ABC Code Set

Description

ABC codes were originally developed to process claims addressing conventional, complimentary, and alternative health care services not routinely included in traditional medical billing codes (ABC Coding Systems). These codes provide a more detailed description of health care services to assure appropriate reimbursement (Giannini, 2005). ABC codes fill in the missing gaps found in the older medical coding systems making the new billing system more reliable and cost effective. Not only are these codes used to improve billing systems but they are also used in practice management, medical record keeping, insurance claims, benefits, and administrative activities.

The mission of this specific vocabulary is empowering greater access to quality care at less cost. The vision of this vocabulary is improving the health and welfare of our nation and our world. The ABC coding system incorporates their mission and vision into practice by getting the right care to the right people, in the right time and place, at a rationale cost (ABC Coding Systems).

Organizational Structure

Each ABC code consists of a string of five alphabetic characters used to identify thousands of different services. These five characters are organized in a hierarchical structure which groups similar products, remedies, and supplies together in a fluid manner. Practitioner modifiers, legal practice guidelines, and relative value units, are additional terminologies paired with the original five character code to make it complete.

The five character code is followed by a two character code that identifies the type of practitioner who provided the service reflected in the code. The ABC code plus the practitioner modifier can be linked to state specific legal practice guidelines assuring compliance within state statutes, regulations, and law. The ability to link the code with legal practice guidelines that tend to vary from state to state decreases malpractice and fraudulent billing charges. Relative value units (RVUs) are used to establish the financial worth of a specific intervention. RVUs are multiplied by regional conversion factors to obtain a dollar amount for services.

Intended Uses and Settings

The ABC code is recognized by the American Nurses Association (ANA) and is already integrated with other coding systems including the Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCSII). It is designed to fit into existing standard claim forms and software applications making it readily available and accessible for health care professionals. Acupuncturists, naturopaths, massage therapists, reflexologists, social workers, advanced practice nurses, and registered nurses are just a few of the health care professionals utilizing the ABC coding system (Bolen, 2007).

It is important for nursing as a profession to be included in the interoperable electronic medical record that is going to be the future of health care. The ABC coding system contains approximately 800 nursing procedures gathered from the Nursing Interventions Classifications (NIC). With the ABC coding system, these interventions can be documented and interfaced with an electronic health record justifying nursing care and the profession.

Potential Benefits for Clinical Practice

There are many benefits to using the ABC vocabulary in clinical practice. First, this vocabulary allows advanced practice nurses as well as multiple other health care professionals to easily and reliably bill for their services. Second, the code is standardized. It consists of five to seven letters which relate respectively to the procedure, provider, and intervention provided. This system helps eliminate unnecessary confusion. Third, the code is computerized and linked to state specific legal practice guidelines. It only permits practitioners to bill for services they are cleared to provide. This offers a safeguard against diagnosing, treating, or providing any other action that is not within the practitioner's scope of practice. Fourth, the codes can be used for a variety of reasons making them invaluable as far as generating data and reports for individual practitioners, management staff, and insurance companies. Fifth, bills and claims can be made online. This creates increased operational efficiencies for providers, i.e. reduction of time spent on claims adjudication and facilitation of a prompter response for payment of services. Finally, according to the ABC website, the biggest benefit of using this coding system is that they improved healthcare operations and healthcare industry just as universal product codes (UPC bar codes) have improved the retail industry. These codes allow business providers to carry out essential business practices like claims processing, forecasting, insurance billing, practice management, and third party reimbursement in an automated manner.

Historical Development

ABC Codes are five-digit alpha codes (e.g., AAAAA) used by licensed and non-licensed healthcare practitioners to supplement medical codes (e.g. CPT and HCPCS II) on standard electronic (e.g. American National Standards Institute, Accredited Standards Committee X12 N 837P healthcare claims and on standard paper claims (e.g., CMS 1500 Form) to describe services, remedies and/or supply items provided and/or used during patient visits. ABC codes contain both a short description (e.g. 80 characters or less) and an expanded definition of the service, remedy and/or supply item. ABC codes were created and designed by ABC Coding Solutions.

ABC codes fill gaps in healthcare administrative coding that conventional medical code sets do not cover and support preferred provider contracting, claims, payments and comparative outcome studies. Additionally, ABC codes are tied to state legislative references regarding scope of practice and training requirements on a code, state and practitioner-specific basis.

"Historical Development" section cited from Wikipedia.org

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