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The importance of ICD-10 codes
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One of the types of codes that appear on
healthcare provider accounts is known as ICD-10 codes. These
codes are used to inform medical schemes about what conditions
their members were treated for so that claims can be settled
correctly.
ICD-10 stands for International Classification of Diseases
and Related Health Problems (10th revision). It is a coding system
developed by the World Health Organisation (WHO), that translates
the written description of medical and health information into
standard codes, e.g. J03.9 is an ICD-10 code
for acute tonsillitis (unspecified) and G40.9 denotes
epilepsy (unspecified).
When you join a medical scheme, you choose and pay for a particular
benefit option. This benefit option contains a basket of services
that often has limits on the health services that will be paid
for. Because ICD-10 codes provide accurate information on the
condition you have been diagnosed with, these codes help the
medical scheme to determine what benefits you are entitled to
and how these benefits could be paid.
This becomes very important if you have a PMB condition, as
these can only be identified by the correct ICD-10 codes. Therefore,
if the incorrect ICD-10 codes are provided, your PMB-related
services might be paid from the wrong benefit (such as from your
medical savings account), or it might not be paid at all if your
day-to-day or hospital benefits limits have been exhausted.
ICD-10 codes must also be provided on medicine prescriptions
and referral notes to other healthcare providers (e.g. pathologists
and radiologists) who are not all able to make a diagnosis. Therefore,
they require the diagnosis information from your referring doctor
so that their claim to your medical scheme can also be paid out
of the correct pool of money.
Important note: Medical schemes are obliged
by law to treat information about members’ conditions with
the utmost confidentiality. They are not allowed to disclose
even ICD-10 codes to any other party, including employers or
family members. |
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