PRESCRIBED MINIMUM BENEFITS Categories …

1 PRESCRIBED MINIMUM BENEFITSC ategories ( diagnosis and Treatment Pairs) constituting thePrescribed MINIMUM BENEFITS Package under section 29 (1) (o) of theMedical Schemes Act (listed by Organ-System chapter)BRAIN AND NERVOUS SYSTEMCode: diagnosis :Treatment:906 AAcute generalised paralysis, includingpolio and Guillain-BarreMedical management ; ventilation andplasmapheresis341 ABasal ganglia, extra-pyramidaldisorders; other dystonias nosInitial diagnosis ; initiation of medicalmanagement950 ABenign and malignant brain tumours,treatableMedical and surgical management ,which includes radiation therapy andchemotherapy49 ACompound/depressed fractures of skullCraniotomy/craniectomy213 ADifficulty in breathing, eating,swallowing, bowel, or bladder controldue to non-progressive neurological(including spinal) condition or injuryMedical and surgical management ;ventilation83 AEncephalocele; congenitalhydrocephalusShunt; surgery902 AEpilepsy (status epilepticus, initialdiagnosis, candidate for neurosurgery)Medical management ; ventilation;neurosurgery211 AIntraspinal and intracranial abscessMedical and surgical management905 AMeningitis acute and subacuteMedical and surgical management513 AMyasthenia gravis; musculardystrophy; neuro-myopathies nosInitial diagnosis ; initiation of medicalmanagement; therapy for acutecomplications and exacerbations510 APeripheral nerve injury with openwoundNeuroplasty940 AReversible CNS abnormalities due toother systemic diseaseMedical and surgical management1 ASevere/moderate head injury:haematoma/edema with loss ofconsciousnessMedical and surgical management ;ventilation84 ASpina bifidaSurgical management941 ASpinal cord compression, ishaemia ordegenerative disease nosMedical and surgical management901 AStroke due to haemorrhage, orischaemiaMedical management ; surgery28 ASubarachnoid and intracranialhaemorrhage/haematoma.

2 Compressionof brainMedical and surgical management305 ATetanusMedical management ; ventilation265 ATransient cerebral ischemia; life-threatening cerebrovascular conditionsnosEvaluation; medical management ;surgery109 AVertebral dislocations/fractures, openor closed with injury to spinal cordRepair/reconstruction; medicalmanagement; inpatient rehabilitationup to 2 months684 AViral meningitis, encephalitis, myelitisand encephalomyelitisMedical managementEYECode: diagnosis :Treatment:47 BAcute orbital cellulitisMedical and surgical management394 BAngle-closure glaucomaIridectomy; laser surgery; medical andsurgical management586 BBell s palsy; exposurekeratoconjunctivitisTarsorrhaphy ; medical and surgicalmanagement950 BCancer of eye and orbit treatableMedical and surgical management ,which includes radiation therapy andchemotherapy901 BCataract; aphakiaExtraction of cataract; lens implant911 BCorneal ulcer; superficial injury of eyeand adnexaConjunctival flap; medicalmanagement405 BGlaucoma associated with disorders ofthe lensSurgical management386 BHerpes zoster and herpes simplex withophthalmic complicationsMedical management389 BHyphemaRemoval of blood clot; observation485 BInflammation of lacrimal passagesIncision; medical management909 BOpen wound of eyeball and other eyestructuresMedical and surgical management407 BPrimary and open angle glaucoma withfailed medical managementTrabeculectomy; other surgery419 BPurulent endophthalmitisVitrectomy922 BRetained intraocular foreign bodySurgical management904 BRetinal detachment, tear and otherretinal disordersVitrectomy; laser treatment; othersurgery906 BRetinal vascular occlusion; centralretinal vein occlusionLaser surgery409 BSympathetic uveitis and degenerativedisorders and conditions of globe;sight-threatening thyroid optopathyEnucleation; medical management ;surgeryEAR, NOSE, MOUTH AND THROATCode: diagnosis :Treatment:33 CAcute and chronic mastoiditisMastoidectomy.

3 Medical management482 CAcute otitis mediaMedical and surgical management ,including myringotomy900 CAcute upper airway obstruction,including croup, epiglottitis and acutelaryngotracheitisMedical management ; intubation;tracheostomy950 CCancer of oral cavity, pharynx, nose,ear, and larynx treatableMedical and surgical management ,which includes chemotherapy andradiation therapy241 CCancrum orisMedical and surgical management38 CChoanal atresiaRepair of choanal atresia133 CCholesteatomaMedical and surgical management910 CChronic upper airway obstruction,resulting in cor pulmonaleSurgical and medical management901 CCleft palate and/or cleft lip withoutairway obstructionRepair12 CDeep open wound of neck, includinglarynx; fracture of larynx or trachea,openMedical and surgical management ;ventilation346 CEpistaxis not responsive to anteriorpackingCautery/repair/control haemorrhage521 CForeign body in ear and noseRemoval of foreign body; and medicaland surgical management29 CForeign body in pharynx, larynx,trachea, bronchus and oesophagusRemoval of foreign body339 CFracture of face bones, orbit, jaw;injury to optic and other cranial nervesMedical and surgical management219 CLeukoplakia of oral mucosa, includingtongueIncision/excision; medical management132 CLife-threatening diseases of pharynxnos, including retropharyngeal abscessMedical and surgical management457 COpen wound of ear-drumTympanoplasty; medical management240 CPeritonsillar abscessIncision and drainage of abscess;tonsillectomy; medical management347 CSialoadenitis; abscess/fistula ofsalivary glandsSurgery543 CStomatitis, cellulitis and abscess of oralsoft tissue; Vincent s anginaIncision and drainage; medicalmanagementRESPIRATORY SYSTEMCode: diagnosis :Treatment:903 DBacterial, viral, fungal pneumoniaMedical management , ventilation158D# Respiratory failure, regardless ofcause# Medical management ; oxygen.

4 Ventilation157 DAcute asthmatic attack; pneumonia dueto respiratory syncytial virus in personsunder age 3 Medical management125 DAdult respiratory distress syndrome;inhalation and aspiration pneumoniasMedical management ; ventilation315 DAtelectasis (collapse of lung)Medical and surgical management ;ventilation340 DBenign neoplasm of respiratory andintrathoracic organsBiopsy; lobectomy; medicalmanagement; radiation therapy950 DCancer of lung, bronchus, pleura,trachea, mediastinum and otherrespiratory organs treatableMedical and surgical management ,which includes chemotherapy andradiation therapy170 DEmpyema and abscess of lungMedical and surgical management934 DFrank haemoptyisisMedical and surgical management203 DHypoplasia and dysplasia of lungMedical and surgical management900 DOpen fracture of ribs and sternum;multiple rib fractures; flail chestMedical and surgical management ,ventilation5 DPneumothorax and haemothoraxTube thoracostomy/thoracotomyHEART AND VASCULATURECode: diagnosis :Treatment:155 EMyocarditis; cardiomyopathy;transposition of great vessels;hypoplastic left heart syndromeMedical and surgical management ;cardiac transplant108 EPericarditisMedical and surgical management907 EAcute and subacute ischemic heartdisease, including myocardialinfarction and unstable anginaMedical management ; surgery.

5 Percutaneous procedures284 EAcute pulmonary heart disease andpulmonary emboliMedical and surgical management35 EAcute rheumatic feverMedical management908 EAneurysm of major artery of chest,abdomen, neck, unruptured or rupturednosSurgical management26 EArterial embolism/thrombosis:abdominal aorta, thoracic aortaMedical and surgical management204 ECardiac failure: acute or recentdeterioration of chronic cardiac failureMedical treatment98 EComplete, corrected and othertransposition of great vesselsRepair97 ECoronary artery anomalyAnomalous coronary artery ligation309 EDiseases and disorders of aortic valvenosAortic valve replacement210 EDiseases of endocardium; endocarditisMedical management314 EDiseases of mitral valveValvuloplasty; valve replacement;medical management902 EDisorders of arteries: visceralBypass graft; surgical management18 EDissecting or ruptured aortic aneurysmSurgical management915 EGangrene; severe atherosclerosis ofarteries of extremities; diabetesmellitus with peripheral circulatorydiseaseMedical and surgical managementincluding amputation294 EGiant cell arteritis, kawasaki disease,hypersensitivity angiitisMedical management450 EHereditary haemorrhagic telangiectasiaExcision901 EHypertension acute life-threateningcomplications and malignanthypertension; renal artery stenosis andother curable hypertensionMedical and surgical management111 EInjury to major blood vessels trunk,head and neck, and upper limbsRepair19 EInjury to major blood vessels ofextremitiesLigation903 ELife-threatening cardiac arrhythmiasMedical and surgical management ,pacemakers, cardioversion900 ELife-threatening complications ofelective cardiac and major vascularproceduresMedical and surgical management497 EMultiple valvular diseaseSurgical management355 EOther aneurysm of artery peripheralSurgical management905 EOther correctable congenital cardiacconditionsSurgical repair; medical management100 EPatent ductus arteriosus.

6 Aorticpulmonary fistula persistentLigation209 EPhlebitis and thrombophlebitis, deepLigation and division; medicalmanagement914 ERheumatic pericarditis; rheumaticmyocarditisMedical management16 ERupture of papillary muscleMedical and surgical management627 EShock/hypotension life threateningMedical management ; ventilation99 ETetralogy of fallot (TOF)Total repair tetralogy93 EVentricular septal defect persistentClosureGASTRO-INTESTINAL SYSTEMCode: diagnosis :Treatment:920 FAnal fissure; anal fistulaFissurectomy; fistulectomy; medicalmanagement41 FAbscess of intestineDrain abscess; medical management489 FAcquired hypertrophic pyloric stenosisand other disorders of the stomach andduodenumSurgical management254 FAcute diverticulitis of colonMedical and surgical management ,including colon resection124 FAcute vascular insufficiency ofintestineColectomy337 FAmoebiasis; typhoidMedical management264 FAnal and rectal polypExcision of polyp9 FAppendicitisAppendectomy952 FCancer of retroperitoneum,peritoneum, omentum and mesentery treatableMedical and surgical management ,which includes chemotherapy andradiation therapy950 CCancer of the gastro-intestinal tractincluding oesophagus, stomach, bowel,rectum, anus treatableMedical and surgical management ,which includes radiation therapy andchemotherapy95 FCongenital anomalies of upperalimentary tract excluding tongueMedical and surgical management214 FOesophageal strictureDilation; surgery516 FOesophageal varicesMedical management ; surgical shunt;sclerotherapy902 FGastric or intestinal ulcers withhaemorrhage or perforationSurgery; endoscopic diagnosis ;medical management901 FGastroenteritis and colitis with life-threatening haemorrhage ordehydration, regardless of causeMedical management6 FHernia with obstruction and/organgrene; uncomplicated hernias underage 18 Repair.

7 Bowel resection20 FIntestinal obstruction without mentionof hernia; symptomatic foreign body instomach, intestines, colon and rectumExcision; surgery; medicalmanagement232 FParalytic ileusMedical management498 FPeritoneal adhesionSurgical management3 FPeritonitis, regardless of causeMedical and surgical management555 FRectal prolapsePartial colectomy292 FRegional enteritis; idiopathicproctocolitis acute exaccerbationsand complications onlyMedical and surgical management900 FRupture of intra-abdominal organRepair; splenectomy; resection507 FThrombosed and complicatedhaemorrhoidsHaemorrhoidectomy ; incisionLIVER, PANCREAS AND SPLEENCode: diagnosis :Treatment:325 GAcute necrosis of liverMedical management327 GAcute pancreatitisMedical management , and whereappropriate, surgical management36 GBudd-Chiari syndrome, and othervenous embolism and thrombosisThrombectomy/ligation910 GCalculus of bile duct with cholecystitisMedical management ;cholecystectomy; other open or closedsurgery950 GCancer of liver, biliary system andpancreas treatableMedical and surgical management255 GCyst and pseudocyst of pancreasDrainage of pancreatic cyst156 GDisorders of bile ductExcision; repair910 GGallstone with cholecystitis and/orjaundiceMedical management ;cholecystectomy; other open or closedsurgery743 GHepatorenal syndromeMedical management27 GLiver abscess; pancreatic abscessMedical and surgical management911 GLiver failure; hepatic vascularobstruction; inborn errors of livermetabolism; biliary atresiaLiver transplant, other surgery, medicalmanagement231 GPortal vein thrombosisShuntMUSCULOSKELETAL SYSTEM.

8 TRAUMA NOSCode: diagnosis :Treatment:353 HAbscess of bursa or tendonIncision and drainage32 HAcute osteomyelitisMedical and surgical management950 HCancer of bones treatableMedical and surgical management ,which includes chemotherapy andradiation therapy206 HChronic osteomyelitisIncision and drainage902 HClosed fractures/dislocations of limbbones/epiphyses excluding fingersand toesReduction/relocation85 HCongenital dislocation of hip; coxavara and valga; congenital clubfootRepair/reconstruction147 HCrush injuries of trunk, upper limbs,lower limb, including blood vesselsSurgical management ; ventilation;acute renal dialysis491 HDislocations/fractures of vertebralcolumn without spinal cord injuryMedical management ; surgicalstabilisation500 HDisruptions of the achilles/quadricepstendonsRepair178 HFracture of hipReduction; hip replacement445 HInjury to internal organsMedical and surgical management900 HOpen fracture/dislocation of bones orjointsReduction/relocation; medical andsurgical management34 HPyogenic arthritisMedical and surgical management901 HTraumatic amputation of limbs, hands,feet, and digitsReplantation/amputationSKIN AND BREASTCode: diagnosis :Treatment:465 JAcute lymphadenitisIncision and drainage; medicalmanagement900 JBurns, greater than 10% of bodysurface, or more than 5% involvinghead, neck, hands, perineumDebridement; free skin graft; medicalmanagement950 JCancer of breast treatableMedical and surgical management ,which includes chemotherapy andradiation therapy954 JCancer of skin, excluding malignantmelanoma treatableIf histologically confirmed, medicaland surgical management , whichincludes radiation therapy952 JCancer of soft tissue, includingsarcomas and malignancies of theadnexa treatableMedical and surgical management ,which includes chemotherapy andradiation therapy349 JCellulitis and abscesses with risk oforgan or limb damage or septicemia ifuntreated.

9 Necrotising fasciitisMedical and surgical management901 JDisseminated bullous skin disease,including pemphigus, pemphigoid,epidermolysis bullosa, epidermolytichyperkeratosisMedical management951 JLethal midline granulomaMedical management , which includesradiation therapy953 JMalignant melanoma of the skin treatableMedical and surgical management ,whic