Alternative Billing Concepts (ABC)

The Alternative Billing Concepts are codes that were intended to provide billing codes to fill gaps in traditional medical code sets.  Originally these gaps were met by the now retired  state-specific Healthcare Common Procedure Coding System (HCPCS) III codes. The ABC Codes were intended to be useful for nurse practitioners and other non-MD or DO practitioners. However, they have failed to gain traction in the current US medically oriented healthcare system.

The ABC codes consist of over 4,500 codes that are useful in integrative healthcare services. The codes are a “… a five letter string followed by a two character code modifier. The string identifies the service, remedy, or supply item. The code modifier identifies the practitioner type.” These codes are updated annually and are in the UMLS Metathesaurus as resources permit. (See (http://www.nlm.nih.gov/research/umls/sourcereleasedocs/
current/ALT/ )

Testing  of the use of the ABC codes in Alaska between 2004 and 2009 showed  that their use resulted in a 50% decrease in overall healthcare costs. Nevertheless, in 2006 the U.S. Government made it a policy to refuse to recognize electronic billing with ABC codes, a policy still in effect today.

References

Medical Billing Codes—Will Nurses and Alternative Medicine Ever Get a Foot in the Door? (November 13, 2012). An excellent recent review of the place that the ABC codes do and do not have in healthcare billing.
http://www.anh-usa.org/medical-billing-codes/

Alternative Billing Concept Coding System. A 2007 paper by Hannah Beintema, Elizabeth Isaacson, Danilo Lovinaria, and Laura Mickelson for a class at the University of Minnesota. Provides a good history of the ABC codes and reasons why they are still not allowed in electornic billing by Medicare and Medicaid.
https://wiki.umn.edu/pub/HealthInformatics/Group1-VocabFall07/Assignment2final.docx

Why Billing Codes for Alternative Medical Treatments By Melinna Giannini Volume 1. No 3, 1997. Although dated, this Webpage provides a good perspective on the ABC Codes.
http://www.abccodes.com/ali/ARTpertinent_link/ARTMy_Health97.asp

Created August 30, 2014