Having only four billing codes (with modifiers) for Chiropractic, has caused payers to limit reimbursement to the narrowest interpretation of national scope of practice. The accompanying arbitrary capitation of fees for services rendered has also become a very real disservice to both patients and providers. As you well know, payers also frequently request additional "supporting documentation" in the form of Narrative Reports and SOAP Notes, slowing reimbursement and cash flow to a crawl. This is because the needed information was not made available to them in electronic messaging formats when using the current codes.

A new billing coding system has been Patented in the US (with patent pending status in 90 other countries) specifically for Complimentary and Alternative Medicine. This system includes 13 Provider types with well over 2,500 codes for Chiropractors (potential use based on actual state by state scope of practice). Included in the Y2K Version of the ABC Codes© are two NSA© Entrainment billing codes (see specific codes, in the following article).

The ABC Codes© system tells payers exactly what a Chiropractor may legally do in each of the 51 geographic regions of the United States, thereby allowing full scope of practice based on state specific laws. More importantly, it also complies with the 1996 Federal Health Insurance Portability and Accountability Act (HIPAA Act) intent. This Act requires that all billing codes must accurately reflect the actual patient encounter to avoid the possibility of HCFA fines of up to $10,000 per line item. (As a member of your State Chiropractic Association you may request to review you own state’s Scope of Practice by contacting Judy Lee, Executive Director of the ICAN Institute at 505/527-0636. In return for the 1.5 hours required for this review you will receive a free copy of the ABC Code set---a $99 value.)

Use of this coding system will also allow payer data to develop that may be compared directly with the costs and outcomes of many years of MD/DO only, warehoused allopathic data. Think of the implications? A mechanism is finally in place that develops data for payers demonstrating which providers (and procedures) are actually working. This billing system allows pertinent, usable, hard data to develop quickly, while the exorbitantly expensive clinical trials and longitudinal studies are still underway. All data tracks from the identical source of warehoused allopathic data---the ICD-9 diagnosis code. No costly computer system changes are needed at any level of use since these five digit, all-alpha billing codes just "drop down" into all current computer systems and the HCFA 1500 billing form (including provider office software, claims routing, all the way through payers’ systems and ajudication processes).

The electronic messaging nomenclature meets all current and all projected standards set by the American National Standards Institute (ANSI-X12N), has been voted into their Implementation Guide as an Optional Code Set and has already been included in the Unified Medical Language System and National Library of Medicine.

Not previously having a mechanism available to study (real) Chiropractic treatment patterns meant payers had no way to calculate their actual risk. Chiropractic care could not be a fully underwritten insurance benefit without this assessment of risk. The current, arbitrary dollar capitations on Chiropractic benefits and "discount card" services resulted as a first attempt to meet the high patient demands for Chiropractic care. Hopefully this situation may soon be a thing of the past once payers realize which providers are actually controlling costs.

For more information on the ABC Codes© visit www.alternativelink.com

Judylee@ICANnameit.org 
1065 S. Main Street - Bldg C
Las Cruces, NM 88044
505/527-0636 x 206
FAX: 505/523-4152

Due to the Y2K hardware/software concerns of the insurance companies who have built the ABC Codes© into their budget plan to implement the codes after mid January 2000. This will happen on a state by state basis. Leave your name with Brian Mangas (Brian@alternativelink.com) so that he can e mail you as payers in your state begin implementing/utilizing the system. In the meantime do not use the new codes for third party payment.

ABC Code© for Level One Basic Entrainment:
CBBBG (This is the code!)
NSA© Level One Entrainment Contact or Impulse, Basic Care,
(may bill once for each 15 minute period of care)
Expanded Definition (is included in electronic format to tell payers exactly what is being done---without
having to submit Narrative Reports. It is also included in the official Unified Medical Language System
and National Library of Medicine):

Network Spinal Analysis™, Level One, Basic Care:
clinical application of a low force contact (of one second or less) to tissues overlying the spine in the area of the vertebral-spinal cord attachments for the purpose of developing:

frequency entrained spinal oscillators; and/or self generated somatopsychic responses to advance spinal and neural integrity; and/or automatic self regulatory processes for adverse mechanical spinal cord tension and/or advance in the wellness index.

Furthermore, Basic Care entrainment contact (consisting of light contacts of one-second or less) are administered to: enhance cognitive awareness of the spine and its motion tension and ease patterns; develop strategies of the body to spontaneously reduce its spinal cord and spinal tension patterns and produce spontaneous self generation motion to advance spinal and neural integrity. The contact is not aimed at correction of a spinal misalignment, subluxation, fixation or pain. 

Training Standard (tells payers that only DCs who document this training may bill for this service):

Current, active, licensure as a Doctor of Chiropractic in the state where practicing and passing scores on Part One Certification Examination in Network Spinal Analysis™ by Innate Intelligence Inc. of Colorado.

ABC Code© for Level Two Intermediate Entrainment:
CBBBH (This is the code!)
NSA© Level Two Entrainment Contact or Impulse, Intermediate Care 
(may bill once for each 15 minute period of care)

Expanded Definition:
Level Two, Intermediate Care includes clinical application of low force contacts or impulses (that may last several seconds) to tissues overlying the spine in the area of the vertebral-spinal cord attachments, on the articulation of greatest motion and ease for the purpose of :

developing intermediate level frequency entrained spinal oscillators; and/or self generated somatopsychic responses to advance spinal and neural integrity; and/or automatic self regulatory processes for adverse mechanical spinal cord tension and/or advance in the wellness index.

Furthermore, Intermediate Care entrainment contacts or impulses enhance differentiated segmental motion and the development of two spinal frequency entrained oscillators. A variety of force applications may be applied to achieve this response under the term impulse. Neither entrainment contact nor impulse is aimed at correction of a spinal misalignment, subluxation, fixation or pain.

Training Standard:

Current, active, licensure as a Doctor of Chiropractic in the state where practicing and passing scores on Part Two Certification Examination in Network Spinal Analysis™ by Innate Intelligence Inc. of Colorado.