ICD-10 will apply to all members of the healthcare profession within South Africa..

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1 FREQUENTLY ASKED QUESTIONS REGARDING ICD 10 CODES 1. What is ICD-10? ICD-10 stands for International Classification of Diseases and Related Health Problems version 10. This is a set of codes which translates the written description of a diagnosis into a coded format e.g. acute tonsillitis = J03.9. This set of codes form part of an international standard of diagnostic codes and is owned and maintained by the World Health Organisation. 2. Why do we need ICD-10 codes? In the past, providers of health services such as General Practitioners (GPs) described diagnoses each in their own way. This made it impossible to use uniform diagnoses and as a result, it was decided to standardize the diagnoses. The National Department of Health and the Council of Medical Schemes had driven a process to formalise ICD-10 as the diagnostic coding standard for South Africa as part of the legislative requirements of the Medical Schemes Act. The benefits to the medical industry of using ICD-10 codes are numerous, but the most pertinent include: Appropriate management of medical services and benefits Faster payment of claims Disease profiling which will allow for improved research and treatment plans 3. Where will ICD-10 be implemented? ICD-10 will apply to all members of the healthcare profession within South Africa.. 4. Who will be required to use ICD-10? As per the regulations of the Medical Schemes Act, all providers of healthcare such as hospitals, doctors, allied professionals, etc. will be required to make use of ICD-10 codes 5. Will all healthcare professionals be required to submit ICD-10 codes? In accordance with the Medical Schemes Act all healthcare professionals are required to provide ICD-10 codes. 6. When did the submission of ICD-10 codes became mandatory? The official on which the legislation of ICD-10 came into effect was 1 January Will all conditions require ICD-10 coding? Yes, with effect from 1 January 2005 the full ICD-10 coding system will be implemented in contrast to 2004 where ICD-10 codes were only required for the 25 conditions on the Chronic Disease List. 8. Will the implementation of ICD-10 codes be restricted to the private sector only? No, ICD-10 codes will be implemented in both the private and public sector.

2 9. Will claims be rejected if submitted without ICD-10 codes with effect from 1 January 2005? No, claims will not be rejected. All claims submitted without ICD-10 codes or invalid ICD-10 codes will be processed as normal but returned to providers with information messages and error codes highlighting the need to submit ICD-10 codes. This process will be followed from 1 January February Has any scheme within the Medscheme stable commenced with the rejections of claims if submitted without valid ICD-10 codes? Yes, Massmart Health Plan commenced with rejections on 1 April When will the remainder of the schemes within the Medscheme stable commence with the rejection of claims if submitted without invalid ICD-10 codes? Medscheme will be following a phased-in approach and rejections will be implemented per discipline concentrating on disciplines which have the highest ratio of PMB claims Claims will be rejected per discipline group on the following basis: if ICD-10 code is omitted from claim line if ICD-10 code is invalid. 12. How and when will Medscheme s rejection strategy be implemented? The rejection strategy will be implemented as follows: Phase 1 March 2007 Phase 2 May 2007 Phase 3 Specialist Physician 018 Physiotherapy 072 Phytotherapy 103 Cardiology 021 General Dental 054 Oral Pathology 098 Practice Psychiatry 022 Dieticians 084 Unattached operating theatres/day Clinics 076 Rheumatology 031 Anaesthetists 010 Private Rehab 059 Hospital (acute) Pulmonology 017 Paediatricians 032 Drug & Alcohol 047 Rehabilitation Neurology 020 Optometrists 070 Hospices 079 Urology 046 Registered 088 Sub- acute facilities 049 Nurse Ophthalmology 026 Radiography 039 Mental health 055 Institutions Gastroenterology 019 Dermatology 012 Paediatric 033 Cardiology Obstetrics & Gynaecology 016 Periodontics 092 Clinical 027 Haematology Clinical Services 090 Neurosurgery 024 Maxillo-facial & Oral Surgery July

3 Approved UOTU/Day 077 Clinics Occupational 066 Therapy Dental Therapy 095 Foreign Services & 006 internal practices Psychologists 086 Otorhinolaryngology 030 Private Hospital 057 (A Status) Surgery/ Paediatric 042 Surgery Orthopaedics 028 Private Hospital 058 (B Status) Optical Dispensers 071 Social Workers 089 Cardio Thoracic 044 Surgery Group Practice 050 Speech therapy & 082 Audiology Ambulance Services 009 Advanced Prosthodontics 094 Nuclear Medicines 025 Homeopaths 008 Orthotists & 087 prosthetists Medical oncology 023 Chiropractors 004 Orthodontics 064 Clinical Technology 075 Radiation 040 oncology/nuclear Medicine/Oncology Orthoptists 074 Blood & Blood 003 Products courier Nursing Agencies/ 080 Home Care Service Audiology 083 Group practice 051 Hospitals Provincial hospitals 056 Blood Transfusion 078 Services Naturopathy 101 Psychometry 085 Medical Scientists 069 Community Dentistry 096 Community Health 097

4 Ambulance service- 011 Intermediate Art Therapists 067 Phase 4 1 August 2007 General Medical Practice 14/15 Phase 5 1 October 2007 Pharmacies 060 Pathologists 052 Diagnostic Radiologists 038 Phase 6 Namibian Practitioner Ambulance Services Basic Independent Occupational Specialists Physical Medicine Plastic & Reconstructive Surgery Travel Clinic Pharmocotherapist Podiatry Masseurs Registered Counsellors Ambulance Services - other Dental Technology Osteopathy Ayurveda Practitioner Acupuncturist Therapeutric Aroma therapist Therapetic Massage Therapist Therapetic Reflexologist 1 December

5 13. How will the phased rejection strategy be communicated to the Healthcare Professionals? Healthcare Professionals will be informed via the following means:. edv- With Remittance Advice Posted in Remittance Advice As abbreviated messages on Remittance Advices Articles in Good Practice Posted on website 14. At which level must Healthcare Professionals need to supply ICD-10 codes? Healthcare Professionals need to supply valid and complete ICD-10 codes which means that any code must be coded to its highest level of specificity at its appropriate 3 rd, 4 th or 5 th character level Will the privacy, confidentiality and security of member information be jeopardised through the submission of ICD-10 codes? No, ICD-10 codes will be handled in the same confidential manner as is currently the case with members personal details and clinical information contained on medical accounts to ensure the continued privacy and security of member information. 17. Are ICD-10 codes required on line level for hospital claims? No, ICD-10 codes must only be supplied on header level in respect of hospital claims. 18. How are multiple ICD-10 codes on line level differentiated from one another? The forward slash (/) is used as a delimiter.