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Differences Between the CPT Coding and the ACMA Coding
Chinese Herbal Medicine (CHM) is the major component of Traditional Chinese Medicine (TCM). It is very popular in China and more than 100 countries, and has billions of patients around the world. CHM has been recommended by the World Health Organization (WHO) for many diseases treatments, including some acute diseases and most chronic diseases. However, because CHM came to America later than acupuncture, it was less known than acupuncture in US. In recent years, CHM has becoming more and more popular in US. In February 2004, after the ephedra event, the FDA's commissioner was changed around this time. The FDA's attitude towards Chinese Herbal Medicine (CHM) was changed too associated with the FDA commissioner's replacement. In this month, the FDA issued a Final Rule. In the Final Rule, for the first time in history, FDA acknowledged that Chinese Herbal Medicine can treat diseases, which distinguished Chinese Herbal Medicine from other dietary supplements. More information on these issues are available in [1]. In September 2005, NIH, FDA, NCCAM, Harvard University, Yale University, Merck, Johnson & Johnson, etc. attended the TCM International Science and Technology Fair in China to understand more about Chinese Herbal Medicine (CHM) and related fields. In April 2006, NIH invited Chinese Medicine Doctors (CMD) from China to present CHM treatments on cancers. More information about CHM in English speaking nations can be found at On Chinese Herbal Medicine. The increased popularity of CHM has brought up the health insurance coverage issue for CHM. Reference: [1]. Letter to the Congress. ACMA Publication Issue Aug 2002.
The insurance industry requested ACMA to provide coding for the professional practice of CHM by Chinese Medicine Doctors (CMD). Because the CPT Coding has been used in Western Medicine (WM) for many years, some people tried to apply the CPT Coding to the CHM. However, WM and CHM are two completely different medicines [1, 2]. Due to these differences, the WM CPT coding is inapplicable to CHM. Following, we will analyze the underlying causes that make it inappropriate to apply the CPT Coding to CHM practices.
References: [1]. Xu B. Mathematical Herbal Medicine. ACMA Publication Issue May 2, 2005. [2]. Xu B, Molony D, Yuan C.S. Handbook of Chinese Medicine. The Haworth Medical Press. New York. To be published.
Differences Between the CPT Coding and the ACMA Coding Chinese Herbal Medicine (CHM) is completely different from Western Medicine (WM), which makes their coding properties very different. Western Medicine and Chinese Herbal Medicine are similar to two different languages (e.g. English vs. Chinese). CPT Coding and ACMA Coding are similar to the English grammar and Chinese grammar. Using CPT coding for CHM is similar to using English grammar for Chinese language. It would be invalid. The Chinese language need to use the Chinese grammar -- ACMA Coding. For more information on the comparison and differences between CPT Coding and ACMA Coding, please go to ACMA Coding vs. CPT Coding, ACMA Publication March 30, 2006
Above differences between CHM and WM have raised another issue, coding operability, for the insurance industry. Due to the fundamental and complicated differences between CHM and WM, it would be very impractical and time-consuming for insurance companies to follow the CPT Coding in covering CHM treatments in the process of insurance coverage. If the CPT Coding were used for CHM practices, insurance companies would find it very hard to process the CPT codes in its daily operation. Therefore, from the insurance operation viewpoint, the CPT codes cannot be used for the professional practice of CHM by CMD. CHM coding needs to follow Chinese Herbal Medicine's own characteristics.
The ACMA Coding is the first coding system specifically designed for the professional practice of Chinese Herbal Medicine (CHM) by Chinese Medicine Doctors (CMD). The precursor of the ACMA Coding was the coding system developed and used for the professional practice of Chinese Herbal Medicine (CHM) by Chinese Medicine Doctor (CMD) at the American Chinese Medicine Association (ACMA) and the Center for Holistic and Herbal Therapy (CHHT). After five years use and test, it has been proved that this coding system is able to take into consideration of the unique characteristics that CHM has, and can be applied successfully to cover the professional practice of CHM by CMD. Based on above coding used at ACMA and CHHT, the ACMA Coding was developed and established in response to the insurance industry's requests and needs. ACMA Coding (1) It has taken into consideration of the unique characteristics that CHM has; (2) It has resolved the technical difficulties and avoided the dilemma in applying the CPT Coding to CHM; (3) It is practical and applicable for insurance industry to cover the professional practice of CHM by CMD; (4) It is convenient in operation for CMD to follow; (5) It is convenient in operation for insurance companies to process.
You will find more information on the ACMA Coding in this section and the Fees section.
Application of the ACMA Coding ACMA Coding is designed for the professional practice of Chinese Herbal Medicine (CHM) by Chinese Medicine Doctors (CMD). Explanation on CHM, TCM, and CM: In the early stage of English translations of Chinese Medicine, the terms TCM (stands for Traditional Chinese Medicine), CM (stands for Chinese Medicine), and CHM were mixed together. Both TCM and CM were used to refer to CHM. However, these terms are not exactly the same. The distinctions and differences between these terms need to be clarified [1]. (a) TCM and CM are general terms for Chinese Medicine. Rigorously speaking, they include CHM, acupuncture, moxibustion, tui na, an mo, zheng gu, cupping, qi gong, tai ji, gua sha, etc all branches of Chinese Medicine [2]. (b) There are some differences between TCM and CM. TCM emphasizes more on the traditional part of Chinese Medicine, while CM covers both traditional and contemporary Chinese Medicine. (c) CHM is the major branch of Chinese Medicine [2]. Because CHM is the major component of Chinese Medicine, the public and patients usually use CM and TCM to refer CHM in China. Some English translations and publications also use TCM or CM to refer to CHM. (d) ACMA Coding is designed for CHM mainly. It is not designed for other branches of Chinese Medicine. Therefore, the terms CM or TCM are too broad to be applicable here. Therefore, for accuracy purpose, the term CHM should be used in the ACMA Coding.
References [1] Xu B, Molony D, Yuan C.S. Handbook of Chinese Medicine. The Haworth Medical Press. New York. To be published. [2] Xu, B. About Chinese Medicine. ACMA Publication Issue Oct 2001. [3] Xu, B. About Doctor of Chinese Medicine (CMD) Education. ACMA Publication Issue Aug 1, 2004.
If you have questions, suggestions, or comments on the ACMA Coding, please direct your feedbacks to info@americanchinesemedicineassociation.org
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