Sorry Jan, but you have this wrong. ICD-9 stands for International
Classification of Diseases, 9th revision. The ICD codes were developed and
are revised by the WHO in order to standardize the reporting of disease
occurrence around the world. Now on the other hand ___CPT codes___ are
developed and copyrighted by the AMA as a mechanism to standardize service
billing for physicians around the US. The AMA got the insurance industry to
accept this classification of services provided by medical practitioners so
that billing would be simplified. Prior to implementation of CPT coding,
each company had its own description of services provided and the medical
providers (who were primarily physicians at that time) had to guess what to
call their services and hope that they had used the description that would
bring payment for what they had done.
I understand that the dental organizations have worked out a similar
standardization of billing with insurers. I believe most other groups have
shown their para-professional status, being subservient to the medical
profession, by working to get their billings paid using the CPT service
codes. Most of the codes have been modified over the years, there is
actually an annual revision of the CPT codes published by the AMA. Since
originally most of the para-professional occupations evolved out of working
under the supervision of the physician, codes were developed at the request
of physicians, to facilitate the receipt of payment by the physician for
services rendered by his/her employees.
The chances of IBCLC's receiving insurance reimbursement for services
rendered is relatively low if they are not affiliated with a physician,
unless they have successfully negotiated a contract to provided services.
Since IBCLC's are not licensed by most states at this time, their chances of
obtaining such a contract is probably pretty low, because many states
mandate reimbursement for licensed hcp's but the insurance companies are
pretty hesitant to pay for services by unlicensed practitioners. (I've been
watching the massage therapists in Nevada, who have recently organized a
drive to obtain state licensure for this very reason. They have previously
been unregulated in some counties and regulated by a local board in others.
Because of that they had been denied reimbursement.) Eligibility for
insurance reimbursement is one of the driving forces behind the direct-entry
midwifery drive for licensure in many states, also.
Melinda Hoskins, MS, RN, IBCLC, SNM (CNEP)
Who has only spent the last 15 years helping my husband run his family
practice office
and dealt with all the coding details repeatedly.
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]]On Behalf Of [log in to unmask]
Sent: Monday, April 03, 2000 9:12 AM
To: [log in to unmask]
Subject: ICD-9 codes
Elisheva rightly asks,
<< Jan, for those of us outside of the quasi-medical world, who generates
these
codes? Are they insurance/compensation related, or medical per se?
Because,
while I agree with Rachel that letting the medical model take over
lactation
would be problematic, surely letting insurance companies decide what LC's
are
competent to do is stretching things too far!
>>
They are determined by the American Medical Association, with (probably)
input from the other disciplines such as pediatrics, obstetrics, and so on.
I took the diagnoses I listed directly off the pediatric "superbill" which
is
what insurance companies must have before they will reimburse the pediatric
practice at all. Unfortunately IBCLCs cannot generate their own set of
codes
and expect to be paid by insurance companies. Won't work.
As far as insurance companies determining what IBCLCs are competent or not
to
do -- hey -- they make those determinations all the time with physicians,
with what medical tests you can and cannot have, with the length of time you
can stay in the hospital, with which specialist you may or may not see, with
what treatments you may or may not have. Why should we be any different?
Jan B -- now old, snarky, AND cynical in Wheaton
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