January 2019 Vol. 145
Changes made to the 2018 SAMA Medical Doctors’ Coding structure for 2019
In line with their mandate from their members, SAMA (South African Medical Association) has been updating the procedure coding system used by medical doctors in order to keep abreast of new developments in medical practice.
No tariffs are included, but relative value units were assigned to the codes as these are time related units that are scientifically calculated to ensure inter disciplinary relativity.
Tariffs can be calculated by using the specific rand conversion factor determined by the specific medical scheme that is responsible for the payment of the account. Every doctor can also use his own discretion of determining his own specific rand conversion factor to fit his specific billing policy.
Please note that the changes are not necessarily accepted by the medical schemes and if the new codes are used on accounts the payment thereof will be dependent on the specific scheme rules.
SAMWUMED: Service Providers
The South African Municipal Workers Union National Medical Aid (SAMWUMED), has performed well at year end of 2018. This is at a time when most schemes are making losses. Joe Seoloane, the Curator for SAMWUMED, said the Scheme, which was placed under Provisional Curatorship in May 2018, has made great progress and remains open for business.
For queries, please contact:
Portia Ntsaluba: SAMWUMED Communications and Marketing Manager
Tel: 021 697 950
M: 084 393 5661
South African Standards Guideline GSN0009
Some codes require a 4th character “X”.
These ICD-10 codes are found in categories M45, T08, T10, T12, V98, and V99.
The “X” in place of a fourth character:
The use of the “X” as a fourth [4th] character in five  character level codes, where no fourth [4th] character is available is an International Standard which has been adopted and agreed on by local software vendors.
M45 – Ankylosing spondylitis [Site code required which will be placed in the fifth character space]
M45.X9 – Ankylosing spondylitis, site unspecified
T08 – Fracture of spine, level unspecified [The fifth character will denote open or closed]
T08.X0 – Fracture of spine, level unspecified, closed.
The fourth [4th] character is replaced by either a capital (upper case) “X” or small (lower case) “x” where codes do not have a valid fourth [4th] character but require a fifth [5th] character.