ICD-10 is an important code that appears on healthcare provider accounts. This code is used to inform medical schemes about the type of conditions members have received, so that claims can be settled correctly.
What does the code represent? ICD-10 stands for Classification of Diseases and Related Health Problems (10th Revision). The World Health Organization developed this coding, used as a simple way to translate written description of health and medical information into standard codes. A simple example of this is the code G40.9, used to denote epilepsy (unspecified), or J03.9, an ICD-10 code used to represent tonsillitis (unspecified).
The Value of ICD-10 Codes
Upon joining a medical scheme, the member chooses and pays for a particular benefit option. The chosen benefit option contains a basket of services that oftentimes imposes limits on the health services that are covered and paid for. Since ICD-10 codes provide accurate information on the diagnosed condition of the member, medical schemes use these codes to determine what benefits the member is entitled to, and how the benefits can be paid.
This becomes even more important should you have a PMB condition, as these conditions can only be identified by using the specific ICD-10 codes. Should the incorrect ICD-10 code be provided, then your PMB-related services might be covered and paid from the wrong benefit, such as from the medical savings account. Or, worse yet, it may not be paid at all if your hospital or day-to-day benefits limits have already been exhausted.
It is therefore also necessary that all ICD-10 codes must be supplied on medicine prescriptions, along with referral notes to other healthcare providers, such as radiologists or pathologists who aren’t able to make a diagnosis. They will subsequently require the diagnosis information from the referring doctor, enabling their claim from your medical aid scheme be paid from the correct pool of money.
Important Note Regarding ICD-10 Codes
The law requires medical schemes to treat information about members’ conditions with the utmost privacy and confidentiality. They aren’t allowed to disclose your ICD-10 codes to any other party, including family members or employers.
If you have any questions relating to medical billing or ICD-10 codes, please contact us for assistance.