Billing/Reimbursement strategies - Understanding ICD 10 coding Q&A

Abstract

The South African government made the inclusion of ICD 10 codes on all medical accounts compulsory from 1 July 2005. By law, practitioners are required to include the ICD 10 code that applies to the relevant medical diagnosis for every single line item on a medical account since 1 July 2005. This should be used in conjunction with Nappi-codes when medicine or stock is issued. The ICD 10 codes also ensure that the medical aid has the necessary information to route claims to the correct benefit categories for the patients benefit options. This is particularly beneficial in the case of Prescribed Minimum Benefits (PMBs) to ensure that these claims are funded via the medical scheme fund and not the day-to-day savings account of the patient. ICD 10 coding is still very new in South Africa, and the diagnostic codes are often used incorrectly. To understand the use of ICD 10 codes we first need to answer a few questions.