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April 2019 Vol.148

Cancellations and No-Shows

SpesNet has recently received a number of queries relating to the charging of consultations that patients fail to attend, or to cancel timeously. We would consequently like to clarify the rules and ethical guidelines for those practices that may have any uncertainty in this regard.

The current rules and guidelines related to the billing of such consultations are, as highlighted by the Medical Coding Doctors’ Manual of 2019 and the Health Professions Council of South Africa, as follows:

Medical Coding Doctors’ Manual

Rule D:

Cancellation of appointments and no-shows: In cases where a patient did not show up for an appointment or did not take timely steps to cancel an appointment, Rule D may be applied to the relevant consultation item.

Should the practitioner apply Rule D, ALL of the following must be adhered to:

(1) Timely cancellation of a general practitioner appointment must be two hours and in the case of a specialist one calendar day prior to the appointment;

(2) The practitioner must be able to provide evidence of failure to find an alternative patient between the time of receiving the cancellation notice and the time of the cancelled appointment;

(3) The practitioner must be able to provide sufficient proof that the patient was informed at the time of booking about the cancellation of appointments policy;

(4) The practitioner shall first establish the reasons for the patient’s failure to cancel or honour the appointment, death and hospitalisation are excluded. Each case shall, be considered on merit and, if circumstances warrant, the patient will not be held liable.

(5) Rule D must be quoted on the account to indicate that the appointment was not cancelled.

The Health Professions Council of South Africa (HPCSA)

A notification on the Health Professions Council of South Africa’s website recently observed the following regarding appointment no-shows:

The nature of certain professions or specialties registered with the Health Professions Council of South Africa (HPCSA) may make it difficult for practitioners to sustain their practice if patients do not honour their appointments.

As a result, some practitioners charge patients for failing to arrive for their appointments.

There has been some confusion on the ethical basis of this practice. There is currently no ethical rule prohibiting practitioners from charging patients for failing to honour their appointments.

The practice of charging for a no-show is well articulated in Section 17 of the Consumer Protection Act which states that; a consumer has the right to cancel any advance booking reservation or order for any goods or services to be supplied. It states that a supplier who makes a commitment or accepts a reservation to supply goods or services may impose a reasonable charge for cancellation of the order or reservation, and a charge is unreasonable if it exceeds a fair amount in the circumstances, taking into account:

(1) The nature of the goods or services that were reserved or booked;

(2) The time the notice of cancellation was provided by the consumer/patient;

(3) The reasonable potential for the service provider, acting diligently, to find an alternative consumer between the time of receiving the cancellation notice and the time of the reservation that was cancelled;

(4) The general practice of the relevant industry.

This Consumer Protection Act further states that a supplier may not impose any cancellation fee in respect of a booking, reservation or order if the consumer is unable to honour the booking, reservation or order because of the death or hospitalisation of the person for whom or for whose benefit the booking, reservation or order was made. In view of this, the Medical and Dental Professions Board has reviewed its ethical ruling of October 2001 and ruled on this matter as follows:

A patient reserves the right to cancel a medical or dental appointment, and a medical or dental practitioner may not charge a consultation fee or a procedure fee for such a cancelled appointment unless:

(1) A cancellation was made less than 24 hours for a specialist appointment and less than two hours for a general practitioner appointment, before the appointment time.

(2) A practitioner can provide evidence of failure to find an alternative patient between the time of receiving the cancellation notice and the time of the cancelled appointment.

(3) The practitioner can provide sufficient proof that the patient was informed about the cancellation of appointments policy.

(4) The practitioner has first established the reasons for the patient’s failure to cancel or honour the appointment.

The HPCSA advises practitioners who have a cancellation or no-show policy to inform their patients at the time of booking that there will be charges incurred for failing to arrive for an appointment.

HPCSA Ethical Guideline

The Health Professions Council of South Africa (HPCSA) Ethical Guideline as contained in Booklet 2 (2008), states the following:

Fees and commission:

7. (5) A practitioner shall not charge or receive fees for services not personally rendered, except for services rendered by another practitioner in his or her employment or with whom he or she is associated as a partner, shareholder or locum tenens.

In all circumstances it would always be prudent to consider and evaluate each case on its own merits when considering the above-mentioned provisions.

We hope that this provides some clarity on this issue. Should you have any further queries please feel free to contact SpesNet on (012) 683 0340.


Coding Corner

Have questions regarding Coding? Coding Corner is there to lend you a hand with some of the more common Coding queries.


Abbreviations:
PDX: Primary diagnosis
SDX: Secondary diagnosis

Coding of Dialysis and chronic renal failure:
The dialysis code should be assigned in the secondary position and the reason for the dialysis, the condition requiring dialysis, should be sequenced as the primary code.

Coding chronic renal failure and renal dialysis include the codes:

Z49.1 Extracorporeal dialysis (renal) NOS
Z49.2 Other dialysis, Peritoneal dialysis

The code Z99.2 Dependence on renal dialysis:
Z99.2 is used when other medical / surgical treatment is rendered and it needs to be indicated that the patient is dependent on dialysis.
In other words it is not specific to the billing of the dialysis.

N18. Chronic Kidney disease:
For coding purposes the following measurements are used:
N18.1 Stage 1 - GFR (>90mL/min)
N18.2 Stage 2 - GFR (60 – 89 mL/min)
N18.3 Stage 3 - GFR (30 – 59 mL/min)
N18.4 Stage 4 - GFR (15 – 29 mL/min)
N18.5 Stage 5 - GFR (< 15 mL/min)

Example:
Patient is admitted for dialysis for chronic renal failure, stage 5
PDX: N18.5 Chronic kidney disease, stage 5
SDX: Z49.1 Extracorporeal dialysis

Example:
Hypertensive renal disease, chronic renal failure, stage 5
PDX: I11.0 Hypertensive renal disease with renal failure
SDX: N18.5 Chronic kidney disease, stage 5
SDX: Z49.1 Extracorporeal dialysis

Example:
Hypertensive heart and renal disease, chronic renal failure, stage 5
PDX: I13.0 Hypertensive heart and renal disease with (congestive) heart failure
SDX: I51.9 Heart disease, unspecified
SDX: N18.5 Chronic kidney disease, stage 5
SDX: Z49.1 Extracorporeal dialysis

IOD@SpesNet

Please note that COID Tariffs for all treatments between 01 April 2019 to 31 March 2020 have been increased by 6.4%.

 

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