EBM, ICD and ABC

[Guest guest]

LHC has left the door open to use codes other than ICD-9 in order to

make insurance claims. But are there any? It was suggested to me

that a set of codes applicable to OM are currently being tested. They

are the ABC codes. But I believe these codes are not diagnostic

codes. They are procedure codes and should be compared to CPT codes,

not ICD-9.

 

see more at

http://www.alternativelink.com/ali/ARTpertinent_link/ARTInter_Journal00.asp

 

an alternative set of diagnostic codes unique to OM would allow us to

make claims for lung wilt due to yin vacuity (BTW, another coup for

the wiseman crowd; the only way to use codes of this nature is with a

standard vocuabulary. We can't agree amongst ourselves what to call

things, but we want insurers to reimburse us anyway. uh-huh). In

order to develop the OM diagnostic codes, we need to have professional

standards of care so there is some inter-rater reliability to these

dx. It does no good to label something if the definition of the label

is allowed to shift at the whim of the px. This gets back to how do

we prove our diagnoses exist in the real world and that we can

reliably identify and treat them? The sole answer is research, which

brings us full circle to the issue of EBM. LHC has suggested that our

scope may need to be restricted based upon the existing evidence.

That it must be explicit about what we can and cannot treat. Several

times the report alluded to the fact that we can treat all areas of

the body as if this may not be appropriate.

 

Perhaps some of this sounds familiar, as it resembles a lot of what I

have been writing here for years. We need research to prove our dx

are real, our rx are active, our strategies are effective and all

three of these are intimately linked. If we do not do these things,

we may see ourselves go the route of the chiros, limited to treating a

few pain complaints, at least if you want reimbursement. I won't

claim to have vision, but I can see the writing on the wall. So

what's next. I bet we put our heads in the sand and just hope for the

best. Again, forestalling necessary research under the pretense that

something else is more important. Because if we have nothing to bring

to the table when we are stripped of our rights to use current ICD9

codes, then it could be months or years before the problem is rectified.

 

The time is now to work to avoid any or all of the nightmare scenarios

that are possible. First, people said sit tight and wait for LHC. Now

the same people are saying sit tight and wait for the legislature.

The position of the LHC was predictable, though. As is the response

of the legislature. We need a contingency plan now. The beauty is

that research can only help, even in the best case scenario, so why

not. We should support the society for acupuncture research as the

current best organized entity working towards this goal. However CHA

has a direct interest in this as well. I have expended much time and

energy here lobbying for essential research. However I am perhaps too

personally controversial for CHA as my sole proprietorship to be

recipient of the funding for this goal. That is why I have proposed

creating a nonprofit entity with a board to work on developing

professional diagnostic standards and codes, demonstrating interrater

reliability of dx, validity of zang-fu paradigm and clinical efficacy

of herbology for a wide range of complaints. The board, not me, would

handle all finacial matters. We would need 1000 members to donate

$500 each to get the ball rolling on grantwriting and translation

projects. I would be glad to participate at the discretion of the

board as an employee involved in coordination of these various

projects.

 

[Guest guest]

LHC has left the door open to use codes other than ICD-9 in order to

make insurance claims. But are there any? It was suggested to me

that a set of codes applicable to OM are currently being tested. They

are the ABC codes. But I believe these codes are not diagnostic

codes. They are procedure codes and should be compared to CPT codes,

not ICD-9.

<<<First i do not think the ABC codes have disease codes they are procedure

codes if i am not mistaken. Second if you think that mainstream will ever take

kidney yin def seriously you are dreaming. If we let go of the right to make a

diagnosis we can kiss our assess good buy.

Alon