ITAP MANAGED CARE WORKING GROUP TASK TEAM 1: … Documents... · 2018-04-05 · ITAP TT1 MC - Glaucoma – Sept 17 1 ITAP MANAGED CARE WORKING GROUP TASK TEAM 1: CHRONIC DISEASE CONDITIONS

ITAP TT1 MC - Glaucoma – Sept 17

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ITAP MANAGED CARE WORKING GROUP

TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL’s)

– GLAUCOMA –

Explanatory note to the Managed Care minimum reporting data specification (excelspreadsheet)

The aim of the project is to measure the value added by managed care organisations, by means of capturing, measuring and reporting onclinical process indicators to demonstrate the clinical outcome/s achieved. Hence this is by no means a representation of the full protocol,policy or guideline on Glaucoma management.

Additionally, these process indicators and or outcomes achieved will be reported on within the Annual statutory returns.


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Meetings and discussions were held with industry representatives and subject matter experts prior to finalising the minimum dataspecification.

1) Goal

The value of managing a disease is to establish measurable goals that result in quality of care.(Diagnosis, treatment and care of all beneficiaries should be in line with evidence base medicine, cost effectiveness and affordability).

· Maintain the individuals visual function and related quality of life at a sustainable cost.· Lower IOP and slow rate of visual field deterioration. Target IOP is specific to each individual.· Prevent complications and optimally manage the progression of disease.

2) Identification of beneficiaries that have Glaucoma / or registered on a managed care program

Please ensure the relevant consent has been obtained and confidentially maintained when obtaining personal health information.

Identification of beneficiaries registered on the program may include· Registered on chronic and or disease management programs· ICD-10 Codes or other relevant clinical coding· Anatomical Therapeutic Chemical Classification System (ATC Class)· National stock numbers (State stock code)

3) Minimum data specification: Process indicators, clinical outcomes and data

The level of Active Management of Glaucoma will depend on the nature of the contract, the level of services covered and the feestructure for those services, e.g. screening, medication, procedures etc.

http://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System


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The minimum required fields for the effective collection of appropriate data to demonstrate the value of the managed careinterventions for the below mentioned categories are detailed by way of process indicators (see attached spreadsheet).

· Diagnosis

The diagnosis of Glaucoma is made by the specified registered practitioner.o Congenital Glaucomao Closed Angle Glaucomao Open Angle Glaucoma

· Investigationso Tonometryo Fundus examinationo Gonooiscopyo Disc and Nerve Fibre layer analysiso Disc Photographyo Optical coherence tomographyo Central corneal thickness measurement

· Discipline Type

The service providers must be registered with their relevant statutory bodies and as indicated by discipline coded list providedby BHF.

4) Treatment – Glaucoma

Congenital Glaucoma Closed Angle Glaucoma Open Angle Glaucoma

Surgery / Medication Medication, Laser and / or Drainage /Cataract Surgery

Medication (first line / Second line)

Drainage surgery


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Medication:

- S01E - Antiglaucoma preparations and miotics

* Please note these recommendations do not replace the published algorithms, PMB entitlements etc. It is a means of measuring thevalue and quality of care provided.

* The above is merely the initial phase of the ITAP Task Team 1- CDL project and as such is not exhaustive.

Full details can be seen on the accompanying excel spreadsheets.

5) Clinical Outcomes measures

· Number of all cause admissions· Number of admissions for Glaucoma· Number of Beneficiaries treated on medication alone· Number of Beneficiaries that had surgery· Number of beneficiaries that had repeated surgery / theatre· Cost of medication pre-surgery versus post-surgery

* Information in regards to ICD-10 coding may be found on the following sitehttp://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11

6) Reporting (MCO and Scheme)*Definitions will be the same utilised within the Annual statutory returns – see Circular 10 of 2015. For full detailshttp://www.medicalschemes.com/files/Circulars/Circular10Of2015.pdf

All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to theservice rendered by your organisation.

http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11

http://www.medicalschemes.com/files/Circulars/Circular10Of2015.pdf


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6.1 By Managed Care Organisation: Management out of hospital

- Time period: Benefit year (Reporting period – Start and end)- Per benefit option- Per Scheme- Member- Beneficiary- Service Date (Benefit Year)- Gender – Male / Female- Age (Age of the beneficiary is to be calculated as the Year of Reporting - Year of Birth)

a) Program Demographics

Year: Bi-Annual

Actual number of beneficiariesregistered for Glaucoma on thePharmacy Benefit and or Activedisease management program

(Longer than 6 months onprogram)

Number of new registrations inthe period

Number of beneficiaries who leftprogram *

Male Female Male Female Male FemaleUnder 11 to 44 to 910 to 1415 to 1920 to 2425 to 2930 to 34


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35 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 8485 andaboveTotal

*Left the program – This may include various reason codes i.e. left the scheme, death, suspensions etc.

b) Clinical Management

Year:Annual

Total Number of beneficiariestreated with medication only

Total Number of Beneficiaries thathad surgery (Laser / DrainageSurgery)

Total Number of Beneficiariesidentified with 2 or more co-morbidities

AgeGroups Female Male Female Male Male Female

Under 11 to 44 to 910 to 14


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15 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 8485 andaboveTotal

Co-morbiditieso Hypertensiono Diabeteso Eye Injuryo Cortisone use

6.2 Management in Hospital

- Time period: 1 January to 31 December (Service dates / financial year), define per quarter- Per benefit option- Per Scheme- Hospital Admissions:


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o All cause admissionso Glaucoma admissions

- Hospital Categoryo Day Admissiono Long Stayo Readmission

- Gender- Age

Admission definitions

§ Glaucoma related admission - please refer to attached list of ICD10 Codes.§ Mortality / Exit codes – Where a hospital notifies the schemes / MCO / Administrator that a member is

deceased. See attached§ Emergency room – Definition as per Circular 10 of 2015§ Hospital admission

· A day case is when admission day is same as discharge date

· A long stay is when discharge date is after the admission day.

· A re-admission is when a patient from hospital is readmitted within 90 days of previous discharge date.


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a) Hospital Category: Day Case

Scheme Total numberof

admissions(All Cause)

Total numberof admissions

(Glaucoma)Related

Admission per category Mortality(Exit

Codes =Expire)

Claimedamount

Riskpaid

amountSurgical Medical Paediatric EmergencyRoom (Only)

Male Female Male Female Male Female Male Female

b) Hospital Category: Long Stay



Total numberof related

admissions(Glaucoma)


Codes =Expire)

Claimedamount

Riskpaid



c) Hospital Category: Re-admission




admissions(Glaucoma)


Codes =Expire)

Claimedamount

Riskpaid



7) References· Task Team 1 of the Managed Care ITAP working group;· Standard treatment guidelines and Essential medicine list· Circular 10 of 2015· South African Glaucoma Society

Entry andVerification

ProcessIndicators

Disease ManagementProgram Algorithm Outcomes Data Spec

ICD10 Description ATC Class ATC Class Investigation Tariff Code Tariff Description Program Algorithm Outcome Data specsH40 Glaucoma S01E Antiglaucoma preparations and miotics Initial Diagnosis Date of Diagnosis CDL Algorithm No of hosp admissions (All Cause) MembershipH40.0 Glaucoma suspect 3009

Basic capital equipment used in own rooms by ophthalmologists. Only to becharged at first and follow-up consultations. Not to be charged for post-operativefollow-up consultations Date of Registration No of hosp admissions (Glaucoma) Scheme name

H40.1 Primary open-angle glaucoma 3014 Tonometry per test with maximum of 2 tests for provocative tonometry (one or botheyes) Number of beneficiaries treated with medication only Option name

H40.2 Primary angle-closure glaucoma 3003 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 oritem 3012) Numer of beneficiaries that underwent surgery Member No

H40.3 Glaucoma secondary to eyetrauma

3002Gonioscopy Dependent code

H40.4 Glaucoma secondary to eyeinflammation

3026 Digital Tomography of optic nerve with Scanning Laser Ophthalmoscope (SLO).Limited to two exams per annum Number of beneficiaries who post surgery Date of birth

H40.5 Glaucoma secondary to other eyedisorders

3027Fundus photography 0-5 days post-operative procedure - Theatre revisist Gender

H40.6 Glaucoma secondary to drugs 3028 Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye - annual Repeat surgery - 60 to 360 days post initial surgeryH40.8 Other glaucoma 3017 Retinal threshold test inclusive of computer disc storage for Delta of Statpak

programs - annual ClaimsH40.9 Glaucoma, unspecified 3020 Special eye investigations: Pachymetry: Only when own instrument is used, per

eye. Only in addition to corneal surgery (once per life) Number of drops before vs after surgery (180days) Date of serviceH42.8 Glaucoma in other diseases

classified elsewhere Cost of drops before surgery versus cost of drops after surgery Doctor typeQ15.0 Congenital glaucoma Practice number

3026 Digital Tomography of optic nerve with Scanning Laser Ophthalmoscope (SLO).Limited to two exams per annum (Old technology) ICD -10 Code

Other 3027 Fundus photography (Annually) DSP: Y or NH42 Glaucoma in diseases classified

elsewhere3028

Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye Tariff Code / UPFSH42.0 Glaucoma in endocrine,

nutritional and metabolic diseases3018

Retinal threshold trend evaluation (additional to item 3017) (Annually) Nappi codes

3020Special eye investigations: Pachymetry: Only when own instrument isused, per eye. Only in addition to corneal surgery (Once in life time) ATC Class

3009 Basic capital equipment used in own rooms by ophthalmologists. Only to becharged at first and follow-up consultations. Not to be charged for post-operativefollow-up consultations. (x3 per year) CPT Code

3014 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 oritem 3012) (x3 per year) Claimed Amount

3003 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 oritem 3012) (x3 per year) Benefit Amount

3002 Gonioscopy. (x3 per year) Member Amount3017 Retinal threshold test inclusive of computer disc storage for Delta of Statpak

programs. (x2 per year) Length of StayLevel of Care

Surgery Exit Reason code

3021

Special eye investigations: Retinal function assessment including refractionafter ocular surgery (within four months), maximum two examinations.(x2 per year)

3080Examination of eyes under general anaesthetic where no surgery is done.(x4 per year) Clinical results

FEV13061 Drainage operation

3062Implantation of aqueous shunt device/seton in glaucoma (additional toitem 3061)

3063 Cyclocryotherapy or cyclodiathermy Program3064 Laser trabeculoplasty Date of Diagnosis3065 Removal of blood from anterior chamber Date of Registration3067 Goniotomy3149 Iridectomy or iridotomy by open operation as isolated procedure

3153Iridectomy or iridotomy by laser or photocoagulation as isolatedprocedure (maximum one procedure)

3157 Division of anterior synechiae as isolated procedure3158 Repair iris as in dialysis: Anterior chamber reconstruction3199 Repair of conjunctiva by grafting3196 Diamond knife: Use of own diamond knife during intraocular surgery

3201Laser apparatus (ophthalmic): Hire fee for one or both eyes done in onesitting (Not to be used with IOL Master)

Management

GlaucomaSurgery

CPT Code Description65855 Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series)66150 Fistulisation of sclera for glaucoma; trephination with iridectomy66155 Fistulisation of sclera for glaucoma; thermocauterisation with iridectomy66160 Fistulisation of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy66165 Fistulisation of sclera for glaucoma; iridencleisis or iridotasis66170 Fistulisation of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery66172 Fistulisation of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma

(includes injection of antifibrotic agents)

ITAP TT1 MC - Haemophilia _Sept 2017

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ITAP MANAGED CARE WORKING GROUP

TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL’s)

– HAEMOPHILIA –

Explanatory note to the Managed Care minimum reporting data specification (excelspreadsheet)

The aim of the project is to measure the value added by managed care organisations, by means of capturing, measuring and reporting onclinical process indicators to demonstrate the clinical outcome/s achieved. Hence this is by no means a representation of the full protocol,policy or guideline on Haemophilia management.

Additionally, these process indicators and or outcomes achieved will be reported on within the Annual statutory returns.


2

Meetings and discussions were held with industry representatives and subject matter experts prior to finalising the minimum dataspecification.

1) Goal

The value of managing a disease is to establish measurable goals that result in quality of care.(Diagnosis, treatment and care of all beneficiaries should be in line with evidence base medicine, cost effectiveness and affordability).

· Prevent complications and optimally manage the progression of disease.

2) Identification of beneficiaries that have Haemophilia/ or registered on a managed care program

Please ensure the relevant consent has been obtained and confidentially maintained when obtaining personal health information.

Identification of beneficiaries registered on the program may include· Registered on chronic and or disease management programs· ICD-10 Codes or other relevant clinical coding· Anatomical Therapeutic Chemical Classification System (ATC Class)· National stock numbers (State stock code)

3) Minimum data specification: Process indicators, clinical outcomes and data

The level of Active Management of Haemophilia will depend on the nature of the contract, the level of services covered and the feestructure for those services, e.g. screening, medication, procedures etc.

The minimum required fields for the effective collection of appropriate data to demonstrate the value of the managed careinterventions for the below mentioned categories are detailed by way of process indicators (see attached spreadsheet).

http://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System


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· Diagnosis

The diagnosis of Haemophilia is made by the specified registered practitioner.Distinguish between hereditary and acquired haemophilia

· InvestigationsPathology (Blood)

o Factor VIII related antigeno Coagulation factors: Quantitativeo Full blood counto Platelet counto Fibrinogen titreo Partial thromboplastin timeo Prothrombin indexo Therapeutic drug level: Dosageo Bleeding timeo Blood volume, dye methodo Coagulation factor inhibitor assay

ScreeningDue to continuation treatment and receiving plasma product, beneficiaries to be screened for

o HIVo Hepatitis

Pregnancy – beneficiaries that are at risk to be screened and offered genetic counselling.

· Discipline Type

The service providers must be registered with their relevant statutory bodies and as indicated by discipline coded list providedby BHF.

4) Treatment – Haemophilia


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ATC Description

B02AA02 Tranexamic acidB02BD02 Coagulation factor VIIIB02BD03 Factor VIII inhibitor bypassing activityB02BD08 Eptacog Alfa (Activated)B02BD04 Coagulation factor IX

B02BD06Von Willebrand factor and coagulation factor VIII incombination

H01BA Vasopressin and analoguesH01BA02 Desmopressin

* Please note these recommendations do not replace the published algorithms, PMB entitlements etc. It is a means of measuring thevalue and quality of care provided.

* The above is merely the initial phase of the ITAP Task Team 1- CDL project and as such is not exhaustive.

Full details can be seen on the accompanying excel spreadsheets.

5) Clinical Outcomes measures

· Number of all cause admissions· Number of admissions for haemophilia

§ Major Bleeds§ Minor Bleeds

· Number of beneficiaries with target joints


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· All-cause mortality

* Information in regards to ICD-10 coding may be found on the following sitehttp://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11

6) Reporting (MCO and Scheme)*Definitions will be the same utilised within the Annual statutory returns – see Circular 10 of 2015. For full detailshttp://www.medicalschemes.com/files/Circulars/Circular10Of2015.pdf

All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to theservice rendered by your organisation.

6.1 By Managed Care Organisation: Management out of hospital

- Time period: Benefit year (Reporting period – Start and end)- Per benefit option- Per Scheme- Member- Beneficiary- Service Date (Benefit Year)- Gender – Male / Female- Age (Age of the beneficiary is to be calculated as the Year of Reporting - Year of Birth)

a) Program Demographics

Year: Bi-Annual

Actual number of beneficiariesregistered for Haemophilia on thePharmacy Benefit and or Activedisease management program

(Longer than 6 months on

Number of new registrations inthe period

Number of beneficiaries who leftprogram *

http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11

http://www.medicalschemes.com/files/Circulars/Circular10Of2015.pdf


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program)Male Female Male Female Male Female

Under 11 to 44 to 910 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 8485 andaboveTotal

*Left the program – This may include various reason codes i.e. left the scheme, death, suspensions etc.

b) Clinical Management


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Year:Annual

Number of beneficiaries withMinor /Major Bleedsadmissions

Number of beneficiaries withtarget joints

Number of beneficiariestreated with Radio-Isotopes Total Number of Beneficiaries

identified with 2 or more co-morbidities

AgeGroups Female Male Female Male

Female MaleMale Female

Under 11 to 44 to 910 to 1415 to 1920 to 2425 to 2930 to 3435 to 3940 to 4445 to 4950 to 5455 to 5960 to 6465 to 6970 to 7475 to 7980 to 8485 andaboveTotal

6.2 Management in Hospital

- Time period: 1 January to 31 December (Service dates / financial year), define per quarter


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- Per benefit option- Per Scheme- Hospital Admissions:

o All cause admissionso Haemophilia admissions

- Hospital Categoryo Day Admissiono Long Stayo Re-admission

- Gender- Age

Admission definitions

§ Haemophilia related admission - please refer to attached list of ICD10 Codes.§ Mortality / Exit codes – Where a hospital notifies the schemes / MCO / Administrator that a member is

deceased. See attached§ Emergency room – Definition as per Circular 10 of 2015§ Hospital admission

· A day case is when admission day is same as discharge date

· A long stay is when discharge date is after the admission day.

· A re-admission is when a patient from hospital is readmitted within 90 days of previous discharge date.


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a) Hospital Category: Day Case

Scheme Total number ofadmissions (All

Cause)

Total number ofadmissions

(HaemophiliaRelated)

Admission per category Mortality(Exit Codes

= Expire)

Claimedamount

Riskpaid



b) Hospital Category: Long Stay




admissions(Haemophilia)


Codes =Expire)

Claimedamount

Riskpaid

amountSurgical ICU / SICU /HC

Medical Paediatric EmergencyRoom (Only)

Male Female Male Female Male Female Male Female Male Female

c) Hospital Category: Re-admission

Scheme Total numberof admissions

(All Cause)

Total number ofrelated admissions

(Haemophilia)

Admission per category Mortality(Exit Codes

= Expire)

Claimedamount

Riskpaid



7) References· Task Team 1 of the Managed Care ITAP working group;· Standard treatment guidelines and Essential medicine list· Circular 10 of 2015· Haemophiliac Society

Disease ManagementProgram Algorithm Outcomes Data Spec

ICD10 Description - Haemophilia ATC Class ATC Class Investigation Tariff Code Tariff Description Program Algorithm Outcome Data specsD66 Hereditary factor VIII deficiency Haemophilia (Hereditary) Date of Diagnosis CDL Alogrithm No of hosp admissions (All Cause) MembershipD67 Hereditary factor IX deficiency B02AA02 Tranexamic acid FBC 3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) Date of Registration No of hosp admissions (Hemophilia) Scheme name

B02BD02 Coagulation factor VIII Platelets 3797 Platelet count Casualty visits Option name

Haemophilia (Acquired) B02BD03 Factor VIII inhibitor bypassing activityPlatelet functionstudies 3795 Platelet aggregation per aggregant (require a min of 6) Mortality (all cause) Member No

D68.4 Acquired coagulation factor deficiency B02BD08 Eptacog Alfa (Activated factor VIIa) Fibrogen 3825 Fibrinogen titre Number of Surgeries (Frequency) Dependent code

B02BD04 Coagulation factor IXVon Willebrandfactor

3758Factor VIII related antigen (determine severity) (initial workup) Number of Radio Isotopes (frequency) Date of birth

B02BD06Von Willebrand factor and coagulation factor VIII incombination

Factor XIIIQuantitive

3757Coagulation factors: Quantitative

Number of beneficiaries with 'complications' (See secondary codestab) per system Gender

H01BA02 DesmopressinFactor XIIIQualitative 3744 Fibrin stabilizing factor (urea test) Number of beneficairies with target jointsPTT 3837 Partial thromboplastin time (Mixing studies x3) Claims

Thrombin time 3841 Thrombin time (screen)

Radio IsotopesSee attachedATC codes Number of beneficiaries treated with radio-Isotopes Date of service

Ristocetin co-factor 3857 Ristocetin Cofactor Doctor typeINR 3805 Prothrombin index Practice numberDrug Levels 3806 Therapeutic drug level: Dosage ICD -10 CodeD-Dimer(qualitative) 3854 XDP (Dimer test or equivalent latex slide test) DSP: Y or ND- Dimer(Quantatitive) 3856 D-Dimer (quantitative) Tariff Code / UPFSFDP 3853 Fibrin degeneration products (latex slide) Nappi codes

ATC ClassRadiology X-rays Fractures / target joint CPT Code

MRI On motivation Claimed AmountBenefit AmountMember Amount

INR 3724 Coagulation factor inhibitor assay Length of StayFBC 3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) Level of CarePlatelets 3797 Platelet count Arthropathy Exit Reason codeINR 3805 Prothrombin indexFactor XIIIQuantitive

3757Coagulation factors: Quantitative (per algorithm) Clinical results

Factor XIIIQualitative 3744 Fibrin stabilizing factor (urea test) FEV1

HIV antibodies 3932 Antibodies to human immunodeficiency virus (HIV): ELISA Program3999 Albumin Date of Diagnosis4001 Alkaline phosphatase Date of Registration4131 Alanine aminotransferase (ALT)4009 Bilirubin: Total4010 Bilirubin: Conjugated4117 Protein: Total4130 Aspartate aminotransferase (AST)4134 Gamma glutamyl transferase (GGT)4531 Hepatitis: Per antigen or antibody3942 Hepatitis Rapid Viral Ab

Genetic testing (Factor 8 and 9) - Once off (Maternity to be screened)Genetic councellor

8101 Oral examination8102 Comprehensive oral examination

501Rehabilitation where the pathology requires the undivided attention of thephysiotherapist. Rule 008 does not apply. Duration: 30min.

502

Hydrotherapy where the pathology requires the undivided attention of thephysiotherapist. Rule 008 does not apply. Duration: 30min.

Home RX Nursing - 88 practice

030

Where a consultation was not performed and the nurse attended to or visited thepatient with the sole purpose of administering intramuscular or intravenousmedication. The route of administration of medication to be stated, as well as thename of the medication. Oral, rectal, vaginal medication excluded as well as theapplication of topical medicine.

Note:* first 20 exposures to be performed in a facility with emergency facilities

Target jointA target joint is a joint in which 3 or more spontaneous bleeds have occurred withina consecutive 6-month period.

DentalScreening (Bi-

Nurse (88)

Entry and Verification Process Indicators

Screening (Plasma products given hence screening) - Annually

Hepatitis

Liver FunctionTest (annual)

Physiotherapy -Rehabilitation

Diagnostic

Management

Tariff CodeTariff Description

3641 Tracer test3642 Repeat of further tracer tests for same investigation: Half of above fee

3643If both tracer and therapeutic procedures are done, half fee of tracer test to be chargedplus therapeutic fee

3645 Other organ scanning with use of relevant radio isotopes

WHOATC DescriptionV09 Diagnostic radiopharmaceuticalsV09A Central nervous systemV09AA Technetium (99mTc) compoundsV09AA01 Technetium (99mTc) exametazimeV09AA02 Technetium (99mTc) bicisateV09AB Iodine (123I) compoundsV09AB01 Iodine iofetamine (123I)V09AB02 Iodine iolopride (123I)V09AB03 Iodine ioflupane (123I)V09AX Other central nervous system diagnostic radiopharmaceuticalsV09AX01 Indium (111In) pentetic acidV09AX02 Fludeoxyglucose (18F)V09AX03 Iodine (124I) 2beta-carbomethoxy-3beta-(4 iodophenyl)-tropaneV09AX04 Flutemetamol (18F)V09AX05 Florbetapir (18F)V09AX06 Florbetapen (18F)V09B SkeletonV09BA Technetium (99mTc) compoundsV09BA01 Technetium (99mTc) oxidronic acidV09BA02 Technetium (99mTc) medronic acidV09BA03 Technetium (99mTc) pyrophosphateV09BA04 Technetium (99mTc) butedronic acidV09C Renal systemV09CA Technetium (99mTc) compoundsV09CA01 Technetium (99mTc) pentetic acidV09CA02 Technetium (99mTc) succimerV09CA03 Technetium (99mTc) mertiatideV09CA04 Technetium (99mTc) gluceptateV09CA05 Technetium (99mTc) gluconateV09CA06 Technetium (99mTc) ethylenedicysteineV09CX Other renal system diagnostic radiopharmaceuticalsV09CX01 Sodium iodohippurate (123I)V09CX02 Sodium iodohippurate (131I)V09CX03 Sodium iothalamate (125I)V09CX04 Chromium (51Cr) edetateV09D Hepatic and reticulo endothelial systemV09DA Technetium (99mTc) compoundsV09DA01 Technetium (99mTc) disofeninV09DA02 Technetium (99mTc) etifeninV09DA03 Technetium (99mTc) lidofenin

V09DA04 Technetium (99mTc) mebrofeninV09DA05 Technetium (99mTc) galtifeninV09DB Technetium (99mTc), particles and colloidsV09DB01 Technetium (99mTc) nanocolloidV09DB02 Technetium (99mTc) microcolloidV09DB03 Technetium (99mTc) millimicrospheresV09DB04 Technetium (99mTc) tin colloidV09DB05 Technetium (99mTc) sulfur colloidV09DB06 Technetium (99mTc) rheniumsulfide colloidV09DB07 Technetium (99mTc) phytateV09DX Other hepatic and reticulo endothelial system diagnostic radiopharmaceuticalsV09DX01 Selenium (75Se) tauroselcholic acidV09E Respiratory systemV09EA Technetium (99mTc), inhalantsV09EA01 Technetium (99mTc) pentetic acidV09EA02 Technetium (99mTc) technegasV09EA03 Technetium (99mTc) nanocolloidV09EB Technetium (99mTc), particles for injectionV09EB01 Technetium (99mTc) macrosalbV09EB02 Technetium (99mTc) microspheresV09EX Other respiratory system diagnostic radiopharmaceuticalsV09EX01 Krypton (81mKr) gasV09EX02 Xenon (127Xe) gasV09EX03 Xenon (133Xe) gasV09F ThyroidV09FX Various thyroid diagnostic radiopharmaceuticalsV09FX01 Technetium (99mTc) pertechnetateV09FX02 Sodium iodide (123I)V09FX03 Sodium iodide (131I)V09FX04 Sodium iodide (124I)V09G Cardiovascular systemV09GA Technetium (99mTc) compoundsV09GA01 Technetium (99mTc) sestamibiV09GA02 Technetium (99mTc) tetrofosminV09GA03 Technetium (99mTc) teboroximeV09GA04 Technetium (99mTc) human albuminV09GA05 Technetium (99mTc) furifosminV09GA06 Technetium (99mTc) stannous agent labelled cellsV09GA07 Technetium (99mTc) apcitideV09GB Iodine (125I) compoundsV09GB01 Fibrinogen (125I)V09GB02 Iodine (125I) human albuminV09GX Other cardiovascular system diagnostic radiopharmaceuticalsV09GX01 Thallium (201Tl) chlorideV09GX02 Indium (111In) imciromabV09GX03 Chromium (51Cr) chromate labelled cellsV09GX04 Rubidium (82RB) chlorideV09H Inflammation and infection detectionV09HA Technetium (99mTc) compoundsV09HA01 Technetium (99mTc) human immunoglobulin

V09HA02 Technetium (99mTc) exametazime labelled cellsV09HA03 Technetium (99mTc) antigranulocyte antibodyV09HA04 Technetium (99mTc) sulesomabV09HB Indium (111In) compoundsV09HB01 Indium (111In) oxinate labelled cellsV09HB02 Indium (111In) tropolonate labelled cellsV09HX Other diagnostic radiopharmaceuticals for inflammation and infection detectionV09HX01 Gallium (67Ga) citrateV09I Tumour detectionV09IA Technetium (99mTc) compoundsV09IA01 Technetium (99mTc) antiCarcinoEmbryonicAntigen antibodyV09IA02 Technetium (99mTc) antimelanoma antibodyV09IA03 Technetium (99mTc) pentavalent succimerV09IA04 Technetium (99mTc) votumumabV09IA05 Technetium (99mTc) depreotideV09IA06 Technetium (99mTc) arcitumomabV09IA07 Technetium (99mTc) hynic-octreotideV09IA08 Technetium (99m Tc) etarfolatideV09IA09 Technetium (99m Tc) tilmanoceptV09IB Indium (111In) compoundsV09IB01 Indium (111In) pentetreotideV09IB02 Indium (111In) satumomab pendetideV09IB03 Indium (111In) antiovariumcarcinoma antibodyV09IB04 Indium (111In) capromab pendetideV09IX Other diagnostic radiopharmaceuticals for tumour detectionV09IX01 Iobenguane (123I)V09IX02 Iobenguane (131I)V09IX03 Iodine (125I) CC49-monoclonal antibodyV09IX04 Fludeoxyglucose [18F]V09IX05 Fluorodopa (18F)V09IX06 sodium fluoride (18F)V09IX07 Fluoromethylcholine (18F)V09IX08 Fluoroethylcholine (18F)V09IX09 Gallium (68Ga) edotreotideV09IX10 Fluoroethyl-L-tyrosine (18F)V09IX11 Fluoroestradiol (18F)V09IX12 Fluciclovine (18F)V09X Other diagnostic radiopharmaceuticalsV09XA Iodine (131I) compoundsV09XA01 Iodine (131I) norcholesterolV09XA02 Iodocholesterol (131I)V09XA03 Iodine (131I) human albuminV09XX Various diagnostic radiopharmaceuticalsV09XX01 Cobalt (57Co) cyanocobalamineV09XX02 Cobalt (58Co) cyanocobalamineV09XX03 Selenium (75Se) norcholesterolV09XX04 Ferric (59Fe) citrate

V10 Therapeutic radiopharmaceuticalsV10A Antiinflammatory agents

V10AA Yttrium (90Y) compoundsV10AA01 Yttrium (90Y) citrate colloidV10AA02 Yttrium (90Y) ferrihydroxide colloidV10AA03 Yttrium (90Y) silicate colloidV10AX Other antiinflammatory therapeutic radiopharmaceuticalsV10AX01 Phosphorous (32P) chromicphosphate colloidV10AX02 Samarium (153Sm) hydroxyapatite colloidV10AX03 Dysprosium (165Dy) colloidV10AX04 Erbium (169Er) citrate colloidV10AX05 Rhenium (186Re) sulfide colloidV10AX06 Gold (198Au) colloidalV10B Pain palliation (bone seeking agents)V10BX Various pain palliation radiopharmaceuticalsV10BX01 Strontium (89Sr) chlorideV10BX02 Samarium (153Sm) lexidronamV10BX03 Rhenium (186Re) etidronic acidV10X Other therapeutic radiopharmaceuticalsV10XA Iodine (131I) compoundsV10XA01 Sodium iodide (131I)V10XA02 Iobenguane (131I)V10XA53 Tositumomab/iodine (131I) tositumomabV10XX Various therapeutic radiopharmaceuticalsV10XX01 Sodium phosphate (32P)V10XX02 Ibritumomab tiuxetan[90Y]V10XX03 Radium (223 Ra) dichloride

Discipline Sub-discipline Discipline-description Sub-Discipline description002 000 Nutritionist003 000 Accredited Blood and Blood Product Couriers004 000 Chiropractors008 000 Homoeopaths009 001 Ambulance Service Basic Life Support Service009 002 Ambulance Service Intermediate Life Support Service009 003 Ambulance Service Advance Life Support Service009 004 Ambulance Service Provincial Ambulance Service010 000 Anaesthetists012 000 Dermatology014 000 General Medical Practice015 000 Specialist Family Medicine016 000 Independent Practice Specialist Obstetrics and Gynaecology016 001 Independent Practice Sub Specialist Obstetrics and Gynaecology Critical Care016 002 Independent Practice Sub Specialist Obstetrics and Gynaecology Gynaecological Oncology016 003 Independent Practice Sub Specialist Obstetrics and Gynaecology Medical Genetics016 004 Independent Practice Sub Specialist Obstetrics and Gynaecology Maternal and Foetal Medicine016 005 Independent Practice Sub Specialist Obstetrics and Gynaecology Reproductive Medicine016 006 Independent Practice Sub Specialist Obstetrics and Gynaecology Infectious Diseases017 000 Pulmonology018 000 Independent Practice Specialist Medicine018 001 Independent Practice Subspecialist Medicine Clinical Haematology018 002 Independent Practice Subspecialist Medicine Nephrology018 003 Independent Practice Subspecialist Medicine Cardiology018 004 Independent Practice Subspecialist Medicine Endocrinology018 005 Independent Practice Subspecialist Medicine Pulmonology018 006 Independent Practice Subspecialist Medicine Critical Care018 007 Independent Practice Subspecialist Medicine Geriatric Medicine018 008 Independent Practice Subspecialist Medicine Medical Genetics018 009 Independent Practice Subspecialist Medicine Infectious Diseases018 010 Independent Practice Subspecialist Medicine Gastroenterology018 011 Independent Practice Subspecialist Medicine Medical Oncology018 012 Independent Practice Subspecialist Medicine Rheumatology019 000 Gastroenterology020 000 Neurology021 000 Cardiology021 001 Cardiology Independent Practice Sub Specialist Medicine021 002 Cardiology Independent Practice Sub Specialist Paediatrics021 003 Cardiology Independent Practice Sub Specialist Special Merit022 000 Psychiatry023 000 Medical Oncology024 000 Independent Practice Specialist Neurosurgery024 001 Independent Practice Sub Specialist Neurosurgery Critical Care025 000 Nuclear Medicine026 000 Ophthalmology027 000 Clinical Haemotology027 001 Clinical Haematology Independent Practice Sub Specialist Pathology (Haematological)027 002 Clinical Haematology Paediatrics027 003 Clinical Haematology Medicine028 000 Orthopaedics029 000 Occupational Medicine Independent Practice Specialist

030 000 Otorhinolaryngology031 000 Rheumatology032 000 Paediatrics Independent Practice Specialist032 001 Paediatrics Independent Practice Sub Specialist Neurology032 002 Paediatrics Independent Practice Sub Specialist Developmental Paediatrics032 003 Paediatrics Independent Practice Sub Specialist Medical Oncology032 004 Paediatrics Independent Practice Sub Specialist Infectious Diseases032 005 Paediatrics Independent Practice Sub Specialist Medical Genetics032 006 Paediatrics Independent Practice Sub Specialist Endocrinology032 007 Paediatrics Independent Practice Sub Specialist Gastroenterology032 008 Paediatrics Independent Practice Sub Specialist Neonatology032 009 Paediatrics Independent Practice Sub Specialist Pulmonology032 010 Paediatrics Independent Practice Sub Specialist Rheumatology032 011 Paediatrics Independent Practice Sub Specialist Nephrology032 012 Paediatrics Independent Practice Sub Specialist Critical Care032 013 Paediatrics Independent Practice Sub Specialist Cardiology032 014 Paediatrics Independent Practice Sub Specialist Clinical Haematology034 000 Physical Medicine035 000 Emergency Medicine Independent Practice Specialist036 000 Plastic and Reconstructive Surgery037 000 Medical technology037 001 Medical technology Blood Transfusion Technology037 002 Medical technology Cardiology037 003 Medical technology Chemical Pathology037 004 Medical technology Clinical Pathology037 005 Medical technology Cytotechnology037 006 Medical technology Forensic Pathology037 007 Medical technology Haematology037 008 Medical technology Histopathological Technique037 009 Medical technology Lung Function037 010 Medical technology Microbiology037 011 Medical technology Parasitology037 012 Medical technology Pharmacology037 013 Medical technology Virology037 014 Medical technology Immunology037 015 Medical technology Radio-Isotope Technology038 000 Diagnostic Radiology039 000 Radiography039 001 Radiography Diagnosis039 002 Radiography Therapy039 003 Radiography Nuclear Medicine039 004 Radiography Ultrasound040 000 Independent Practice Specialist Radiation Oncology042 000 Surgery Independent Practice Specialist042 001 Surgery Independent Practice Sub Specialist Vascular Surgery042 002 Surgery Independent Practice Sub Specialist Critical Care042 003 Surgery Independent Practice Sub Specialist Gastroenterology042 005 Surgery Independent Practice Sub Specialist Trauma Surgery044 000 Cardio Thoracic Surgery046 000 Urology047 000 Drug & Alcohol Rehab (Department of Health)047 001 Drug & Alcohol Rehab (Welfare)

048 000 Travel Clinic049 001 Sub-Acute Facilities General Care049 002 Sub-Acute Facilities Psychiatry049 003 Sub-Acute Facilities Physical Rehab049 004 Sub-Acute Facilities All Services049 005 Sub-Acute Facilities Post Natal Unit049 006 Sub-Acute Facilities Psychiatric/Post Natal049 007 Sub-Acute Facilities Rehab/Post Natal049 008 Sub-Acute Facilities Specialised Psychiatric Unit Only050 000 Group practices050 009 Group Practice Primary Care050 010 Delayed Children Development Clinic WELFARE & DOH051 000 Group practices/Hospitals052 000 Pathology Independent Practice Specialist052 001 Pathology Independent Practice Sub-Specialist Anatomy052 002 Pathology Independent Practice Sub-Specialist Chemical052 003 Pathology Independent Practice Sub-Specialist Clinical052 004 Pathology Independent Practice Sub-Specialist Forensic052 006 Pathology Independent Practice Sub-Specialist Medical Genetics052 007 Pathology Independent Practice Sub-Specialist Microbiology052 008 Pathology Independent Practice Sub-Specialist Infectious Diseases052 009 Pathology Independent Practice Sub-Specialist Virology054 000 General Dental Practice055 000 Mental Health Institutions056 000 Provincial Hospitals056 001 Provincial Hospitals District Hospital056 002 Provincial Hospitals Regional Hospital056 003 Provincial Hospitals Tertiary/Academic Hospital056 004 Provincial Hospitals DOH Oral healthcare Centre056 009 Provincial Hospitals Primary Care056 010 Provincial Hospitals DOH Orthotics & Prosthetics Centre056 011 Provincial Hospitals Central Hospital056 012 Provincial Hospitals Specialised Hospital056 013 Provincial Hospitals Small District Hospital056 014 Provincial Hospitals Medium District Hospital056 015 Provincial Hospitals Large District Hospital057 000 Private Hospitals ('A' - Status)057 001 Private Hospitals ('A' - Status) +ICU +Theatre Less than 100 beds057 002 Private Hospitals ('A' - Status) #NAME?057 003 Private Hospitals ('A' - Status) #NAME?057 004 Private Hospitals ('A' - Status) #NAME?057 005 Private Hospitals ('A' - Status) #NAME?057 006 Private Hospitals ('A' - Status) #NAME?057 008 Private Hospital Lesotho #NAME?057 100 Private Hospitals ('A' - Status) Mine Hospilals057 200 Private Hospitals ('A' - Status) State subsidised058 000 Private Hospitals ('B' - Status)059 000 Private Rehab Hospital (Acute)060 000 Pharmacies060 001 Pharmacies Consultant Pharmacy061 000 Pharmacotherapist062 000 Maxillo-facial and Oral Surgery

064 000 Orthodontics066 000 Occupational Therapy067 000 Art Therapists068 000 Podiatry069 000 Medical Scientist Clinical Biochemist069 001 Medical Scientist Genetic Councillor069 002 Medical Scientist Medical Biological Scientist069 003 Medical Scientist Medical Physicist070 000 Optometrists070 001 Supplementary Optometrists Visual Science,Ocular Pathology & Dispensing of Spectacles071 000 Optical dispensers071 001 Supplementary Optical dispensers No limitations072 000 Physiotherapists073 000 Masseurs074 000 Orthoptists075 000 Clinical technology075 001 Clinical technology Cardio-Vascular Perfusion075 002 Clinical technology Pulmonology075 003 Clinical technology Nephrology075 004 Clinical technology Reproductive biology075 006 Clinical technology Neurophysiology075 007 Clinical technology Critical Care075 008 Clinical technology Cardiology076 000 Unattached operating theatres / Day clinics077 000 Approved U O T U / Day clinics078 000 Blood transfusion services079 000 Hospices079 001 Hospices SA Cancer Associations080 000 Nursing Agencies/Home Care Services081 000 Registered Counsellors082 000 Speech therapy and Audiology082 001 Speech Therapy Only082 002 Audiology Only083 000 Hearing Aid Acoustician084 000 Dieticians085 000 Psychometry086 000 Psychologists086 001 Psychologists Clinical086 002 Psychologists Counselling086 003 Psychologists Educational086 004 Psychologists Industrial086 005 Psychologists Neuropsychologists087 000 Orthotists & Prosthetists088 000 Registered nurses088 001 Registered nurses Midwife only088 002 Registered nurses Psychiatric only088 009 Registered nurses Primary Care089 000 Social workers090 000 Clinical services090 001 Clinical services Oxygen Supplier090 002 Clinical services Wheelchairs Supplier090 003 Clinical services Ear & Voice Prosthetic Supplier

090 004 Clinical services Eye Prosthetic Supplier090 005 Clinical services Breast Prosthetic Supplier090 006 Clinical services Cardiac Prosthetic Supplier090 007 Clinical services Stomal/appliances Supplier090 008 Clinical services Medical General Supplier090 009 Clinical services FAMSA (family and marriage counselling)090 011 Clinical services Oncology units (not owned by hospital)090 013 Clinical services Diabetes Appliances090 014 Clinical Services Compression Bandaging & Bone Healing System090 015 Clinical Services Parenteral Nutrition (TPN) - homecare091 000 Biokinetics092 000 Periodontics093 000 Dental Technician094 000 Prosthodontic095 000 Dental therapy096 000 Community dentistry097 000 Independent Practice Specialist Public Health Medicine098 000 Oral pathology101 000 Naturopathy102 000 Osteopathy103 000 Phytotherapy104 000 Ayurveda Ayurveda Practitioner104 001 Ayurveda Primary Healthcare Advisor104 002 Ayurveda Yoga Therapist105 000 Acupuncturist106 000 Therapeutic Aromatherapist107 000 Therapeutic Massage Therapist108 000 Therapeutic Reflexologist109 000 Unani-Tibb110 000 Clinical Pharmacokineticist111 000 Radiopharmacist112 000 Independent Practice Specialist Clinical Pharmacology113 000 Oral Hygiene114 000 Paediatric Surgery Independent Practice Specialist115 000 Medical Genetics

Haemophilia Related ComplicationsRespiratoryHaemorrhage from respiratory passages R04.0 EpistaxisHaemorrhage from respiratory passages R04.1 Haemorrhage from throatHaemorrhage from respiratory passages R04.2 HaemoptysisHaemorrhage from respiratory passages R04.8 Haemorrhage from other sites in respiratory passagesHaemorrhage from respiratory passages R04.9 Haemorrhage from respiratory passages, unspecified

JointM25.0 HaemarthrosisM25.00 Haemarthrosis, multiple sitesM25.01 Haemarthrosis, shoulder regionM25.02 Haemarthrosis, upper armM25.03 Haemarthrosis, forearmM25.04 Haemarthrosis, handM25.05 Haemarthrosis, pelvic region and thighM25.06 Haemarthrosis, lower legM25.07 Haemarthrosis, ankle and footM25.08 Haemarthrosis, other siteM25.09 Haemarthrosis, site unspecified

DentalGingivitis and periodontal diseases K05 Gingivitis and periodontal diseasesGingivitis and periodontal diseases K05.0 Acute gingivitisGingivitis and periodontal diseases K05.1 Chronic gingivitisGingivitis and periodontal diseases K05 Gingivitis and periodontal diseasesGingivitis and periodontal diseases K05.0 Acute gingivitisGingivitis and periodontal diseases K05.1 Chronic gingivitisDental caries K02 Dental cariesDental caries K02.0 Caries limited to enamelDental caries K02.1 Caries of dentineDental caries K02.2 Caries of cementumDental caries K02.3 Arrested dental cariesDental caries K02.4 OdontoclasiaDental caries K02.5 Caries with pulp exposureDental caries K02.8 Other dental cariesDental caries K02.9 Dental caries, unspecified

GITVascular disorders of intestine K55.2 Angiodysplasia of colonPeptic ulcer, site unspecified K27.0 Peptic ulcer, site unspecified, acute with haemorrhagePeptic ulcer, site unspecified K27.2 Peptic ulcer, site unspecified, acute with both haemorrhage and perforationPeptic ulcer, site unspecified K27.4 Peptic ulcer, site unspecified, chronic or unspecified with haemorrhagePeptic ulcer, site unspecified K27.6 Peptic ulcer, site unspecified, chronic or unspecified with both haemorrhage and perforationOther diseases of digestive system K92.1 MelaenaOther diseases of digestive system K92.0 Haematemesis

GenitourinaryRecurrent and persistent haematuria N02 Recurrent and persistent haematuriaRecurrent and persistent haematuria N02.0 Recurrent and persistent haematuria, minor glomerular abnormalityRecurrent and persistent haematuria N02.1 Recurrent and persistent haematuria, focal and segmental glomerular lesionsRecurrent and persistent haematuria N02.2 Recurrent and persistent haematuria, diffuse membranous glomerulonephritisRecurrent and persistent haematuria N02.3 Recurrent and persistent haematuria, diffuse mesangial proliferative glomerulonephritisRecurrent and persistent haematuria N02.4 Recurrent and persistent haematuria, diffuse endocapillary proliferative glomerulonephritisRecurrent and persistent haematuria N02.5 Recurrent and persistent haematuria, diffuse mesangiocapillary glomerulonephritisRecurrent and persistent haematuria N02.6 Recurrent and persistent haematuria, dense deposit diseaseRecurrent and persistent haematuria N02.7 Recurrent and persistent haematuria, diffuse crescentic glomerulonephritisRecurrent and persistent haematuria N02.8 Recurrent and persistent haematuria, otherRecurrent and persistent haematuria N02.9 Recurrent and persistent haematuria, unspecified

PregnancyAntenatal screening Z36.2 Other antenatal screening based on amniocentesis

5026 Ultrasound guided amniocentesis2611 Chorion villus sampling (excluding after-care)

PainSystemic disorders of connective tissue in diseases classified elsewhereM36.2 Haemophilic arthropathy (D66-D68+)

ABBREVIATIONSaPCC Activated prothrombin complex concentrateaPTT Activated partial thromboplastin timeBA Bethesda AssayBC Buffered Citrol 1® Coagulation Control Level 1BDDRFVIII B-domain-deleted recombinant factor VIIIBNPP Buffered Normal Pooled PlasmaBU/mL Bethesda unit per millilitreCFC Clotting factor concentrateCitrol 1 Dade® Citrol 1® Coagulation Control Level 1CI Confidence intervalCV Coefficient of variationECAT External quality Control of diagnostic Assays and Tests FoundationFEIBA Factor Eight Inhibitor Bypassing ActivityFLRFVIII Full-length recombinant factor VIIIFVIII Factor VIIIFIX Factor IXHCCC Haemophilia Comprehensive Care CentreITI Immune tolerance inductionLTA Low-titre FVIII inhibitor assayNA Nijmegen modification of the Bethesda AssayNBU/mL Nijmegen-Bethesda unit per millilitreNPP Normal Pooled PlasmapdFVIII Plasma-derived factor VIIIPPP Platelet poor plasmaPTP Previously treated patientsPUP Previously untreated patientsQC Quality controlRCF Relative centrifugal forcerFVIIa Recombinant activated Factor VIIrFVIII Recombinant factor VIII