The US government’s HIPAA requirements mandate use of a standardised (“CPT”) code set for electronic transactions but the codes are the intellectual property of the AMA. CPT codes, required by law, are “available”…but not for open source software developers. The age of HIPAA has only exacerbated the problem of AMA intellectual property rights to CPT codes. Medical software developers are required to embed these codes into 837p transactions but cannot have access to them freely.

The greed (and avarice?) of the AMA is blocking the development of software their members could use freely. Software developers working on HIPAA compliant billing modules find that they apparently have little recourse but follow the lead of EDS (Electronic Data Systems) in their PES product (Provider Electronic Solutions). That is, to have a table embedded in the SRV section of an 837 p claim where CPT code/descriptions are stored. The codes are inserted into the drill down table as they are entered by clinicians generating a charge – so they might be reused
on subsequent claims. This is a workaround of sorts but hardly a solution. Unfortunately the AMA can’t be sued under the FOIA as they are not publicly funded – in theory. But as always it is the public that pays.

We are required to use a proprietary code set in our transactions…it is a published standard required by government – and yet we don’t have free access to it because it is proprietary. This could be described as an oxymoron. How is it that the same federal government that was forced to publish VistA after the VA was sued under FOIA can mandate the use of proprietary, pay as you go, codes in health care insurance transactions, even with governmental agencies like CMS (the Centers for Medicare and Medicaid Services, formerly HCFA)? Despite the ethical issues involved, it seems unlikely to this observer that the situation will change soon. Particularly if one reflects on the government’s current practice of contracting Halliburton to sell gasoline to the Iraqis at a 50% markup. All the while the American taxpaying public picks up the tab.Conflict Of Interest would appear to be synonymous with Business As Usual.