COUNCIL FOR MEDICAL SCHEMES

 

 

To all stakeholders                                                Tel:   012 431-0500

                                                                                    Fax:   012 430-7644                                                                                                                                                                         Enq:  Patrick Matshidze                                                                              

Ref:   ICD 10 Coding

                                                                                    Date: 17 December 2004

 

 

 

CIRCULAR 58 OF 2004

 

 

ICD 10 CODING PROCESS

 

 

1.      ICD 10 IMPLEMENTATION

 

The implementation of ICD 10 in the medical scheme environment takes effect on 1 January 2005.  All health service providers are encouraged to begin submission of ICD 10 diagnosis codes in their accounts for administrative and statistical purposes.

 

The implementation process will entail a phase-in period of 6 months, to allow stakeholders to finalise their preparations for the implementation of ICD 10.  During this period, no outright rejection of accounts without ICD 10 codes will be permitted.  However, regular monthly meetings will be held in order to monitor and review the implementation process.

 

Submissions of ICD 10 codes will be compulsory from 1 July 2005.  All health service providers will be required to include ICD 10 codes in their accounts to medical schemes, in compliance with legislation.  Any claim that is submitted without ICD 10 codes will be liable for rejection from 1 July 2005.

 

A document with a final set of recommendations on the implementation of ICD 10 is available on the Council for Medical Schemes website on www.medicalschemes.com.

 

 

2.      ICD 10 CODING OF PRESCRIBED MINIMUM BENEFITS (PMB)

 

The process of coding of PMB has been completed.  A full set of all 15 chapters was circulated to various stakeholders for comment during the second half of 2005.  The coded PMB will serve as a guideline during the first half of 2005.  During this time any additional comments, with motivations will be considered.

 

 

 

On 1 July 2005, a final list of coded PMB, incorporating valid comments from stakeholders, will be published. This list will reflect Council’s interpretation of PMB.

 

Should you require clarification or additional information on any of the issues raised herein, please contact us on telephone number 012 431 0500, or alternatively you can e-mail us on research@medicalschemes.com.

 

 

Yours sincerely

 

 

TP Masobe

REGISTAR OF MEDICAL SCHEMES