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November 2018 Vol. 143
Spectramed and Resolution Health merge
The proposed merge between Spectramed Medical Scheme and Resolution Health Medical Scheme will result in the formation of Health Squared Medical Scheme.
Final approval of this merger is still pending confirmation from The Council of Medical Schemes and the Compettion Commission.
Agillity Health, which is currently the managed care provider and administrator of Spectramed Medical Scheme and Resolution Health Medical Scheme, will provide these services to Health Squared Medical Scheme, from 1 January 2019.
Healthcare practitioners who currently have signed payments arrangements with Spectramed Medical Scheme and/or Resolution Health Medical Scheme must please be aware of possible changes to these agreements moving into the new year.
Phishing attacks in healthcare
Phishing is the fraudulent practice of sending e-mails claiming to be from reputable companies in order to encourage individuals to reveal personal information.
The healthcare industry collects some of the most lucrative personal data including: names, identity numbers, health history and various pieces of financial information.
The value of this information has not gone unnoticed by the hacking community.
The top 3 reported phishing e-mail subjects used in the healthcare industry to be cautious of are:
New Message in Mailbox, and
To start to protect yourself and your medical practice against phishing attacks do not click on any links in e-mails and do not share any personal information.
If you are in any doubt, phone the support centre using the support number on the company’s website.
Code 1807 versus code 2493
Code 2493 - Diagnostic laparoscopy
Code 1807 - Procedure performed through a laparoscope
Please note the following with regards to the correct use of these two codes:
• Code 2493 may only be used in conjunction with items 2496-2505 (‘+’ items).
• When only a diagnostic laparoscopy is performed and is not followed by an additional procedure, code 2493 is appropriate.
• When a diagnostic laparoscopy is followed by the indicated laparoscopic procedure, code 1807 and not code 2493 must be used.
• When performing a laparoscopic procedure, please check first whether a dedicated code for this procedure does not already appear in the Medical Doctors Coding Manual (MDCM).
• When an unsuccessful laparoscopic procedure is followed by an ‘open’ procedure, neither code 2493 or 1807 may be added to the appropriate procedure code.
When the use of a psychoactive substance is documented as abuse, dependence , use disorder, intoxication or harmful use, a code should be assigned from the category F10 – F19, with the use of the appropriate 4th character to specify the clinical state.
The Z-codes are listed as:
Z72.0 Tobacco use
Z72.1 Alcohol use
Z72.2 Drug use
These codes should be considered as secondary codes where these conditions influence and impact on the normal medical treatment of a patient.