SAMA Coding

Verification of practice cost studies and 2010 RPL process 

According to the Department of Health (DoH) briefing session on Friday 6 February 2009 in respect of the disciplines/groups that were accepted following the 2008 cost studies, groups are now subjected to the verification process. The Department of Health has since entered into a Confidentiality and Non-Disclosure Agreement with KPMG in this regard to conduct the verification process that will also inform 2010 Reference Price List (RPL). Senior DoH officials have indicated that there is no need for an additional agreement between individual medical practitioners and KPMG or DoH. The National Department of Health explanation is that the Government is automatically bound by existing legislations on Confidentiality and Non-Disclosure agreements (NDAs) regarding the information they get from individuals in the course of the specific Government department's work. This implies that it may thus be superfluous to get individualised NDA's for each person, in this case each medical professional who provides information for the practice cost studies. While that is the DoH considered view based on input from the State Attorneys, concerned medical professionals are at liberty to either directly, or via their legal representative, engage with the DoH's attorneys on this issue. However, failure to participate in the verification process will delay the process and that will be to the detriment of specialists and general practice groups on developing alternative reimbursement and procedure coding models.  


Also, of note is that each medical practitioner taking part in the Practice Costs Studies is specifically made aware that they may be selected for the audit and or verification process. Finally, medical practitioners are hereby reminded that these are "Practice-cost"-, NOT "Practice-income"-studies. Click here to Download the DoH RPL 2010 Briefing_6 Feb 09.ppt Below is a link to the information that has been distributed by the Society of General/Family Practitioners (SGFP) from each Medical Aid or its Administrator in Southern Africa. SGFP is a special interest group of SAMA. The SGFP has stated in its publication that it can not accept liability for any loss incurred in the use thereof, stating that it remains the responsibility of each practice to determine and confirm tariffs. Figures may change if/when an official RPL 2010 is published. The information below is in respect of Medical Scheme NameBenefit Comments on Balance Billing and Name of the Administrator.
  Click here to Download the 2010 update code 0190 tariff summary.pdf
 


ICD-10 diagnostic coding structure

Click here to download ICD-10 Information from the Department of Health's website.

 
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2010 Complete CPT® for South Africa (CCSA) 2010 Complete CPT® for South Africa (CCSA)

The 2010 Complete CPT® for South Africa is available.  For orders, please contact the SAMA Coding Department on coding@samedical.org. Although limited implementation in South Africa, mostly for hospital data collection purposes, the implementation date was 1 January 2010.  

 
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