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ICD-10 Diagnostic Procedure Codes

Update your ICD-10 coding structures before 1 January 2014 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 has not occurred across the industry. The National Department of Health now require that phase 3 and 4.1 of ICD-10 be fully implemented by 1 January 2014 and will not allow any exceptions. For an explanation of the ICD-10 phases visit SAMA’s website.

There will be no ICD-10 phase 3 and phase 4.1 validations and rejections during 2013 (except within contractual agreements and for the management of Prescribed Minimum Benefits [PMBs]). Funders of healthcare have been requested to send warning messages from 1 June 2013 to 31 December 2013 to doctors, informing them that phases 3 and 4.1 will be implemented on 1 January 2014

Failure to use the correct ICD-10 codes may result in medical schemes rejecting claims. To assist our members, SAMA is in the process of incorporating the complete ICD-10 coding structure within its electronic Doctors’ Billing Manual (eDBM) program. All members who have purchased the eDBM will receive an update notification and receive the ICD-10 information free of charge at the end of May 2013. For those who wish to purchase the eDBM 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 http://www.doh.gov.za/docs/notices/2013

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 coding@samedical.org.

SAMA Coding Unit

Private Practice Division

Access to the ICD-10 MIT

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ICD-10 Phase 3 and 4.1

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New ICD-10 MIT information

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