Update your ICD-10 coding structures to avoid rejections of claims by Medical Schemes
In order to ensure consistent ICD-10 coding throughout South Africa, an official electronic ICD-10 Master Industry Table for South Africa (MIT) is published from time to time. Currently both the private and public healthcare industry have adopted some aspects of the ICD-10 coding structure, yet full implementation of ICD-10 phase 3 and phase 4.1 has not occurred across the industry. The National Department of Health now requires that phase 3 and phase 4.1 of ICD-10 be fully implemented by 1 July 2014 and will not allow any exceptions.
Funders of healthcare have been requested to send warning messages from 1 June 2013 to doctors, informing them that phases 3 and 4.1 will be implemented on 1 July 2014. Failure to use the correct ICD-10 codes may result in medical schemes rejecting claims.
All outstanding phase 3 validations commenced on 1 July 2014 ; this includes technical validation of all secondary ICD-10 codes and mandatory use of External Cause Codes(V01.- to Y98) together with injury and poisoning codes (S00.- to T98.-), the validation of dagger and asterisks and sequelae coding rules.
Further, the implementation of phase 4.1 commenced on 1 July 2014.This phase allows for the first step of clinical validations of ICD-10 codes with the aim of more accurate coding to be done for age and gender specific diagnoses.
Please note the implementation of ICD-O (morphology coding) will not be implemented on 1 July 2014, and has been postponed .The new implementation date will be communicated in due course.
Please refer to the notice by the National Department of Health that was sent to all healthcare stakeholders
To assist our members, SAMA has incorporated the complete ICD-10 coding structure within its electronic Medical Doctors’ Coding Manual (eMDCM) program. All members who have purchased the eMDCM will receive an update notification and receive the ICD-10 information free of charge.
To purchase the eMDCM visit SAMA’s website (www.samedical.org/products).
Alternatively the ICD-10 Master Industry Table can be downloaded from the Department of Health’s website at www.health.gov.za/icddoc.php
To read more on the new ICD-10 Master Industry Table and the changes required to your current system, visit SAMA’s website at http://www.samedical.org/icd-10.html
Should you require any further information please do not hesitate to contact SAMA’s coding unit at 012 481 2073 or email firstname.lastname@example.org.
SAMA Coding Unit
Private Practice Department