South African Medical Association







Rendani Tendane: Medical Coding Consultant

The South African Renal Society (SARS) published guidelines for chronic dialysis on the 4th of September 2019. The interpretation below has been included in our Medical Doctor’s Coding Manual for 2020.


Chronic haemodialysis: Per week (in general ward or out-patient dialysis unit).

• Appropriate for prescription and supervision of chronic haemodialysis provided in the dialysis unit or general ward.

• Item 1851 may only be used once per week.

• Appropriate to use this item in conjunction with items 0173-0175 (first hospital visit) and item 0109.

• Item 1851 is not appropriate with items 0190-0193

Dialysis is always performed in accordance to a dialysis prescription.

● Dialysis prescriptions and supervision can be provided by a nephrologist or a medical practitioner with appropriate training in nephrology.

● Haemodialysis provided in a dialysis unit, applies to both outpatients and stabilised in-hospital patients in a general ward.

●The global units for haemodialysis (item 1851) requires regular routine visits to the patient during dialysis and covers:

(a) Dialysis prescription
(b) Assessment of dialysis adequacy
(c) Revision of chronic medication
(d) Counselling
(e) Consultations for chronic and acute conditions
(f) Acute medication and prescriptions

Remote supervision for patients in remote areas (Renal Society of SA – Sept 2019):
When providing Nephrology clinical services and dialysis supervision in remote areas where patients cannot be physically visited, the principle of “remote supervision” should apply.

Currently there is no dedicated billing code for “remote supervision” available.

Due to a lack of designated remote codes, the Renal Society in consultation with some medical aids has agreed to support the use of the 1851 billing code without the physician physically attending to such patients.

The Renal Society is committed to develop appropriate remote dialysis supervision codes in cooperation with SAMA and the Medical Schemes. Until such codes are available, we expect our members to code item 1851 for remote supervision under the following provisions:

• The dialysis patient cannot be visited by a Nephrologist or an accredited physician within a reasonable amount of time or distance;

• The attending Nephrologist/Physicians’ clinical input must be documented;

• Since no routine dialysis rounds can be done in remote locations, regular weekly billing of the code 1851 without visiting the patient cannot be supported;

• When remote dialysis patients travel to see Nephrologists in their rooms the code 1851 can be charged in addition to the room’s consultation codes 0190-0193, since dialysis related issues will be attended to, in addition to the general evaluation.

• Within dialysis units located in main centres/cities, item 1851 can only be used after physically seeing the patient at least once a week.

Please refer to the attached document for detailed guidelines. Should you require more information, please contact SAMA Coding Division on 012 481 2073.


The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181,
South Africa

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