Secret Decoder Ring Required

One of my fondest childhood memories is being a charter member of the 3 Under the Rainbow Club. There were only three members and the president was partial to rainbows, hence the name. We had a special greeting, a logo, secret meetings, and other activities, which I am not allowed to divulge as mandated by our bylaws. Seriously, the best part of the club was the sense of belonging to something special—a club of our own. But this kind of sorority or fraternity goes hand in hand with exclusiveness. However noble our intentions may have been, we still made others feel as though they needed a secret password to be part of the inner circle.

I thought of this while reading a news brief published in Eli Research’s Chiropractic Alert (July/August 2001) about how the American Medical Association (AMA) owns the copyright to CPT codes. "...Senate Minority Leader Trent Lott (R-Miss) says the federally approved ‘monopoly’ is unfair and harms patients by contributing to health care costs. The federal government determines the costs doctors can charge Medicare and Medicaid for services, yet the AMA controls the codes. And the association receives $71 million in annual royalties and book sales...Lott is asking [Department of Health and Human Services Secretary Tommy] Thompson to determine how much the AMA has received in royalties, book sales, and other revenue from its CPT copyright since 1983, and to determine how much the government would save from a universal coding system developed by HHS...The Association of American Physicians and Surgeons [AAPS] applauds Lott’s move. ‘Sen. Lott deserves everyone’s support in his effort to pull the rug out from under the AMA’s secret monopoly on these codes,’ says AAPS spokesperson Kathryn Serkes."

Why does the AMA own the copyright to CPT codes used by the entire health care industry? Furthermore, why does anyone have to pay for something that should be public domain? Ces Soyring, CA, cofounder of the National Academy of Chiropractic Assistants says that the Center for Medicare & Medicaid Services (formerly HCFA) handed the CPT reins over to the AMA. She also says that ICD-9 CM codes are owned by the World Health Organization, but those are public domain.

Is the AMA planning to require not only dues, but also a decoder ring to access CPT codes? The AMA did not earn this knowledge with discipline or research. Yes, they have updated the codes since handed this gift 30 years ago, but is this worth a $71 million paycheck? The health care community is not Napster infringing on intellectual property rights and should not be made to pay for access to CPT codes.

Coding compliance is already a nightmare. According to Medical Newswire, November 5, 2001, "In the past few years, coding compliance has become such a hot target for fraud fighters that many health care organizations are scrambling to shore up their systems any way they can...If your facility is suffering from mysterious claim denials, downcoding, or A/R problems, then ‘it’s time to get everyone up to speed,’ [says] Marcia Castillo, RHIT, a coding instructor with Brown & Fortunato. ‘Those 10,000-plus ICD-9 CM codes are the fundamental basis for both reimbursement and compliance issues.’"

Soyring agrees, "If diagnosis and procedure codes in boxes 21 and 24 do not correspond, the insurance companies will flag this discrepancy."

For the AMA to profit from doing nothing boggles the mind. Should health care practitioners and patients allow this pillage to continue? How can we stop the ubiquitous behemoth that is the AMA?

Miwon Seo
mseo@medpubs.com