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ICD-10 Changes

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 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 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 www.samedical.org

Should you require any further information please do not hesitate to contact SAMA’s coding unit at 012 481 2073 or email [email protected]

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