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HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016

HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016 . COMPARATIVE TARIFFS: Scheme Rates Base Rates GEMS. HEALTHMAN Non- GEMS. Average Private Discovery Contracted GEMS Non- Contracted GEMS. Duration Tariff HEALTHMAN BankMed BankMed Tariffs DH FedHealth FedHealth Tariffs Contracted Tariffs Contracted Profmed Profmed Code Terminology Professional (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF. Units R R R R R R R R R R R R R R. Consultations: See the Notes below for All Tariffs 0107 Newborn Attendance -Visit in Ward 1 0109 Hospital follow-up visit 0113 Newborn Attendance - Emergency at all hours 1 1 0129 Prolonged first/follow-up consultation : 15 min 0132 Repeat Script 0145 Consultation : Away from doctor's room 0146 Unscheduled consultation: Emergency ( ) 0147 Unscheduled consultation:Emergency(not ) 0148 Elective after-hours services(+50%) - - - - - - - - - - - - - - - 0149 Emergency after-hours services(+25%) - - - - - - - - - - - - - - - 0173 Hospital Consultation 0174 Hospital Consultation 1 0175 Hospital Consultation 1 0190 Consultation 0191

HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016 COMPARATIVE TARIFFS: Scheme Rates Code Terminology Average Duration Professional HealthMan Private Tariff

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Transcription of HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016

1 HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016 . COMPARATIVE TARIFFS: Scheme Rates Base Rates GEMS. HEALTHMAN Non- GEMS. Average Private Discovery Contracted GEMS Non- Contracted GEMS. Duration Tariff HEALTHMAN BankMed BankMed Tariffs DH FedHealth FedHealth Tariffs Contracted Tariffs Contracted Profmed Profmed Code Terminology Professional (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF. Units R R R R R R R R R R R R R R. Consultations: See the Notes below for All Tariffs 0107 Newborn Attendance -Visit in Ward 1 0109 Hospital follow-up visit 0113 Newborn Attendance - Emergency at all hours 1 1 0129 Prolonged first/follow-up consultation : 15 min 0132 Repeat Script 0145 Consultation : Away from doctor's room 0146 Unscheduled consultation: Emergency ( ) 0147 Unscheduled consultation.

2 Emergency(not ) 0148 Elective after-hours services(+50%) - - - - - - - - - - - - - - - 0149 Emergency after-hours services(+25%) - - - - - - - - - - - - - - - 0173 Hospital Consultation 0174 Hospital Consultation 1 0175 Hospital Consultation 1 0190 Consultation 0191 Consultation 1 0192 Consultation 1 0199 Chronic Medicine Forms Procedures 0008 Specialist surgeon assistant - - - - - - - - - - - - 0009 Assistant - - - - - - - - - - - - 0011 Emergency after-hours procedures - - - - - - - - - - - - 0018 Surgical modifier for persons with BMI of 35> - - - - - - - - - - - - 0084 Film costs - - - - - - - - - - - - 0201 Cost of Material in treatment - - - - - - - - - - - - 2343 Vaginal hysterectomy: Without repair 8 2 2 2 2 3 2 2345 Vaginal hysterectomy: With repair 9 2 2 2 2 3 2 2437 Hysteroscopy and D&C (excluding after-care) 2 2443 Dilatation and curettage (D&C) (excluding after-care) 1 2445 Evacuation of uterus: Incomplete abortion: Before 12 weeks gestation 2 Total abdominal hysterectomy: With or without unilateral or bilateral salpingo- 2471 oophorectomy - uncomplicated 10 3 2 2 2 3 3 Total abdominal hysterectomy plus vaginal cuff with or without unilateral or 2473 bilateral salpingo-oophorectomy.

3 14 4 4 4 4 5 4 Non-surgical endometrial destruction, Any method, not utilising hysteroscopic 2478 instrumentation or assistance 8 2 2 2 2 3 2 2492 Salpingectomy: Uni - or bilateral or sterilisation for accepted medical reasons 3 1 1 1 1 1 1 2493 Diagnostic laparoscopy (excluding after-care) 3 1 1 1 1 1 1 2497 Laparoscopy: Plus sterilisation 1 Laparoscopy: Plus ablation of endometriosis by laser, harmonic scalpel or 2500 cautery 2 2527 Removal of ovarian tumour or cyst 7 2 2 2 2 2 2 2548 Operation for stress incontinence: Use of tape 9 2 2 2 2 3 2 Tococardiography - pre-natal and intrapartum (including stress and non-stress 2610 test: Own machine) (Excluding after-care) Global obstetric care: All inclusive fee that includes all modes of vaginal delivery (excluding Caesarean section) and obstetric care from the commencement of 2614 labour until after the post-partum visit (6 weeks visit) 3 3 3 3 5 3 Global obstetric care: All inclusive fee that includes all modes of vaginal delivery (excluding Caesarean section) and obstetric care from the commencement of labour until after the post-partum visit (4 weeks visit) (includes malpractice 2614 insurance) 14 - HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016 .

4 COMPARATIVE TARIFFS: Scheme Rates Base Rates GEMS. HEALTHMAN Non- GEMS. Average Private Discovery Contracted GEMS Non- Contracted GEMS. Duration Tariff HEALTHMAN BankMed BankMed Tariffs DH FedHealth FedHealth Tariffs Contracted Tariffs Contracted Profmed Profmed Code Terminology Professional (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF (VAT Incl) RCF. Units R R R R R R R R R R R R R R. Global obstetric care: All inclusive fee for caesarean section and obstetric care from the commencement of labour until after the post-partum visit (6 weeks 2615 visit). See modifier 0011 for emergency caesarean section (all hours) 3 3 3 3 5 3 Global obstetric care: All inclusive fee for caesarean section and obstetric care from the commencement of labour until after the post-partum visit (4 weeks visit).

5 See modifier 0011 for emergency caesarean section (all hours) (includes 2615 malpractice insurance) 13 - Bone densitometry (to be charged once only for one or more levels done at the 3604* same session) 1 1 1 1 1 1 1 Routine obstetric ultrasound at 10 to 20 weeks gestational age preferable at 10. 3615* to 14 weeks gestational age to include nuchal translucency assessment Routine obstetric ultrasound at 20 to 24 weeks to include detailed anatomical 3617* assessment Pelvic organs ultrasound transabdominal probe (this is a gynaecological 3618* ultrasound examination and may not be used in pregnancy) +Colour Doppler (may be added onto any other regional exam, but not to be 3637* added to items 3605, 5110, 5111, 5112, 5113 or 5114) 1 4188* Urine dipstick, per stick (irrespective of the number of tests on stick) 5100* Pelvic organs ultrasound: Transvaginal or trans rectal probe Note: 1.

6 Codes, Descriptors and Unit Values have been extracted from the SAMA Electronic Medical Doctors Coding Manual (eMDCM) previously known as the SAMA Doctors Billing Manual (DBM). 2. Tariffs may differ due to rounding 3. Above codes are the most frequently used codes and is not all inclusive of all the codes 4. Increases from 2015 are as follow: a. HEALTHMAN = 2015 Tariff + b. Bankmed = New to Schedule c. Discovery Health = 2015 Tariff +5%. d. Fedhealth = 2015 Tariff + e. GEMS = 2015 Tariff +5%. f. Profmed = 2015 Tariff +6%. 6. Payment Arrangement Rates have NOT been split between In-Hospital & Out-Hospital. Use as appropriate. 7. The HEALTHMAN tariff for codes that relate to equipment have been retained at GEMS rate*. 8. All Tariffs are inlcusive of VAT.

7 Disclaimer: The above schedule is based on information avaiable to HEALTHMAN and HEALTHMAN will NOT be held responsible for any losses incurred by practitioners resulting from the use of this schedule. Legend: DH = Discovery Health DPA = Direct Payment Arrangement IH = In Hospital OH = Out of Hospital Prem = Premier R = Rand RCF = Rand Conversion Factor (Rand Value per Unit). VAT = Value Added Tax HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016 . COMPARATIVE TARIFFS: Scheme Rates Base Rates Payment Arrangments BankMed BankMed HEALTHMAN Traditional & Traditional & BankMed BankMed Average Private BankMed Comprehensive Comprehensive Plus Plus DH DH DH. Duration Tariff HEALTHMAN Entry Plan Network Network Network Network Prem A Prem A DH Classic DH FedHealth FedHealth FedHealth Code Terminology Professional (VAT Incl) RCF Network (IH) (OH) (IH) (OH) (IH) (OH) Prem B Rate Exec Rate DPA DPA DPA.

8 110% 135% 150% 200% 215% 137% 162% 147% 217% 300% 165% 210% 300%. Units R R R R R R R R R R R R R R R. Consultations: See the Notes below for All Tariffs 0107 Newborn Attendance -Visit in Ward 1 1 1 1 1 1 1 1 0109 Hospital follow-up visit 0113 Newborn Attendance - Emergency at all hours 1 1 1 1 1 1 1 1 1 2 1 1 2 0129 Prolonged first/follow-up consultation : 15 min 0132 Repeat Script 0145 Consultation : Away from doctor's room 0146 Unscheduled consultation: Emergency ( ) - 0147 Unscheduled consultation:Emergency(not ) 0148 Elective after-hours services(+50%) - - - - - - - - - - - - - - - - 0149 Emergency after-hours services(+25%) - - - - - - - - - - - - - - - - 0173 Hospital Consultation - 1 1 0174 Hospital Consultation 1 - 1 1 0175 Hospital Consultation 1 - 1 1 0190 Consultation - 1 1 0191 Consultation 1 - 1 1 0192 Consultation 1 - 1 1 0199 Chronic Medicine Forms 1 Procedures 0008 Specialist surgeon assistant - - - - - - - - - - - - - - - 0009 Assistant - - - - - - - - - - - - - - - 0011 Emergency after-hours procedures - - - - - - - - - - - - - - - 0018 Surgical modifier for persons with BMI of 35> - - - - - - - - - - - - - - - 0084 Film costs - - - - - - - - - - - - - - - 0201 Cost of Material in treatment - - - - - - - - - - - - - - - 2343 Vaginal hysterectomy: Without repair 8 2 3 3 5 5 3 3 3 5 7 4 5 7 2345 Vaginal hysterectomy.

9 With repair 9 3 3 4 5 5 3 4 3 5 8 4 5 8 2437 Hysteroscopy and D&C (excluding after-care) 2 1 1 1 1 1 2 1 1 2 2443 Dilatation and curettage (D&C) (excluding after-care) 1 1 1 2445 Evacuation of uterus: Incomplete abortion: Before 12 weeks gestation 2 1 1 1 1 1 1 Total abdominal hysterectomy: With or without unilateral or bilateral salpingo- 2471 oophorectomy - uncomplicated 10 3 4 4 6 6 3 4 4 6 8 4 6 8 Total abdominal hysterectomy plus vaginal cuff with or without unilateral or 2473 bilateral salpingo-oophorectomy. 14 4 5 6 8 9 5 6 6 8 12 6 8 12 Non-surgical endometrial destruction, Any method, not utilising hysteroscopic 2478 instrumentation or assistance 8 2 3 3 4 5 3 3 3 5 6 3 4 7 2492 Salpingectomy: Uni - or bilateral or sterilisation for accepted medical reasons 3 1 1 1 2 2 1 1 1 2 3 1 2 3 2493 Diagnostic laparoscopy (excluding after-care) 3 1 1 1 2 2 1 1 1 2 3 1 2 3 2497 Laparoscopy: Plus sterilisation 1 1 1 1 1 Laparoscopy: Plus ablation of endometriosis by laser, harmonic scalpel or 2500 cautery 2 1 1 1 1 1 1 2527 Removal of ovarian tumour or cyst 7 2 3 3 4 4 2 3 3 4 6 3 4 6 2548 Operation for stress incontinence.

10 Use of tape 9 3 3 4 5 5 3 4 3 5 7 4 5 8 Tococardiography - pre-natal and intrapartum (including stress and non-stress 2610 test: Own machine) (Excluding after-care) Global obstetric care: All inclusive fee that includes all modes of vaginal delivery (excluding Caesarean section) and obstetric care from the commencement of 2614 labour until after the post-partum visit (6 weeks visit) 3 4 5 6 7 4 5 4 7 9 5 6 9 Global obstetric care: All inclusive fee that includes all modes of vaginal delivery (excluding Caesarean section) and obstetric care from the commencement of labour until after the post-partum visit (4 weeks visit) (includes malpractice 2614 insurance) 14 - - - - - HEALTHMAN GYNAECOLOGY COSTING GUIDE 2016 . COMPARATIVE TARIFFS: Scheme Rates Base Rates Payment Arrangments BankMed BankMed HEALTHMAN Traditional & Traditional & BankMed BankMed Average Private BankMed Comprehensive Comprehensive Plus Plus DH DH DH.


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