Integrative Care  “May” to “shall” 2011 revision of CPT a breakthrough for time intensive, health focused, integrative practicesA change in Current Procedural Technology (CPT) codes may be excellent news for integrative practices according to a recent article in the December


“May” to “shall”: 2011 revision of CPT a breakthrough for time-intensive, health-focused, integrative practices

A change in Current Procedural Technology (CPT) codes may be excellent news for integrative practices according to a recent article in the December eNews of the American Association of Naturopathic Physicians (AANP). The article by Bruce Milliman, ND and Eva Miller, ND states:  

“Effective January 1, 2011, the CPT manual has been revised to state that: ‘When counseling and/or coordination of care dominates (more than 50%) of the physician/patient and/or family encounter, then time shall be considered the key or controlling factor to qualify for a particular level of E/M services. The extent of counseling and/or coordination of care must be documented in the medical record.'”  

Milliman serves the AANP on the Health Care Professionals Advisory Committee (HCPAC) for the CPT. He and Miller go on to state the following: 

“Until 2011, the bolded and italicized “shall” was “may.” This change is of paramount importance to the naturopathic community because time spent with patients in counseling and/or coordination of care is that for which the profession has wanted to get reimbursed. This recognition of time throughout the healthcare system is a remarkable and important change! This change moves the United States towards a healthcare system which invests in wellness and health promotion. This one word change supports naturopathic physicians and other providers who “treat disease by restoring health” (AANP Definition of Naturopathic Medicine Position Paper 1989). 

Comment: If one could put a paradigm shift in a nut-shell, this just might be the holder. The plaintive cry in human life that change takes time appears to finally be reflected in the payment. Time is what it takes to work with patients toward better esteem, to movement up the gradients of readiness to action, to habit change and health. Some evidence of the many positive effects of time well used (defining that is another issue) in whole practice care is here. Coverage of time-well-used can help bring clinical care more deeply into primary prevention and thus into focus as a clinical foundation of a forward-thinking National Prevention Strategy (see Policy, below). Milliman, a long-time member of AMA’s HCPAC, has been like water over stone at the HCPAC-CPT meetings on this issue. Others have supported this direction; Milliman, the son of the founder of the ground-breaking, influential Milliman & Robertson actuarial firm, has been the through line in getting this done. The change is a tremendous accomplishment for the integrative practice community and for the actual movement toward a system that might begin to focus on wellness and health. Now, let’s see how it plays out in the interpretation by insurers.  

Acupuncturists at University of Colorado hospital granted privileges in embryo transfer unit
Acupuncturists have been granted privileges to the embryo transfer (IVF) suite in the operating room of the University of Colorado Hospital, according to a notice from Ben Meyerhoff with the Center for Integrative Medicine at the University of Colorado Hospital. “We are now coordinating on-call [Traditional Chinese Medicine] care with the Endocrinologists of Advanced Reproductive Medicine and on the date of embryo transfer we are performing acupuncture before and after that procedure to increase the embryo’s chances to become a baby.” 

Comment: Step by step, better care options. This time the progress is, happily, baby steps. 


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