes should be distinct from CPT. Cost outcome studies compared with conventional treatments are non-existent. These studies provide crucial information for payers to underwrite the cost of adding alternative healthcare to meet consumer demands.

Alternative Link has developed a system to overcome the failures of the current coding system to provide accurate data and a universal vocabulary for alternative healthcare in a state-specific format. By providing vocabulary to which the alternative healthcare provider may attach a code to a valid description of services, the benefit of having comparisons with conventional treatments can be attained. Tracking of patient outcomes will follow, and those which prove effective can then be designed into benefit plans and added to insurance coverage.

Melinna Giannini is president and co-founder of Alternative Link, LLC. Her goals are to enroll alternative practitioners into managed care networks, supply them with an independent coding system for their treatments and negotiate broader benefits without ceiling caps on treatments. She filed a patient for alternative billing codes after she discovered the inadequacies of the present system. Her background is in the sales and design of health insurance coverage for multi-level employers. She can be reach at phone:(505)527-0636, fax:(505)523-4152, internet:www.alternativelink.com.