South African Medical Association

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Item 0131 and Modifier 0017

The SAMA Private Practice Department is inundated with calls from doctor's rooms regarding the usage of item 0131 and modifier 0017. The common complaint is that medical schemes are rejecting accounts that use one of these 2 items with the consultation code. It has become apparent to us that these items are used incorrectly. To assist our members we have attached the guidelines for these items below:

Item 0131 (Refer to modifier 0017)

Description

Subsequent injections as part of a planned series of injections for the same condition administered by practitioners (refer to modifier 0017) (not chargeable together with any consultation item)


Interpretations

  • Appropriate for second and subsequent injections that form part of a planned course of injections for the same condition
  • Appropriate when doctor personally or nursing professional in his/her employ, administers an injection that form part of a planned course of injections for the same condition
  • The nursing professional may not render their own account for the service
  • If the patient has an unrelated complaint at the time of administering an injection as part of a planned course, only one fee for a visit is appropriate and an additional fee as set out in item 0131 (refer to modifier 0017) may not be added

Modifier 0017 (Refer to item 0131)

Description

Injections administered by practitioners: When desensitisation, intravenous, intramuscular or subcutaneous injections are administered by the practitioner him/herself or nursing professional in his/her employ, to patients who attend the consulting rooms, a first injection forms part of the consultation/visit and only all subsequent injections as part of a planned series of injections for the same condition should be charged according to item 0131 (not chargeable together with a consultation item)


Interpretations

  • Please refer to item 0131: Appropriate for second and subsequent injections that form part of planned course of injections for the same condition
  • Please note that a single injection administered during the course of a consultation forms part of the consultation
  • Item 0131 = 50% of 15-minute office consultation/visit is appropriate if an injection was administered by the doctor personally or by a nursing professional in his/her employ.
  • Appropriate if a doctor personally administers a flu injection or it was administered by a nursing professional in his/her employ.
  • The nursing professional is not entitled to render their own account for the service
  • Not appropriate to add modifier 0017 to a consultation item

Additional information on Item 0131.

  1. First consultation - Consultation item (items 0190-0192 (as appropriate) plus medications (item 0201) will be charged.
  2. For the follow-up injections, item 0131 plus item 0201 should be used.

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