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ICD-10 codes in South Africa

18 March 2010

± minute read

    ICD-10 codes in South Africa
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Author: Cristina Van Der Merwe

There is so much new information and processes you will be confronted with when you open your own practice, and a million different things to keep in mind, that you could ask yourself: “If I studied psychology to help/ assist/ interact with humans… why am I spending so much time on paperwork, computer programs and all these codes?” The ICD-10 is just one of the codes you will have to be familiar with.

What is ICD-10 and why do I need to use it?

ICD-10 stands for the International Classification of Diseases and health-related problems (10th revision). It is produced by the World Health Organisation (WHO), and since January 1, 2005, all healthcare practitioners in South Africa are required, by law, to use this system. The coding is applicable to both the private and public sector.

Where do I get more information on it?

A CD containing the ICD-10 codes is available to all BHF (Board of Health Funders) members or can be ordered from them at clientservices@bhfglobal.com. The list on the CD is updated bi-annually on the 1st July to include the WHO updates. There are organizations that provide training on the use of ICD-10 codes, which can be obtained from the BHF.

But why do we have to use them?

The benefits to the health care industry are numerous, but the most pertinent include:

  • Profiling of disease, which could improved research and treatment plans.
  • It allows for regional and international comparisons of the frequency and occurrence of disease
  • It is important for the development and implementation of disease management programs and risk management.
  • It allows for appropriate management of medical services and benefits
  • Generation of faster payment of claims by the medical aids

How are the codes structured?

The 1st character is a letter and is associated with a specific chapter. A chapter indicates a group of related conditions. This is followed by a numeral. The code can be 3, 4 or 5 characters in length, but codes with 5 characters are not often used in a psychology practice. The more characters in the code, the more specific it is e.g.

F30 Condition (Manic episode) F30.2 More specific (Mania with psychotic symptoms)

Remember: the code has to be to the highest level of specificity.

Which chapters should I be interested in?

The chapters often used by psychology professionals depend on the area of expertise and is usually covered by:

F00-F99 Mental and Behaviour Disorders G00-G99 Diseases of the Nervous system R00-R99 Symptoms and signs involving cognition, perception, emotional state and behaviour Z00-Z99 Factors influencing Health Status and contact with Health Services

Can you be more specific?

The following are some examples of codes used in different psychology practices.

F34.1 Dysthymia F41.2 Mixed anxiety and depressive disorder Z63.5 Disruption of family by separating and divorce

Terminology you need to be familiar with: NOS Not otherwise specified – this implies certain information is not qualified and usually ends with a 9 NEC Not elsewhere classified – this alerts the coder to find a more specific code if available. Principle diagnosis: This refers to the reason for the encounter with the service provider and may differ from the initial or working diagnosis. Secondary diagnosis: This refers to additional conditions which affects the patient care or coexist with the main condition. Co morbidity: This is a pre-existing condition which may or may not require more resource usage e.g. a disease that accompanies the main diagnosis which also requires treatment.

Who has access to these codes and what about confidentiality?

Although the medical schemes state that ICD-10 codes will be handled in the same manner as all personal details and clinical information contained on medical accounts, the patient has to be informed and sign a consent form indicating whether the practitioner is allowed to include/ not include the ICD-10 code on the account. If the patient requests not to display the code, the following codes should be used:

U98.0 Client refuse U98.1 Service provider refuse

Alternatively the client can pay the service provider, knowing he/she will not be ale to claim this from the Medical scheme. We can all learn from each other, so please share your experiences, thoughts and additional useful information with us and fellow professionals. Please comment below, or send me an email at: christina@jvrafrica.co.za

For more information, please contact us on +27(0) 11 781 3705/6/7 or send an email to

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