[openhealth] Re: list of diagnoses and procedures

[Alex Caldwell]

--- In openhealth@yahoogroups.com, "Fred Trotter" <[EMAIL PROTECTED]>
wrote:
>
> >   A "derivative work" includes some portion
> > of the original verbatim and that should be avoided.
> >
> >
> In order to work for billing the codes themselves would have to be
carried
> over from the CPT system. Thus making any attempt to "re-describe"
CPT codes
> a derivative work and largely useless.
> 
> -FT
> 

The real problem is integrating the needed coding seemlesly into the
user of the EMR's workflow so that they can see the patient, do the
documentation from a medical standpoint, but also generate and submit
 the required reimbursement claim at the same time, preferably right
at the point of service.  Unfortunately the world wide Tower of Babel
of incompatable reimbursement systems and jurisdictions over them will
probably limit us to doing this on only a local level.

Re: [openhealth] Re: list of diagnoses and procedures

[Fred Trotter]

>   A "derivative work" includes some portion
> of the original verbatim and that should be avoided.
>
>
In order to work for billing the codes themselves would have to be carried
over from the CPT system. Thus making any attempt to "re-describe" CPT codes
a derivative work and largely useless.

-FT


-- 
Fred Trotter
http://www.fredtrotter.com


[Non-text portions of this message have been removed]

[openhealth] Re: list of diagnoses and procedures

[mspohr]

The copyright covers "expressions of ideas", not the ideas themselves.
 You can certainly reference the original "idea" (description) and
create a new "expression".  A "derivative work" includes some portion
of the original verbatim and that should be avoided.

The idea of the patient not being able to access billing information
(the description) without purchase of the codes is an interesting
ramification of the current odd situation.  I seem to recall that
there was a person who did set up a web site with the CPT codes so
that patients could access their billing information.  He was sued by
the AMA and the web site was closed.  I don't know if this was
litigated fully or he just ran out of money.

However, I think Tim Cook's suggestion that we devote our energy to
some more important standards issue or open source project is a good
one that we should consider.

Regardless of the "fairness" or legality of the current situation with
CPT codes, there are bigger fish to fry.  The AMA has been very
aggressive in defending all of the real and perceived IP rights to CPT
and this is a battle that we really don't want to start.

/Mark


--- In openhealth@yahoogroups.com, 80n <[EMAIL PROTECTED]> wrote:
>
> Is it doable to create new descriptions from just the codes.  Unless the
> meaning of each code is common knowledge then you have to make
recourse to
> the original description, which makes your description a derived
work at the
> very least.
> 
> Is there any clean-room way of arriving at a description that could
not be
> construed to have been derived from the AMA's original description?
> 
> Presumably the patient has the right to see the actual codes that
are used
> on his medical record.  He also has knowledge (one would hope) of the
> procedures performed.  But he has not seen the CPT list, and so can
create a
> workable description that is not tainted by any copyrightable link
to the
> original codes, nor by any other contractual relationship with the AMA.
> 
> 80n
> 
> 
> 
> On 12/12/06, Karsten Hilbert <[EMAIL PROTECTED]> wrote:
> >
> >   On Mon, Dec 11, 2006 at 10:54:32PM -0800, Rod Roark wrote:
> >
> > > Even absent the political ramifications, the resulting new system
> > > will have useful applications. A billing service accepting the new
> > > codes would still need CPT licensing,
> > You guys need to keep straight what you are talking about.
> > At least it gets me confused.
> >
> > One side suggests "writing new *descriptions*" for the
> > *existing* CPT codes. In that case *there are no new
> > codes* which would need any sort of acceptance by a billing
> > service or even CPT licensing.
> >
> > The other party speaks about creating a whole different set
> > of codes alltogether and trying to bring them into use for
> > billing.
> >
> > Adrian Midgley proposes, as usual, the pragmatic solution:
> >
> > First, create new descriptions for the existing CPT codes
> > and introduce those into use. This ought to be doable
> > without interference by anyone. After all, the government
> > cannot force me to use the AMA's descriptions. I can work
> > with the codes alone (without *any* descriptions) if I so want
> > - which is for all practical purposes exactly the same thing
> > as working with alternate descriptions because the payor
> > will never see those.
> >
> > Second, expand upon that established user base to introduce
> > more codes for more purposes.
> >
> > I agree the first part seems doable. I am dubious about the
> > second.
> >
> > Karsten
> > --
> > GPG key ID E4071346 @ wwwkeys.pgp.net
> > E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
> >  
> >
> 
> 
> [Non-text portions of this message have been removed]
>

[openhealth] Re: list of diagnoses and procedures

[Dr. Irving Buchbinder]

Reply to the length of copyright proposed by John Bergman



 Re: list of diagnoses and procedures

Posted
by: "John H. bergman" [EMAIL PROTECTED]
<[EMAIL PROTECTED]>
 jhbergman2002
  Mon Dec 11, 2006 8:17 pm (PST) At
what point does some, or all of the copyrighted material become
public domain? Patents have a life span of what? 10 years... copyrights
also have a lifespan...

The argument that we could 'wait out the copyright' won't work. The
recording and movie industry have maneuvered copyright so that in the United
States copyright is from date of publication + 70 (soon to be 100) years. It
essentially keeps Micky Mouse from running out of copyright status.

Many free projects have railed against this, including the Gutenberg
project, with good data showing that much is lost when the non-moneymaker
books and recordings stay copyrighted forever (or the copyright holder is
lost to memory), or the rights are transferred to some large corporation in
a buyout but that is lost in corporate transfers.

Alas, we here in the US will have to work with this system, and we will
continue to pay to get paid.  The suggestion that we could use an alternate
system and gain traction thereby won't fly here. Physicians already have an
uphill fight with coding and reimbursement without trying to bottom-up
impose a new system. Many of us here in the US remember the 70's when there
were as many as 10 different, non overlapping coding systems, where some
insurance companies (notably Blue Cross Blue Shield) had different coding
systems for different payment levels and schemes.

The inclusion of a single system for billing (and payment) has decreased the
burden on physician offices to learn coding systems. Because many HMO/group
insurers and others see membership in their organizations as 'optional',
outliers trying to impose new codings on them would quickly be marginalized,
and left out of the system (and the payments).

There are physicians in the US who do not accept insurance. Medicare (CMS)
saw that 'out' coming and mandated participation in the program with some
pretty onerous manipulations to -opt out-. The fines are stiff for
overbilling and overcharging Medicare recipients based on CMS formulas.
Compliance is fairly high since accidental overbillings and misbillings are
considered to be Fraud and Abuse and heavily punished. Use of the CPT codes
and adherence to their internal structure (billing partitions) has been
stringent as well.

One can use CPT codes without license if one wishes. There are certain
percentages of code which can be used without paying fees to the AMA. The
impracticality of this is that CPT is updated. If you don't get the updates,
you don't get paid. Redistribution cannot be done without a release from the
AMA (again for certain portions of codebase those are waived).

I hope this helps. I think even in the FOSS world there is general
understanding that some components will be proprietary, owned by someone who
wants to profit by his/her/corporate venture.

-- 
-- 
Irving J. Buchbinder, DPM, DABPS
  Director, FreeMED Software Foundation, INC
  -=Technology advances. People stay the same=-
   Leigh Rubin


[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[Karsten Hilbert]

On Tue, Dec 12, 2006 at 10:24:52AM +, 80n wrote:

> Is it doable to create new descriptions from just the codes.  Unless the
> meaning of each code is common knowledge then you have to make recourse to
> the original description, which makes your description a derived work at the
> very least.
Ah, I missed that point. That might be a bit of a problem, indeed.

> Is there any clean-room way of arriving at a description that could not be
> construed to have been derived from the AMA's original description?
On driver re-engineering this is sometimes done by two teams
of people: one team knowing the original driver and
describing how the *peripheral* (not the driver) works based
on what can be derived from the original driver. The second
team implements (clean-rooms) a new driver based on the
description of how the peripheral works given by the first
team.

So, the first team could tell the second *in their own
terms* (based on their knowledge) what the CPT codes *mean*.
The second team could come up with a label for that code
based on the description given by the first team.

This might work. And it could indeed include the patient, too.

Karsten
-- 
GPG key ID E4071346 @ wwwkeys.pgp.net
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

Re: [openhealth] Re: list of diagnoses and procedures

[Tim Cook]

All,

It is interesting how much energy this conversation is getting.

Now, I must admit that I am not pleased with any government granted 
monopoly.

There are certain rights (and I am not a lawyer) granted under the 
referenced FARS/DFARS for end-users.  You need to check those for 
yourself or collectively.

In the big scheme of things though is it really worth it to pursue 
this?  You can purchase the CPT's from the AMA for under $100 and as a 
vendor (as I recall) it only added about $10 to the EMR (both annual 
assessments). This is not out of line with the amount of work required 
to maintain and coordinate the distribution of a basic vocabulary on 
this scale.

IMHO - if you have (mental/physical) cycles to spare then jump into 
one of the EMR projects, openEHR standards validation or even the 
drugref project. Your energies will be multiplied greatly.

Thanks for your time.


Tim



[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[80n]

Is it doable to create new descriptions from just the codes.  Unless the
meaning of each code is common knowledge then you have to make recourse to
the original description, which makes your description a derived work at the
very least.

Is there any clean-room way of arriving at a description that could not be
construed to have been derived from the AMA's original description?

Presumably the patient has the right to see the actual codes that are used
on his medical record.  He also has knowledge (one would hope) of the
procedures performed.  But he has not seen the CPT list, and so can create a
workable description that is not tainted by any copyrightable link to the
original codes, nor by any other contractual relationship with the AMA.

80n



On 12/12/06, Karsten Hilbert <[EMAIL PROTECTED]> wrote:
>
>   On Mon, Dec 11, 2006 at 10:54:32PM -0800, Rod Roark wrote:
>
> > Even absent the political ramifications, the resulting new system
> > will have useful applications. A billing service accepting the new
> > codes would still need CPT licensing,
> You guys need to keep straight what you are talking about.
> At least it gets me confused.
>
> One side suggests "writing new *descriptions*" for the
> *existing* CPT codes. In that case *there are no new
> codes* which would need any sort of acceptance by a billing
> service or even CPT licensing.
>
> The other party speaks about creating a whole different set
> of codes alltogether and trying to bring them into use for
> billing.
>
> Adrian Midgley proposes, as usual, the pragmatic solution:
>
> First, create new descriptions for the existing CPT codes
> and introduce those into use. This ought to be doable
> without interference by anyone. After all, the government
> cannot force me to use the AMA's descriptions. I can work
> with the codes alone (without *any* descriptions) if I so want
> - which is for all practical purposes exactly the same thing
> as working with alternate descriptions because the payor
> will never see those.
>
> Second, expand upon that established user base to introduce
> more codes for more purposes.
>
> I agree the first part seems doable. I am dubious about the
> second.
>
> Karsten
> --
> GPG key ID E4071346 @ wwwkeys.pgp.net
> E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
>  
>


[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[Karsten Hilbert]

On Mon, Dec 11, 2006 at 10:54:32PM -0800, Rod Roark wrote:

> Even absent the political ramifications, the resulting new system
> will have useful applications.  A billing service accepting the new
> codes would still need CPT licensing,
You guys need to keep straight what you are talking about.
At least it gets me confused.

One side suggests "writing new *descriptions*" for the
*existing* CPT codes. In that case *there are no new
codes* which would need any sort of acceptance by a billing
service or even CPT licensing.

The other party speaks about creating a whole different set
of codes alltogether and trying to bring them into use for
billing.

Adrian Midgley proposes, as usual, the pragmatic solution:

First, create new descriptions for the existing CPT codes
and introduce those into use. This ought to be doable
without interference by anyone. After all, the government
cannot force me to use the AMA's descriptions. I can work
with the codes alone (without *any* descriptions) if I so want
- which is for all practical purposes exactly the same thing
as working with alternate descriptions because the payor
will never see those.

Second, expand upon that established user base to introduce
more codes for more purposes.

I agree the first part seems doable. I am dubious about the
second.

Karsten
-- 
GPG key ID E4071346 @ wwwkeys.pgp.net
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

Re: [openhealth] Re: list of diagnoses and procedures

[Rod Roark]

A lot depends on the desired goal.

If you take the point of view that the government's allowing the AMA
to rake in undeserved millions via this monopoly is just plain wrong,
and you want to do something about it, then creating a community
project to define different but compatible codes and descriptions is
surely bound to shine a spotlight on the issue and lead to some
changes.  By applying the previously-mentioned KISS principle, doing
this should be relatively easy.

Even absent the political ramifications, the resulting new system
will have useful applications.  A billing service accepting the new
codes would still need CPT licensing, but individual practitioners
subscribing to such a service would not.  It doesn't take much thought
to see how this might play out.

Rod
www.sunsetsystems.com

On Monday 11 December 2006 11:56, David Forslund wrote:
> I agree. I don't think you would have to declare them something
> other than CPT codes even if they had the same number.  With
> a different description, they couldn't be certified as the same and
> wouldn't come under the legal agreement of CMS (HCFA). 
> I think it would be nice to have alternative to CPT, but this would
> require more than coming up with code descriptions.  It would require
> calling it something else and entering into agreements with CMS and
> other organizations including states.  This is not a free exercise.
> 
> Dave
> Fred Trotter wrote:
> >
> > I dont think so. From what I understood the codes themselves are 
> > copyright.
> > Further, thier use is mandated by the government for use in medical 
> > billing.
> > This issue has already been the subject of litigation.
> >
> > http://www.usdoj.gov/atr/cases/f2000/2076.htm 
> > 
> >
> > -FT
> >
> > On 12/11/06, mspohr <[EMAIL PROTECTED] > wrote:
> > >
> > > The codes would be the same as those that they currently accept (i.e.
> > > the AMA CPT codes) so there is no issue with the codes.
> > > The problem with the AMA is that they copyright the descriptions and
> > > prevent distribution of their copyrighted descriptions.
> > > The project would be to create new descriptions that were functionally
> > > the same and could be freely distributed under an open license such as
> > > the Creative Commons license (http://creativecommons.org/ 
> > ).
> > >
> > > /Mark
> > >
> > >
> > >
> > > --- In openhealth@yahoogroups.com 
> > , David Forslund <[EMAIL PROTECTED]> 
> > wrote:
> > > >
> > > > This effort would require commitment from the payor that they
> > > > would accept those codes for reimbursement. Otherwise this
> > > > effort will be relatively useless.
> > > >
> > > > Dave
> > > > mspohr wrote:
> > > > >
> > > > > The goal of the CPT code project would be to create a version of
> > > > > procedure codes for use in billing in the US that could be freely
> > > > > distributed.
> > > > > While it would be nice to fit this into an overarching ontology, 
> > this
> > > > > would introduce overhead which is not warranted. The CPT codes
> > > > > themselves are a dead end (except for billing in the US) from both
> > > > > intellectual property and information design standpoints and the 
> > task
> > > > > of an ontology of procedures is better left to something more 
> > suitable
> > > > > such as Snomed or ICD or even the HCPCS.
> > > > >
> > > > > I think KISS applies here.
> > > > >
> > > > > /Mark
> > > > >
> > > > > --- In openhealth@yahoogroups.com 
> > 
> > > > > , Adrian Midgley 
> > > > > wrote:
> > > > > >
> > > > > > Rod Roark wrote:
> > > > > > >
> > > > > > >
> > > > > > > Perhaps I don't understand what you mean, but CPT codes are
> > > just for
> > > > > > > procedures. The project I was suggesting was limited to
> > > restating the
> > > > > > > descriptions for them, with about the same standards for
> > > preciseness
> > > > > > > currently found in CPT. A broader scope would be very daunting.
> > > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > > But if we are going to do (an) ontology, let us not handicap
> > > ourselves
> > > > > > by building it for just one lot of data. It could be written one
> > > > > > chapter at a time, certainly.

Re: [openhealth] Re: list of diagnoses and procedures

[Adrian Midgley]

Fred Trotter wrote:
>
> It is easy at first glance to think that way. Consider the other side
> of the
> equation. The AMA worked for a long time to create accurate procedure and
> diagonsis codes. The goverment choose the AMAs coding scheme for
> reimbursement. But the government cannot simply take a private companies
> copyright and make it public domain;
>







Thus, in order to end up with a system whcih is Libre, first write a new
system.

RE: [openhealth] Re: list of diagnoses and procedures

[John H. bergman]

At what point does some, or all of the copyrighted material become
public domain?  Patents have a life span of what? 10 years... copyrights
also have a lifespan... 

 



From: openhealth@yahoogroups.com [mailto:[EMAIL PROTECTED] On
Behalf Of Fred Trotter
Sent: Monday, December 11, 2006 8:20 PM
To: openhealth@yahoogroups.com
Subject: Re: [openhealth] Re: list of diagnoses and procedures

 

It is easy at first glance to think that way. Consider the other side of
the
equation. The AMA worked for a long time to create accurate procedure
and
diagonsis codes. The goverment choose the AMAs coding scheme for
reimbursement. But the government cannot simply take a private companies
copyright and make it public domain; the AMA owns the copyright. The
court
held that as long as the license fees were not onerous there was nothing
that could be done. As a result we have this "elvish" situation.

This is actually one unique subset on the problem of "owning ideas".
Software Patents and proprietary software are other examples of this
problem.

Hopefully future work will have a more FOSS-compatible perspective.

-FT

Regards,
Fred Trotter

On 12/11/06, K.S. Bhaskar <[EMAIL PROTECTED]
<mailto:ks.bhaskar%40fnf.com> > wrote:
>
> I find this discussion of CPT codes & reimbursement interesting. Let
me
> paraphrase:
>
> "To petition your Government (for reimbursement), you need to submit
> your request in Elvish. Organization XYZ owns the Elvish language.
> Ergo, to communicate with your Government, you need to buy a license
> from XYZ to use Elvish."
>
> This seems quite an incredible state of affairs.
>
> -- Bhaskar
>
>
>
> Yahoo! Groups Links
>
>
>
>

-- 
Fred Trotter
http://www.fredtrotter.com <http://www.fredtrotter.com> 

[Non-text portions of this message have been removed]

 



[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[Fred Trotter]

It is easy at first glance to think that way. Consider the other side of the
equation. The AMA worked for a long time to create accurate procedure and
diagonsis codes. The goverment choose the AMAs coding scheme for
reimbursement. But the government cannot simply take a private companies
copyright and make it public domain; the AMA owns the copyright. The court
held that as long as the license fees were not onerous there was nothing
that could be done. As a result we have this "elvish" situation.

This is actually one unique subset on the problem of "owning ideas".
Software Patents and proprietary software are other examples of this
problem.

Hopefully future work will have a more FOSS-compatible perspective.

-FT

Regards,
Fred Trotter

On 12/11/06, K.S. Bhaskar <[EMAIL PROTECTED]> wrote:
>
> I find this discussion of CPT codes & reimbursement interesting.  Let me
> paraphrase:
>
> "To petition your Government (for reimbursement), you need to submit
> your request in Elvish.  Organization XYZ owns the Elvish language.
> Ergo, to communicate with your Government, you need to buy a license
> from XYZ to use Elvish."
>
> This seems quite an incredible state of affairs.
>
> -- Bhaskar
>
>
>
> Yahoo! Groups Links
>
>
>
>


-- 
Fred Trotter
http://www.fredtrotter.com


[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[Karsten Hilbert]

On Mon, Dec 11, 2006 at 02:16:32PM -0700, David Forslund wrote:

> I think the issue is bigger than that.  The AMA has a legal agreement
> with CMS/HCFA for reimbursement of CPT codes.  If the code isn't an
> "official" CPT code, then reimbursement would be denied by CMS,
> even if you weren't sued by the AMA.   If the descriptions didn't
> match the AMA's then they would easily claim it wasn't "official".

It seems I recall several people saying that the CMS/HCFA
*doesn't see* the descriptions? Because they *are not* on
the bill ? But rather the *code only*. Which, by all
accounts anyone could put there by hand off the top of their
head without owning any EMR at all.

Karsten
-- 
GPG key ID E4071346 @ wwwkeys.pgp.net
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

[openhealth] Re: list of diagnoses and procedures

[mspohr]

Since you only submit the number to CMS and not the description, you
would be submitting an "official" number.  The only issue would be if
you submitted the wrong number based on a description that was not
correct.
For instance, many people publish "instructions" and "clarifications"
for the use of CPT codes since the "official" AMA descriptions can be
ambiguous.  If you relied on a magazine article which had some
incorrect instructions or clarifications on when you could bill using
a certain number, then you could be denied reimbursement... but you
would be denied based on using the wrong billing code.

/Mark


--- In openhealth@yahoogroups.com, David Forslund <[EMAIL PROTECTED]> wrote:
>
> I think the issue is bigger than that.  The AMA has a legal agreement
> with CMS/HCFA for reimbursement of CPT codes.  If the code isn't an
> "official" CPT code, then reimbursement would be denied by CMS,
> even if you weren't sued by the AMA.   If the descriptions didn't
> match the AMA's then they would easily claim it wasn't "official".
> 
> Dave
> mspohr wrote:
> >
> > This decision addresses the question of whether the AMA's copyright
> > becomes invalid when the government mandates it for reimbursement. It
> > uses some tortured logic to say that the CPT is NOT a "system" (that
> > therefore would not be eligible for copyright) but rather an specific
> > expression that can be copyrighted.
> > Following this, it would seem that you could use the "system" (of
> > numbers) but with a different expression (descriptions) and not tread
> > on the AMA's copyright. Other cases (such as with telephone
> > directories) have reaffirmed that you cannot copyright the numbers
> > themselves.
> > However, the AMA would probably sue you anyway.
> >
> > /Mark
> >
> > --- In openhealth@yahoogroups.com 
> > , "Fred Trotter" 
> > wrote:
> > >
> > > I dont think so. From what I understood the codes themselves are
> > copyright.
> > > Further, thier use is mandated by the government for use in medical
> > billing.
> > > This issue has already been the subject of litigation.
> > >
> > > http://www.usdoj.gov/atr/cases/f2000/2076.htm 
> > 
> > >
> > > -FT
> > >
> > > On 12/11/06, mspohr  wrote:
> > > >
> > > > The codes would be the same as those that they currently
accept (i.e.
> > > > the AMA CPT codes) so there is no issue with the codes.
> > > > The problem with the AMA is that they copyright the
descriptions and
> > > > prevent distribution of their copyrighted descriptions.
> > > > The project would be to create new descriptions that were
functionally
> > > > the same and could be freely distributed under an open license
such as
> > > > the Creative Commons license (http://creativecommons.org/ 
> > ).
> > > >
> > > > /Mark
> > > >
> > > >
> > > >
> > > > --- In openhealth@yahoogroups.com 
> > , David Forslund 
wrote:
> > > > >
> > > > > This effort would require commitment from the payor that they
> > > > > would accept those codes for reimbursement. Otherwise this
> > > > > effort will be relatively useless.
> > > > >
> > > > > Dave
> > > > > mspohr wrote:
> > > > > >
> > > > > > The goal of the CPT code project would be to create a
version of
> > > > > > procedure codes for use in billing in the US that could be
freely
> > > > > > distributed.
> > > > > > While it would be nice to fit this into an overarching
> > ontology, this
> > > > > > would introduce overhead which is not warranted. The CPT codes
> > > > > > themselves are a dead end (except for billing in the US)
from both
> > > > > > intellectual property and information design standpoints and
> > the task
> > > > > > of an ontology of procedures is better left to something more
> > suitable
> > > > > > such as Snomed or ICD or even the HCPCS.
> > > > > >
> > > > > > I think KISS applies here.
> > > > > >
> > > > > > /Mark
> > > > > >
> > > > > > --- In openhealth@yahoogroups.com 
> > 
> > > > > > , Adrian Midgley

> > > > > > wrote:
> > > > > > >
> > > > > > > Rod Roark wrote:
> > > > > > > >
> > > > > > > >
> > > > > > > > Perhaps I don't understand what you mean, but CPT
codes are
> > > > just for
> > > > > > > > procedures. The project I was suggesting was limited to
> > > > restating the
> > > > > > > > descriptions for them, with about the same standards for
> > > > preciseness
> > > > > > > > currently found in CPT. A broader scope would be very
> > daunting.
> > > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > >
> > > > > > > But if we are going to do (an) ontology, let us not handicap
> > > > ourselves
> > > > > > > by building it for just one lot of data. It could be
written one
> > > > > > > chapter at a time, certainly.
> > > > > > >
> > > > > >
> > > > 

[openhealth] Re: list of diagnoses and procedures

[mspohr]

Yes, your paraphrase is correct and it is an absurd situation.  
In the US we have a strong tradition of supporting "free enterprise".
 Unfortunately, this has been corrupted to mean "government granted
monopolies to the private sector".  This is established through our
"free enterprise" election system (contribute to the politician of
your choice who will then pass the legislation you need to run your
business without undue interference from competitors).

This is only a small example of the problem.  A much larger example is
in the case of pharma which patents drug compounds which have been
discovered with government grants.

/Mark


--- In openhealth@yahoogroups.com, "K.S. Bhaskar" <[EMAIL PROTECTED]> wrote:
>
> I find this discussion of CPT codes & reimbursement interesting. 
Let me 
> paraphrase:
> 
> "To petition your Government (for reimbursement), you need to submit 
> your request in Elvish.  Organization XYZ owns the Elvish language. 
> Ergo, to communicate with your Government, you need to buy a license 
> from XYZ to use Elvish."
> 
> This seems quite an incredible state of affairs.
> 
> -- Bhaskar
>

Re: [openhealth] Re: list of diagnoses and procedures

[K.S. Bhaskar]

I find this discussion of CPT codes & reimbursement interesting.  Let me 
paraphrase:

"To petition your Government (for reimbursement), you need to submit 
your request in Elvish.  Organization XYZ owns the Elvish language. 
Ergo, to communicate with your Government, you need to buy a license 
from XYZ to use Elvish."

This seems quite an incredible state of affairs.

-- Bhaskar

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

I think the issue is bigger than that.  The AMA has a legal agreement
with CMS/HCFA for reimbursement of CPT codes.  If the code isn't an
"official" CPT code, then reimbursement would be denied by CMS,
even if you weren't sued by the AMA.   If the descriptions didn't
match the AMA's then they would easily claim it wasn't "official".

Dave
mspohr wrote:
>
> This decision addresses the question of whether the AMA's copyright
> becomes invalid when the government mandates it for reimbursement. It
> uses some tortured logic to say that the CPT is NOT a "system" (that
> therefore would not be eligible for copyright) but rather an specific
> expression that can be copyrighted.
> Following this, it would seem that you could use the "system" (of
> numbers) but with a different expression (descriptions) and not tread
> on the AMA's copyright. Other cases (such as with telephone
> directories) have reaffirmed that you cannot copyright the numbers
> themselves.
> However, the AMA would probably sue you anyway.
>
> /Mark
>
> --- In openhealth@yahoogroups.com 
> , "Fred Trotter" <[EMAIL PROTECTED]>
> wrote:
> >
> > I dont think so. From what I understood the codes themselves are
> copyright.
> > Further, thier use is mandated by the government for use in medical
> billing.
> > This issue has already been the subject of litigation.
> >
> > http://www.usdoj.gov/atr/cases/f2000/2076.htm 
> 
> >
> > -FT
> >
> > On 12/11/06, mspohr <[EMAIL PROTECTED]> wrote:
> > >
> > > The codes would be the same as those that they currently accept (i.e.
> > > the AMA CPT codes) so there is no issue with the codes.
> > > The problem with the AMA is that they copyright the descriptions and
> > > prevent distribution of their copyrighted descriptions.
> > > The project would be to create new descriptions that were functionally
> > > the same and could be freely distributed under an open license such as
> > > the Creative Commons license (http://creativecommons.org/ 
> ).
> > >
> > > /Mark
> > >
> > >
> > >
> > > --- In openhealth@yahoogroups.com 
> , David Forslund  wrote:
> > > >
> > > > This effort would require commitment from the payor that they
> > > > would accept those codes for reimbursement. Otherwise this
> > > > effort will be relatively useless.
> > > >
> > > > Dave
> > > > mspohr wrote:
> > > > >
> > > > > The goal of the CPT code project would be to create a version of
> > > > > procedure codes for use in billing in the US that could be freely
> > > > > distributed.
> > > > > While it would be nice to fit this into an overarching
> ontology, this
> > > > > would introduce overhead which is not warranted. The CPT codes
> > > > > themselves are a dead end (except for billing in the US) from both
> > > > > intellectual property and information design standpoints and
> the task
> > > > > of an ontology of procedures is better left to something more
> suitable
> > > > > such as Snomed or ICD or even the HCPCS.
> > > > >
> > > > > I think KISS applies here.
> > > > >
> > > > > /Mark
> > > > >
> > > > > --- In openhealth@yahoogroups.com 
> 
> > > > > , Adrian Midgley 
> > > > > wrote:
> > > > > >
> > > > > > Rod Roark wrote:
> > > > > > >
> > > > > > >
> > > > > > > Perhaps I don't understand what you mean, but CPT codes are
> > > just for
> > > > > > > procedures. The project I was suggesting was limited to
> > > restating the
> > > > > > > descriptions for them, with about the same standards for
> > > preciseness
> > > > > > > currently found in CPT. A broader scope would be very
> daunting.
> > > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > >
> > > > > > But if we are going to do (an) ontology, let us not handicap
> > > ourselves
> > > > > > by building it for just one lot of data. It could be written one
> > > > > > chapter at a time, certainly.
> > > > > >
> > > > >
> > > >
> > >
> > >
> > >
> > >
> > >
> > > Yahoo! Groups Links
> > >
> > >
> > >
> > >
> >
> >
> > --
> > Fred Trotter
> > http://www.fredtrotter.com 
> >
> >
> > [Non-text portions of this message have been removed]
> >
>

[openhealth] Re: list of diagnoses and procedures

[mspohr]

This decision addresses the question of whether the AMA's copyright
becomes invalid when the government mandates it for reimbursement.  It
uses some tortured logic to say that the CPT is NOT a "system" (that
therefore would not be eligible for copyright) but rather an specific
expression that can be copyrighted. 
Following this, it would seem that you could use the "system" (of
numbers) but with a different expression (descriptions) and not tread
on the AMA's copyright.  Other cases (such as with telephone
directories) have reaffirmed that you cannot copyright the numbers
themselves.  
However, the AMA would probably sue you anyway.

/Mark


--- In openhealth@yahoogroups.com, "Fred Trotter" <[EMAIL PROTECTED]>
wrote:
>
> I dont think so. From what I understood the codes themselves are
copyright.
> Further, thier use is mandated by the government for use in medical
billing.
> This issue has already been the subject of litigation.
> 
> http://www.usdoj.gov/atr/cases/f2000/2076.htm
> 
> -FT
> 
> On 12/11/06, mspohr <[EMAIL PROTECTED]> wrote:
> >
> > The codes would be the same as those that they currently accept (i.e.
> > the AMA CPT codes) so there is no issue with the codes.
> > The problem with the AMA is that they copyright the descriptions and
> > prevent distribution of their copyrighted descriptions.
> > The project would be to create new descriptions that were functionally
> > the same and could be freely distributed under an open license such as
> > the Creative Commons license (http://creativecommons.org/).
> >
> > /Mark
> >
> >
> >
> > --- In openhealth@yahoogroups.com, David Forslund  wrote:
> > >
> > > This effort would require commitment from the payor that they
> > > would accept those codes for reimbursement.  Otherwise this
> > > effort will be relatively useless.
> > >
> > > Dave
> > > mspohr wrote:
> > > >
> > > > The goal of the CPT code project would be to create a version of
> > > > procedure codes for use in billing in the US that could be freely
> > > > distributed.
> > > > While it would be nice to fit this into an overarching
ontology, this
> > > > would introduce overhead which is not warranted. The CPT codes
> > > > themselves are a dead end (except for billing in the US) from both
> > > > intellectual property and information design standpoints and
the task
> > > > of an ontology of procedures is better left to something more
suitable
> > > > such as Snomed or ICD or even the HCPCS.
> > > >
> > > > I think KISS applies here.
> > > >
> > > > /Mark
> > > >
> > > > --- In openhealth@yahoogroups.com
> > > > , Adrian Midgley 
> > > > wrote:
> > > > >
> > > > > Rod Roark wrote:
> > > > > >
> > > > > >
> > > > > > Perhaps I don't understand what you mean, but CPT codes are
> > just for
> > > > > > procedures. The project I was suggesting was limited to
> > restating the
> > > > > > descriptions for them, with about the same standards for
> > preciseness
> > > > > > currently found in CPT. A broader scope would be very
daunting.
> > > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > > But if we are going to do (an) ontology, let us not handicap
> > ourselves
> > > > > by building it for just one lot of data. It could be written one
> > > > > chapter at a time, certainly.
> > > > >
> > > >
> > >
> >
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
> 
> 
> -- 
> Fred Trotter
> http://www.fredtrotter.com
> 
> 
> [Non-text portions of this message have been removed]
>

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

I agree. I don't think you would have to declare them something
other than CPT codes even if they had the same number.  With
a different description, they couldn't be certified as the same and
wouldn't come under the legal agreement of CMS (HCFA). 
I think it would be nice to have alternative to CPT, but this would
require more than coming up with code descriptions.  It would require
calling it something else and entering into agreements with CMS and
other organizations including states.  This is not a free exercise.

Dave
Fred Trotter wrote:
>
> I dont think so. From what I understood the codes themselves are 
> copyright.
> Further, thier use is mandated by the government for use in medical 
> billing.
> This issue has already been the subject of litigation.
>
> http://www.usdoj.gov/atr/cases/f2000/2076.htm 
> 
>
> -FT
>
> On 12/11/06, mspohr <[EMAIL PROTECTED] > wrote:
> >
> > The codes would be the same as those that they currently accept (i.e.
> > the AMA CPT codes) so there is no issue with the codes.
> > The problem with the AMA is that they copyright the descriptions and
> > prevent distribution of their copyrighted descriptions.
> > The project would be to create new descriptions that were functionally
> > the same and could be freely distributed under an open license such as
> > the Creative Commons license (http://creativecommons.org/ 
> ).
> >
> > /Mark
> >
> >
> >
> > --- In openhealth@yahoogroups.com 
> , David Forslund <[EMAIL PROTECTED]> 
> wrote:
> > >
> > > This effort would require commitment from the payor that they
> > > would accept those codes for reimbursement. Otherwise this
> > > effort will be relatively useless.
> > >
> > > Dave
> > > mspohr wrote:
> > > >
> > > > The goal of the CPT code project would be to create a version of
> > > > procedure codes for use in billing in the US that could be freely
> > > > distributed.
> > > > While it would be nice to fit this into an overarching ontology, 
> this
> > > > would introduce overhead which is not warranted. The CPT codes
> > > > themselves are a dead end (except for billing in the US) from both
> > > > intellectual property and information design standpoints and the 
> task
> > > > of an ontology of procedures is better left to something more 
> suitable
> > > > such as Snomed or ICD or even the HCPCS.
> > > >
> > > > I think KISS applies here.
> > > >
> > > > /Mark
> > > >
> > > > --- In openhealth@yahoogroups.com 
> 
> > > > , Adrian Midgley 
> > > > wrote:
> > > > >
> > > > > Rod Roark wrote:
> > > > > >
> > > > > >
> > > > > > Perhaps I don't understand what you mean, but CPT codes are
> > just for
> > > > > > procedures. The project I was suggesting was limited to
> > restating the
> > > > > > descriptions for them, with about the same standards for
> > preciseness
> > > > > > currently found in CPT. A broader scope would be very daunting.
> > > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > > But if we are going to do (an) ontology, let us not handicap
> > ourselves
> > > > > by building it for just one lot of data. It could be written one
> > > > > chapter at a time, certainly.
> > > > >
> > > >
> > >
> >
> >
> >
> >
> >
> > Yahoo! Groups Links
> >
> >
> >
> >
>
> -- 
> Fred Trotter
> http://www.fredtrotter.com 
>
> [Non-text portions of this message have been removed]
>
> _

Re: [openhealth] Re: list of diagnoses and procedures

[Fred Trotter]

I dont think so. From what I understood the codes themselves are copyright.
Further, thier use is mandated by the government for use in medical billing.
This issue has already been the subject of litigation.

http://www.usdoj.gov/atr/cases/f2000/2076.htm

-FT

On 12/11/06, mspohr <[EMAIL PROTECTED]> wrote:
>
> The codes would be the same as those that they currently accept (i.e.
> the AMA CPT codes) so there is no issue with the codes.
> The problem with the AMA is that they copyright the descriptions and
> prevent distribution of their copyrighted descriptions.
> The project would be to create new descriptions that were functionally
> the same and could be freely distributed under an open license such as
> the Creative Commons license (http://creativecommons.org/).
>
> /Mark
>
>
>
> --- In openhealth@yahoogroups.com, David Forslund <[EMAIL PROTECTED]> wrote:
> >
> > This effort would require commitment from the payor that they
> > would accept those codes for reimbursement.  Otherwise this
> > effort will be relatively useless.
> >
> > Dave
> > mspohr wrote:
> > >
> > > The goal of the CPT code project would be to create a version of
> > > procedure codes for use in billing in the US that could be freely
> > > distributed.
> > > While it would be nice to fit this into an overarching ontology, this
> > > would introduce overhead which is not warranted. The CPT codes
> > > themselves are a dead end (except for billing in the US) from both
> > > intellectual property and information design standpoints and the task
> > > of an ontology of procedures is better left to something more suitable
> > > such as Snomed or ICD or even the HCPCS.
> > >
> > > I think KISS applies here.
> > >
> > > /Mark
> > >
> > > --- In openhealth@yahoogroups.com
> > > , Adrian Midgley 
> > > wrote:
> > > >
> > > > Rod Roark wrote:
> > > > >
> > > > >
> > > > > Perhaps I don't understand what you mean, but CPT codes are
> just for
> > > > > procedures. The project I was suggesting was limited to
> restating the
> > > > > descriptions for them, with about the same standards for
> preciseness
> > > > > currently found in CPT. A broader scope would be very daunting.
> > > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > But if we are going to do (an) ontology, let us not handicap
> ourselves
> > > > by building it for just one lot of data. It could be written one
> > > > chapter at a time, certainly.
> > > >
> > >
> >
>
>
>
>
>
> Yahoo! Groups Links
>
>
>
>


-- 
Fred Trotter
http://www.fredtrotter.com


[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

So could one use the CPT number for reimbursement without some
certification that they are the same as the "real" CPT codes?

Dave
mspohr wrote:
>
> The codes would be the same as those that they currently accept (i.e.
> the AMA CPT codes) so there is no issue with the codes.
> The problem with the AMA is that they copyright the descriptions and
> prevent distribution of their copyrighted descriptions.
> The project would be to create new descriptions that were functionally
> the same and could be freely distributed under an open license such as
> the Creative Commons license (http://creativecommons.org/ 
> ).
>
> /Mark
>
> --- In openhealth@yahoogroups.com 
> , David Forslund <[EMAIL PROTECTED]> 
> wrote:
> >
> > This effort would require commitment from the payor that they
> > would accept those codes for reimbursement. Otherwise this
> > effort will be relatively useless.
> >
> > Dave
> > mspohr wrote:
> > >
> > > The goal of the CPT code project would be to create a version of
> > > procedure codes for use in billing in the US that could be freely
> > > distributed.
> > > While it would be nice to fit this into an overarching ontology, this
> > > would introduce overhead which is not warranted. The CPT codes
> > > themselves are a dead end (except for billing in the US) from both
> > > intellectual property and information design standpoints and the task
> > > of an ontology of procedures is better left to something more suitable
> > > such as Snomed or ICD or even the HCPCS.
> > >
> > > I think KISS applies here.
> > >
> > > /Mark
> > >
> > > --- In openhealth@yahoogroups.com 
> 
> > > , Adrian Midgley 
> > > wrote:
> > > >
> > > > Rod Roark wrote:
> > > > >
> > > > >
> > > > > Perhaps I don't understand what you mean, but CPT codes are
> just for
> > > > > procedures. The project I was suggesting was limited to
> restating the
> > > > > descriptions for them, with about the same standards for
> preciseness
> > > > > currently found in CPT. A broader scope would be very daunting.
> > > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > But if we are going to do (an) ontology, let us not handicap
> ourselves
> > > > by building it for just one lot of data. It could be written one
> > > > chapter at a time, certainly.
> > > >
> > >
> >
>
> _

[openhealth] Re: list of diagnoses and procedures

[mspohr]

The codes would be the same as those that they currently accept (i.e.
the AMA CPT codes) so there is no issue with the codes.
The problem with the AMA is that they copyright the descriptions and
prevent distribution of their copyrighted descriptions.  
The project would be to create new descriptions that were functionally
the same and could be freely distributed under an open license such as
the Creative Commons license (http://creativecommons.org/).

/Mark



--- In openhealth@yahoogroups.com, David Forslund <[EMAIL PROTECTED]> wrote:
>
> This effort would require commitment from the payor that they
> would accept those codes for reimbursement.  Otherwise this
> effort will be relatively useless.
> 
> Dave
> mspohr wrote:
> >
> > The goal of the CPT code project would be to create a version of
> > procedure codes for use in billing in the US that could be freely
> > distributed.
> > While it would be nice to fit this into an overarching ontology, this
> > would introduce overhead which is not warranted. The CPT codes
> > themselves are a dead end (except for billing in the US) from both
> > intellectual property and information design standpoints and the task
> > of an ontology of procedures is better left to something more suitable
> > such as Snomed or ICD or even the HCPCS.
> >
> > I think KISS applies here.
> >
> > /Mark
> >
> > --- In openhealth@yahoogroups.com 
> > , Adrian Midgley  
> > wrote:
> > >
> > > Rod Roark wrote:
> > > >
> > > >
> > > > Perhaps I don't understand what you mean, but CPT codes are
just for
> > > > procedures. The project I was suggesting was limited to
restating the
> > > > descriptions for them, with about the same standards for
preciseness
> > > > currently found in CPT. A broader scope would be very daunting.
> > > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > But if we are going to do (an) ontology, let us not handicap
ourselves
> > > by building it for just one lot of data. It could be written one
> > > chapter at a time, certainly.
> > >
> >
>

Re: [openhealth] Re: list of diagnoses and procedures

[David Forslund]

This effort would require commitment from the payor that they
would accept those codes for reimbursement.  Otherwise this
effort will be relatively useless.

Dave
mspohr wrote:
>
> The goal of the CPT code project would be to create a version of
> procedure codes for use in billing in the US that could be freely
> distributed.
> While it would be nice to fit this into an overarching ontology, this
> would introduce overhead which is not warranted. The CPT codes
> themselves are a dead end (except for billing in the US) from both
> intellectual property and information design standpoints and the task
> of an ontology of procedures is better left to something more suitable
> such as Snomed or ICD or even the HCPCS.
>
> I think KISS applies here.
>
> /Mark
>
> --- In openhealth@yahoogroups.com 
> , Adrian Midgley <[EMAIL PROTECTED]> 
> wrote:
> >
> > Rod Roark wrote:
> > >
> > >
> > > Perhaps I don't understand what you mean, but CPT codes are just for
> > > procedures. The project I was suggesting was limited to restating the
> > > descriptions for them, with about the same standards for preciseness
> > > currently found in CPT. A broader scope would be very daunting.
> > >
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > But if we are going to do (an) ontology, let us not handicap ourselves
> > by building it for just one lot of data. It could be written one
> > chapter at a time, certainly.
> >
>

[openhealth] Re: list of diagnoses and procedures

[mspohr]

The goal of the CPT code project would be to create a version of
procedure codes for use in billing in the US that could be freely
distributed.
While it would be nice to fit this into an overarching ontology, this
would introduce overhead which is not warranted.  The CPT codes
themselves are a dead end (except for billing in the US) from both
intellectual property and information design standpoints and the task
of an ontology of procedures is better left to something more suitable
such as Snomed or ICD or even the HCPCS.

I think KISS applies here.

/Mark


--- In openhealth@yahoogroups.com, Adrian Midgley <[EMAIL PROTECTED]> wrote:
>
> Rod Roark wrote:
> >
> >
> > Perhaps I don't understand what you mean, but CPT codes are just for
> > procedures. The project I was suggesting was limited to restating the
> > descriptions for them, with about the same standards for preciseness
> > currently found in CPT. A broader scope would be very daunting.
> >
> 
> 
> 
> 
> 
> 
> 
> 
> 
> But if we are going to do (an) ontology, let us not handicap ourselves
> by building it for just one lot of data.  It could be written one
> chapter at a time, certainly.
>

[openhealth] Re: list of diagnoses and procedures

[Alex Caldwell]

I can confirm this from doing my own billing in my practice. Only the
code numbers are used. The descriptions are not included, neither on
the printed CMS 1500 claim forms, nor the electronic ANSI X12 837 format.

Alex Caldwell

--- In openhealth@yahoogroups.com, Rod Roark <[EMAIL PROTECTED]> wrote:
>
> Payers will always invent excuses to reject claims.  However in my
> experience the CPT description is not submitted as part of a claim.
> 
> Rod
> www.sunsetsystems.com
> 
> On Saturday 09 December 2006 14:53, Peter Holt Hoffman wrote:
> > I have a question about this though: don't at least some payers 
> > reject claims where the description is not 100% identical to what the 
> > AMA publishes?
> > 
> > -- Peter.
> > 
> > 
> > --- In openhealth@yahoogroups.com, Rod Roark  wrote:
> > >
> > > I think, then, a good web-based community project would be the
> > > creation of a whole new set of codes and descriptions.  However the
> > > codes would happen to map one-to-one with the CPT codes, and the
> > > mapping would be created/shared only among those with CPT licenses.
> > > 
> > > Publications that reference CPT codes could be trivially changed to
> > > reference the new codes, and individual practitioners would have no
> > > need or use for the mapping table or anything else containing CPT
> > > codes.
> > > 
> > > Rod
> > > www.sunsetsystems.com
>

Re: [openhealth] Re: list of diagnoses and procedures

[Rod Roark]

Payers will always invent excuses to reject claims.  However in my
experience the CPT description is not submitted as part of a claim.

Rod
www.sunsetsystems.com

On Saturday 09 December 2006 14:53, Peter Holt Hoffman wrote:
> I have a question about this though: don't at least some payers 
> reject claims where the description is not 100% identical to what the 
> AMA publishes?
> 
> -- Peter.
> 
> 
> --- In openhealth@yahoogroups.com, Rod Roark <[EMAIL PROTECTED]> wrote:
> >
> > I think, then, a good web-based community project would be the
> > creation of a whole new set of codes and descriptions.  However the
> > codes would happen to map one-to-one with the CPT codes, and the
> > mapping would be created/shared only among those with CPT licenses.
> > 
> > Publications that reference CPT codes could be trivially changed to
> > reference the new codes, and individual practitioners would have no
> > need or use for the mapping table or anything else containing CPT
> > codes.
> > 
> > Rod
> > www.sunsetsystems.com

[openhealth] Re: list of diagnoses and procedures

[Peter Holt Hoffman]

I have a question about this though: don't at least some payers 
reject claims where the description is not 100% identical to what the 
AMA publishes?

-- Peter.


--- In openhealth@yahoogroups.com, Rod Roark <[EMAIL PROTECTED]> wrote:
>
> I think, then, a good web-based community project would be the
> creation of a whole new set of codes and descriptions.  However the
> codes would happen to map one-to-one with the CPT codes, and the
> mapping would be created/shared only among those with CPT licenses.
> 
> Publications that reference CPT codes could be trivially changed to
> reference the new codes, and individual practitioners would have no
> need or use for the mapping table or anything else containing CPT
> codes.
> 
> Rod
> www.sunsetsystems.com

Re: [openhealth] Re: list of diagnoses and procedures

[Rod Roark]

I think, then, a good web-based community project would be the
creation of a whole new set of codes and descriptions.  However the
codes would happen to map one-to-one with the CPT codes, and the
mapping would be created/shared only among those with CPT licenses.

Publications that reference CPT codes could be trivially changed to
reference the new codes, and individual practitioners would have no
need or use for the mapping table or anything else containing CPT
codes.

Rod
www.sunsetsystems.com

On Saturday 09 December 2006 13:18, mspohr wrote:
> Copyright covers "expressions" of ideas and as such covers the AMA's
> descriptions.  Theoretically, if you wrote different descriptions,
> they would not be covered by the AMA copyright.  However, the AMA has
> been very aggressive in defending their monopoly on the codes so they
> might threaten a community project.
> There is also the issue of the codes themselves.  Even though you
> can't copyright lists of numbers (codes)... the famous "telephone
> directory" case, the AMA might try to claim that they own the numbers
> also.
> 
> /Mark
> 
> 
> --- In openhealth@yahoogroups.com, Rod Roark <[EMAIL PROTECTED]> wrote:
> >
> > That leads me to ask: does the AMA claim copyright on the CPT codes
> > themselves, or just on the descriptions of the codes?  If the latter,
> > I think there would be a lot of merit in a community project to
> > create and maintain new descriptions.  I've been told that the AMA's
> > descriptions are not very physician-friendly.
> > 
> > Rod
> > www.sunsetsystems.com
> > 
> > On Saturday 09 December 2006 10:18, 80n wrote:
> > > This reminds me of a similar situation in the UK with postcodes (their
> > > equivalent of zip codes).  Unlike the US where zip codes are in
> the public
> > > domain, the British Post Office owns the postcode database and
> protects it
> > > agressively.
> > > 
> > > An enterprising group of people recently started an initiative at
> > > www.FreeThePostcode.org to "reverse engineer" the postcode database by
> > > getting people to record their own postcode and geographic
> location on the
> > > web-site.  So far they have not been closed down by the post office.
> > > 
> > > I'm wondering if anything like a similar approach could work with
> CPT codes?
> > > 
> > > 80n

[openhealth] Re: list of diagnoses and procedures

[mspohr]

Copyright covers "expressions" of ideas and as such covers the AMA's
descriptions.  Theoretically, if you wrote different descriptions,
they would not be covered by the AMA copyright.  However, the AMA has
been very aggressive in defending their monopoly on the codes so they
might threaten a community project.
There is also the issue of the codes themselves.  Even though you
can't copyright lists of numbers (codes)... the famous "telephone
directory" case, the AMA might try to claim that they own the numbers
also.

/Mark


--- In openhealth@yahoogroups.com, Rod Roark <[EMAIL PROTECTED]> wrote:
>
> That leads me to ask: does the AMA claim copyright on the CPT codes
> themselves, or just on the descriptions of the codes?  If the latter,
> I think there would be a lot of merit in a community project to
> create and maintain new descriptions.  I've been told that the AMA's
> descriptions are not very physician-friendly.
> 
> Rod
> www.sunsetsystems.com
> 
> On Saturday 09 December 2006 10:18, 80n wrote:
> > This reminds me of a similar situation in the UK with postcodes (their
> > equivalent of zip codes).  Unlike the US where zip codes are in
the public
> > domain, the British Post Office owns the postcode database and
protects it
> > agressively.
> > 
> > An enterprising group of people recently started an initiative at
> > www.FreeThePostcode.org to "reverse engineer" the postcode database by
> > getting people to record their own postcode and geographic
location on the
> > web-site.  So far they have not been closed down by the post office.
> > 
> > I'm wondering if anything like a similar approach could work with
CPT codes?
> > 
> > 80n
>

Re: [openhealth] Re: list of diagnoses and procedures

[Rod Roark]

That leads me to ask: does the AMA claim copyright on the CPT codes
themselves, or just on the descriptions of the codes?  If the latter,
I think there would be a lot of merit in a community project to
create and maintain new descriptions.  I've been told that the AMA's
descriptions are not very physician-friendly.

Rod
www.sunsetsystems.com

On Saturday 09 December 2006 10:18, 80n wrote:
> This reminds me of a similar situation in the UK with postcodes (their
> equivalent of zip codes).  Unlike the US where zip codes are in the public
> domain, the British Post Office owns the postcode database and protects it
> agressively.
> 
> An enterprising group of people recently started an initiative at
> www.FreeThePostcode.org to "reverse engineer" the postcode database by
> getting people to record their own postcode and geographic location on the
> web-site.  So far they have not been closed down by the post office.
> 
> I'm wondering if anything like a similar approach could work with CPT codes?
> 
> 80n

Re: [openhealth] Re: list of diagnoses and procedures

[80n]

This reminds me of a similar situation in the UK with postcodes (their
equivalent of zip codes).  Unlike the US where zip codes are in the public
domain, the British Post Office owns the postcode database and protects it
agressively.

An enterprising group of people recently started an initiative at
www.FreeThePostcode.org to "reverse engineer" the postcode database by
getting people to record their own postcode and geographic location on the
web-site.  So far they have not been closed down by the post office.

I'm wondering if anything like a similar approach could work with CPT codes?

80n

On 12/9/06, mspohr <[EMAIL PROTECTED]> wrote:
>
>   The AMA CPT codes have a tortuous history and are currently in a
> legally ambiguous place supported by aggressive AMA lawyers. It is
> similar to the legally tenuous position of the RIAA that they can
> control what you can do with the music you have purchased.
>
> A short history.
> In testimony before congress in 1997, T. Reginald Harris, Chairman of
> the AMA CPT Editorial Board stated: "The AMA has taken additional
> steps to make CPT available over the Internet and is expected to
> complete an agreement with the HCFA in the very near future. Under the
> agreement, complete public access to HCFA data files containing CPT
> will be available, free of charge, both domestically and internationally."
> Congress then passed legislation mandating use of the CPT codes for
> medical billing.
> However, the AMA did not make the codes freely available domestically
> and internationally. Instead, they have been selling the codes under
> very restrictive licensing agreements and in fact earn tens of
> millions of dollars a year from these fees.
>
> The AMA has been very aggressively policing "misuse" of the codes (for
> example, taking legal action against people who have made the codes
> "freely available on the Internet"). Their legal position is tenuous
> and has never been tested fully in court. Instead, they have relied
> on the intimidation of their lawyers to produce compliance. Similar
> cases such as Feist v. Rural Telephone and DrewTech v. SAE have
> produced results which would seem to prohibit the AMA from charging
> for the codes.
>
> That said, it is probably best not to challenge the AMA. Our corrupt
> politicians should address the problem but of course, they will not go
> against a big contributor.
>
> You can buy the codes for use (under their restrictive license) from
> the AMA and that is probably the best course of action.
>
> /Mark
>
>
> Alex Caldwell wrote:
> >
> > --- In openhealth@yahoogroups.com , Tim
> Cook <[EMAIL PROTECTED]> wrote:
> > >
> > > Alex Caldwell wrote:
> > > The way I interpret the agreement on
> > > > the site, I believe it is OK to do this as long as you just do it
> > > > just for yourself for your own internal use, but you are not allowed
> > > > to re-distribute them. So perhaps it would be OK to distribute the
> > > > Open Source EMR minus these codes, but include instructions for the
> > > > user for downloading this file and importing the codes themselves
> > > > into their own personal copy of the EMR:
> > >
> > > DISCLAIMER: IANAL but
> > >
> > > "Grant and Limitations. You, as an individual, are authorized to use
> > > CPT only as contained in the CPT(r)/Medicare Relative Value Payment File
> > > (the "File") solely for your own personal information and only within
> > > the United States."
> > >
> > > specifically EXCLUDES any use outside of the (Excel) file and any use
> > > outside the US. It goes on to say that you are prohibited for using
> > > them in place of purchasing the CPT book or creating any derivative
> > > work.
> > >
> > > When we licensed CPTs for use in FreePM the AMA was very attentive to
> > > the distribution and we had to submit quarterly audits to them. I
> > > suggest you ensure you adhere to their licensing restrictions I
> > > understand they are very aggressive in pursuing their copyright on
> > > their government granted monopoly.
> > >
> > > Cheers,
> > > --
> > > Timothy (Tim) Cook, MSc
> >
> > Thanks Tim,
> >
> > I was going by the agreement on this page on the CMS site which links
> > to the download for the Excel file:
> >
> >
>
> http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf
> >
> > It did not seem to me as restrictive as what you are quoting there. I
> > notice many doctors do things with CPT, such as having them printed
> > by a local printing house on their own customized superbills. I've
> > never heard of anyone being pursued for that. It would seem that if
> > you included a subset of the CPT codes that you use in your own
> > practice in order to interact with Medicare for billing transactions
> > in the course of your own business, and you get them yourself for
> > your own personal use, not distributed with the EMR, but just loaded
> > into it by yourself, it would not violate the conditions. I cannot see
> > that loading 

[openhealth] Re: list of diagnoses and procedures

[mspohr]

The AMA CPT codes have a tortuous history and are currently in a
legally ambiguous place supported by aggressive AMA lawyers.  It is
similar to the legally tenuous position of the RIAA that they can
control what you can do with the music you have purchased.

A short history. 
In testimony before congress in 1997, T. Reginald Harris, Chairman of
the AMA CPT Editorial Board stated:  "The AMA has taken additional
steps to make CPT available over the Internet and is expected to
complete an agreement with the HCFA in the very near future. Under the
agreement, complete public access to HCFA data files containing CPT
will be available, free of charge, both domestically and internationally."
Congress then passed legislation mandating use of the CPT codes for
medical billing.
However, the AMA did not make the codes freely available domestically
and internationally.  Instead, they have been selling the codes under
very restrictive licensing agreements and in fact earn tens of
millions of dollars a year from these fees.

The AMA has been very aggressively policing "misuse" of the codes (for
example, taking legal action against people who have made the codes
"freely available on the Internet").  Their legal position is tenuous
and has never been tested fully in court.  Instead, they have relied
on the intimidation of their lawyers to produce compliance.  Similar
cases such as Feist v. Rural Telephone and DrewTech v. SAE have
produced results which would seem to prohibit the AMA from charging
for the codes.

That said, it is probably best not to challenge the AMA.  Our corrupt
politicians should address the problem but of course, they will not go
against a big contributor. 

You can buy the codes for use (under their restrictive license) from
the AMA and that is probably the best course of action. 

/Mark




Alex Caldwell wrote:
>
> --- In openhealth@yahoogroups.com, Tim Cook <[EMAIL PROTECTED]> wrote:
> >
> > Alex Caldwell wrote:
> > The way I interpret the agreement on
> > > the site, I believe it is OK to do this as long as you just do it
> > > just for yourself for your own internal use, but you are not allowed
> > > to re-distribute them. So perhaps it would be OK to distribute the
> > > Open Source EMR minus these codes, but include instructions for the
> > > user for downloading this file and importing the codes themselves
> > > into their own personal copy of the EMR:
> >
> > DISCLAIMER: IANAL but
> >
> > "Grant and Limitations. You, as an individual, are authorized to use
> > CPT only as contained in the CPT®/Medicare Relative Value Payment File
> > (the "File") solely for your own personal information and only within
> > the United States."
> >
> > specifically EXCLUDES any use outside of the (Excel) file and any use
> > outside the US. It goes on to say that you are prohibited for using
> > them in place of purchasing the CPT book or creating any derivative
> > work.
> >
> > When we licensed CPTs for use in FreePM the AMA was very attentive to
> > the distribution and we had to submit quarterly audits to them. I
> > suggest you ensure you adhere to their licensing restrictions I
> > understand they are very aggressive in pursuing their copyright on
> > their government granted monopoly.
> >
> > Cheers,
> > --
> > Timothy (Tim) Cook, MSc
>
> Thanks Tim,
>
> I was going by the agreement on this page on the CMS site which links
> to the download for the Excel file:
>
>
http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf
>
> It did not seem to me as restrictive as what you are quoting there. I
> notice many doctors do things with CPT, such as having them printed
> by a local printing house on their own customized superbills. I've
> never heard of anyone being pursued for that. It would seem that if
> you included a subset of the CPT codes that you use in your own
> practice in order to interact with Medicare for billing transactions
> in the course of your own business, and you get them yourself for
> your own personal use, not distributed with the EMR, but just loaded
> into it by yourself, it would not violate the conditions. I cannot see
> that loading a subset of CPT codes into your EMR would be any
> different than printing them on a superbill or having your coder enter
> then into your claims. But that's just the way I look at it, which
> may not hold up. I imagine CMS and other 3rd party payors and
> clearinghouses must have agreements with AMA to use CPT. Do their
> agreements extend in any way to cover individual providers that do
> business with these 3rd party payors that use CPT?
>
> Alex
>


--- In openhealth@yahoogroups.com, "Alex Caldwell" <[EMAIL PROTECTED]> wrote:
>
> --- In openhealth@yahoogroups.com, Tim Cook  wrote:
> >
> > Alex Caldwell wrote:
> >   The way I interpret the agreement on
> > > the site, I believe it is OK to do this as long as you just do it
> > > just for yourself for your own internal use, but you are not allowed
> > > to 

Re: [openhealth] Re: list of diagnoses and procedures

[Tim Cook]

Tim Cook wrote:

> 
> I should have provided a reference for my quote. It is from the 
> "clickable" license agreement on the AMA site.
> 

I should have probably also noted that they are available from the AMA 
on CD in ASCII for less than $100 / year. So it would be cheaper to 
purchase them than to pay for an attorney's interpretation of the 
license or risk raising red flags about open source projects 
circumventing their copyrights.

Just my 2cents.

Cheers,
-- 
Timothy (Tim) Cook, MSc
Health Informatics Consultant
Jacksonville, FL
Ph: 904-322-8582
http://home.comcast.net/~tw_cook/
EMAIL: [EMAIL PROTECTED]
SKYPE: timothy.cook
Yahoo IM: tw_cook




[Non-text portions of this message have been removed]

Re: [openhealth] Re: list of diagnoses and procedures

[Tim Cook]

Alex Caldwell wrote:

> Thanks Tim,
> 
> I was going by the agreement on this page on the CMS site which links
> to the download for the Excel file:
> 
> http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf
> 
> It did not seem to me as restrictive as what you are quoting there. I
> notice  many doctors do things with CPT,  such as having them printed
> by a local printing house on their own customized superbills.  I've
> never heard of anyone being pursued for that. It would seem that if
> you included a subset of the CPT codes that you use in your own
> practice in order to interact with Medicare for billing transactions
> in the course of your own business,  and you get them yourself for
> your own personal use, not distributed with the EMR, but just loaded
> into it by yourself, it would not violate the conditions. I cannot see
> that loading a subset of CPT codes into your EMR would be any
> different than printing them on a superbill or having your coder enter
> then into your claims.   But that's just the way I look at it, which
> may not hold up.  I imagine CMS and other 3rd party payors and
> clearinghouses must have agreements with AMA to use CPT.  Do their
> agreements extend in any way to cover individual providers that do
> business with these 3rd party payors that use CPT?
> 
> Alex

I should have provided a reference for my quote. It is from the 
"clickable" license agreement on the AMA site.

https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?checkXwho=done

As far as interpretation I would refer you to your attorney. That's 
what we did. Of course use for submission to Medicare etc is covered 
under the referenced DFARS.

Cheers,
Tim





-- 
Timothy (Tim) Cook, MSc
Health Informatics Consultant
Jacksonville, FL
Ph: 904-322-8582
http://home.comcast.net/~tw_cook/
EMAIL: [EMAIL PROTECTED]
SKYPE: timothy.cook
Yahoo IM: tw_cook




[Non-text portions of this message have been removed]

[openhealth] Re: list of diagnoses and procedures

[Alex Caldwell]

--- In openhealth@yahoogroups.com, Tim Cook <[EMAIL PROTECTED]> wrote:
>
> Alex Caldwell wrote:
>   The way I interpret the agreement on
> > the site, I believe it is OK to do this as long as you just do it
> > just for yourself for your own internal use, but you are not allowed
> > to re-distribute them. So perhaps it would be OK to distribute the
> > Open Source EMR minus these codes, but include instructions for the
> > user for downloading this file and importing the codes themselves
> > into their own personal copy of the EMR:
> 
> DISCLAIMER: IANAL but
> 
> "Grant and Limitations.  You, as an individual, are authorized to use 
> CPT only as contained in the CPT®/Medicare Relative Value Payment File 
> (the "File") solely for your own personal information and only within 
> the United States."
> 
> specifically EXCLUDES any use outside of the (Excel) file and any use 
> outside the US.  It goes on to say that you are prohibited for using 
> them in place of purchasing the CPT book or creating any derivative 
> work.
> 
> When we licensed CPTs for use in FreePM the AMA was very attentive to 
> the distribution and we had to submit quarterly audits to them.  I 
> suggest you ensure you adhere to their licensing restrictions I 
> understand they are very aggressive in pursuing their copyright on 
> their government granted monopoly.
> 
> Cheers,
> -- 
> Timothy (Tim) Cook, MSc

Thanks Tim,

I was going by the agreement on this page on the CMS site which links
to the download for the Excel file:

http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf

It did not seem to me as restrictive as what you are quoting there. I
notice  many doctors do things with CPT,  such as having them printed
by a local printing house on their own customized superbills.  I've
never heard of anyone being pursued for that. It would seem that if
you included a subset of the CPT codes that you use in your own
practice in order to interact with Medicare for billing transactions
in the course of your own business,  and you get them yourself for
your own personal use, not distributed with the EMR, but just loaded
into it by yourself, it would not violate the conditions. I cannot see
that loading a subset of CPT codes into your EMR would be any
different than printing them on a superbill or having your coder enter
then into your claims.   But that's just the way I look at it, which
may not hold up.  I imagine CMS and other 3rd party payors and
clearinghouses must have agreements with AMA to use CPT.  Do their
agreements extend in any way to cover individual providers that do
business with these 3rd party payors that use CPT?

Alex

Re: [openhealth] Re: list of diagnoses and procedures

[Tim Cook]

Alex Caldwell wrote:
  The way I interpret the agreement on
> the site, I believe it is OK to do this as long as you just do it
> just for yourself for your own internal use, but you are not allowed
> to re-distribute them. So perhaps it would be OK to distribute the
> Open Source EMR minus these codes, but include instructions for the
> user for downloading this file and importing the codes themselves
> into their own personal copy of the EMR:

DISCLAIMER: IANAL but

"Grant and Limitations.  You, as an individual, are authorized to use 
CPT only as contained in the CPT®/Medicare Relative Value Payment File 
(the "File") solely for your own personal information and only within 
the United States."

specifically EXCLUDES any use outside of the (Excel) file and any use 
outside the US.  It goes on to say that you are prohibited for using 
them in place of purchasing the CPT book or creating any derivative 
work.

When we licensed CPTs for use in FreePM the AMA was very attentive to 
the distribution and we had to submit quarterly audits to them.  I 
suggest you ensure you adhere to their licensing restrictions I 
understand they are very aggressive in pursuing their copyright on 
their government granted monopoly.

Cheers,
-- 
Timothy (Tim) Cook, MSc
Health Informatics Consultant
Jacksonville, FL
Ph: 904-322-8582
http://home.comcast.net/~tw_cook/
EMAIL: [EMAIL PROTECTED]
SKYPE: timothy.cook
Yahoo IM: tw_cook




[Non-text portions of this message have been removed]

[openhealth] Re: list of diagnoses and procedures

[Alex Caldwell]

--- In openhealth@yahoogroups.com, Adrian Midgley <[EMAIL PROTECTED]> 
wrote:
>
> "a list of diagnoses and procedures
> 
> Does anyone know one which is free to use and edit if needed and 
in 
an
> easy format to parse into a database"
> 
> Asked a colleague in another place.  Do we have a list of such 
lists?
> 
> What would the panel prefer?
> 
> Thanks.
> 
> -- 
> Midgley
>

Adrian, 
 
In the US,  in order to get paid by Medicare or any other 3rd party 
payor, we are required to use the following.  Of course it's 
totally different than what the entire rest of the world uses, so 
probably of no use to your colleague. In the course of developing 
the billing module for tkFP, I found the following links to be very 
useful. Anyone desiring to include billing in an EMR in the US would 
need these:
 
HCPCS (Health Care Common Procedure Coding System) Level I and Level 
II codes.  Level I HCPCS codes are also known as "CPT-4 codes" and 
are  maintained by the American Medical Association, which 
apparently owns  the rights to their distribution.  I could not find 
a site with an  authorized FREE download for the level I HCPCS (CTP-
4) codes in a an electronic file.  The AMA will sell them to you, 
however, or you can buy them from some of their authorized 
distributors.  But the AMA does have a site where you can look them 
up one by one here:
 
 https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
 
I did find some files on the CMS (Centers for Medicare  & Medicaid 
Services) web site that do, in fact, have ALL the CPT codes in an  
electronic format suitable for slurping up into one's EMR.  These 
were  not really intended for such use, but were for publishing 
Medicare's  payment schedule.  But they do have all the codes in an 
Excel format.  One can export the  codes out of Excel, say in a CSV 
format, and then  easily write a little script to slurp up the codes 
into your open  source EMR.  The way I interpret the agreement on 
the site, I believe it is OK to do this as long as you just do it  
just for yourself for your own internal use, but you are not allowed 
to re-distribute them. So perhaps it would be OK to distribute the 
Open  Source EMR minus these codes, but include instructions for the 
user  for  downloading this file and importing the codes themselves 
into  their own personal copy of the EMR: 
 
 http://www.cms.hhs.gov/apps/ama/license.asp?
file=/physicianfeesched/downloads/pe_townhall_hcpcs_level.zip  
 
The level II HCPCS codes, commonly referred to as the "Alpha-
numeric" codes because they start with a letter and have 4 numerals, 
are mostly for supplies used in the course of  treatments that 3rd 
party payors cover, such as chemotherapy 
medications and "durable medical equipment " i.e. wheelchairs etc. 
They are also used for a few other odd-ball codes that are not in 
CPT-4 like Medicare influenza shot administration.  
Level II HCPCS codes are maintained by CMS (Centers for Medicare  & 
Medicaid Services).  Level II codes for 2007 can be downloaded from 
here:

 http://www.cms.hhs.gov/HCPCSReleaseCodeSets/downloads/anweb07.zip

ICD-9 Codes are used for billing in the U.S.  Files with the codes 
and abbreviated descriptions can be downloaded from here. 
 
 http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/06_codes.asp

 
Alex Caldwell M.D.
Tulare, California, USA