Aptekersvereniging van
Suid-Afrika
– Nasionale Kantoor –
Vir die gesondheid en welvaart van die mense
Pharmaceutical Society of
South Africa
– National Office –
For the health and welfare of the people
ICD10 Coding for Pharmacies in South Africa
From 1 July 2005, all providers of healthcare are required to include diagnostic codes (ICD10 codes) on all
claims and accounts for services rendered. The inclusion of ICD10 codes will indicate the diagnosis for that
specific medicine.
What is ICD10?
ICD10 stands for “International Statistical Classification of Diseases and Related Health Problems – version
10”. This is a set of codes, which translates the written description of a diagnosis into a coded format. This
set of codes forms part of an international standard of diagnostic codes and is owned and maintained by
World Health Organisation.
Legislative requirement
Regulation 5(f) of the Medical Schemes Act (Act No. 131 of 1998) governs the current implementation of
ICD10 diagnosis coding on all claims/accounts from all suppliers of service. It reads as follows:
“The account or statement contemplated in section 59 (1) of the Act must contain the following – (f) the
relevant diagnostic and such other item code numbers that relate to such relevant health service”
Coding information
• When dispensing a prescription the pharmacist may only use a valid code indicated by the prescriber.
• The pharmacist is not entitled to supply his/her own code (in other words a diagnosis) according to
his/her own discretion if the prescriber did not indicate the appropriate code on a new prescription.
The pharmacists might be held legally liable in these circumstances.
• For OTC medication – the pharmacist must enter a valid ICD10 code on the invoice/ print-out.
• Where multiple codes are supplied to the pharmacist, an effort must be made to enter them all, in
order of importance. If the software field does not allow the character size of the coding, the most
significant set of codes must be entered.
• Do not enter incomplete/invalid codes.
• Software vendors will have a look-up function in the dispensing programmes for the most frequently
used codes.
• The ICD10 Technical Task Team appeals to all pharmacists to maintain a high standard of ICD10
coding.
• Where an “Incorrect ICD10 code” error is received from the switches, try checking for typing errors
on your side. If still no resolution, contact the prescriber.
• Please do not use default codes as a first option.
• If there is a coding problem or uncertainty, which cannot be resolved by the software vendor or
administrator/medical scheme, feel free to contact the Pharmaceutical Society and explain your
problem via e-mail or fax. All received queries will be referred to the next Technical meeting.
Contact person: Suzanne Bornman [email protected] or fax: 012 301 0836
P O Box 26039, Arcadia, 0007 – Pharmacy House, 6 de Veer Lane, Arcadia – Tel:+27 (012) 301-0820,
Fax: +27 (012) 301-0828 (Admin), +27 (012) 301-0836 (Professional), Website: www.pssa.org.za, E-mail: [email protected]
Posbus 26039, Arcadia, 0007 – Farmasiehuis, De Veersteeg 6, Arcadia – Tel: +27 (012) 301-0820,
Faks: +27 (012) 301-0828 (Admin), +27 (012) 301-0836 (Professioneel), Webadres: www.pssa.org.za, E-pos: [email protected]
Coding Guidelines
Acute prescriptions
• The code or codes as supplied by the prescriber must be entered per line item of medicine.
• Multiple codes to be separated with the back-slash (\) character.
Repeat Prescriptions
• Repeat of prescription before 1 July 2005
Use Z76.0 Issue of repeat Prescription.
•
Repeat of prescription starting 1 July 2005
Use the codes as indicated on the original prescription.
Thereafter – no code changes with normal repeat prescriptions unless:
- Prescriber informs pharmacist of changes,
- New chronic supply form with new codes, etc.
•
Repeat of Contraceptives
Use Z30.4 - Surveillance of Contraceptive Drugs.
When doing a repeat, check for Z76.8 and Z76.0 items and try to replace these codes with the correct
codes.
•
Prescriptions where the prescriber does not supply a code
• Use Z76.9 - Person encountering Health services in Unspecified Circumstances.
• When using this code the Medical Scheme may contact the prescriber and query the reason for not
supplying the valid ICD code.
• It is important to note – use this code sparingly and only if there is no alternative available at the
time.
Issuing of Emergency Medicine/ Telephonic prescriptions
• Use Z76.8 - Person encountering Health services in Other Specified Circumstances.
• This is for use when the prescriber is not able to supply the correct code at that specific time and the
pharmacist is required to issue the medicine and claim the prescription electronically.
OTCs/ PAT prescriptions
• Where symptoms are known
• Use R codes and select the appropriate symptom code.
o The R codes are a set of codes from Chapter 18 Symptoms, signs and abnormal clinical and
laboratory findings, not elsewhere classified.
o Usually these are secondary codes used in combination with other primary diagnostic codes.
o Examples: R05 Cough / R51 Headache, etc.
OTCs/ PAT prescriptions
• Where symptoms are NOT known at that point in time
• Use Z76.8 - Person encountering Health services in Other Specified Circumstances.
o These are normal preventative medication e.g. Panado® syrup for children to be kept as
emergency stock at home.
Disclaimer – June 2005
These codes are a subset of the full list of ICD10 codes. Additional codes may be applicable outside of those listed.
The PSSA and the ICD10 Technical Task Team do not accept any responsibility for the interpretation of these codes.
A CD with the complete list of ICD10 codes is available from BHF.
PRESCRIPTIONS
Person encountering health services in unspecified circumstances
Persons encountering health services in other specified circumstances
Issue of repeat prescription
Surveillance of contraceptive drugs
Patient refusal to disclose clinical information
Provider refusal to disclose clinical information
Persons encountering health services in other specified circumstances
SCREENING TESTS/OTHERS
Examination of blood pressure
Pregnancy confirmed
WHO Full Description
Application
Screening test - blood pressure
Screening test - pregnancy
No code supplied
Telephonic/emergency prescriptions
Repeat scripts dated before July 2005
Repeat contraceptives
No informed consent – patient refusal
No informed consent – prescriber refusal
Alone standing items e.g. gauze, needle
Disclaimer – June 2005
These codes are a subset of the full list of ICD10 codes. Additional codes may be applicable outside of those listed.
The PSSA and the ICD10 Technical Task Team do not accept any responsibility for the interpretation of these codes.
A CD with the complete list of ICD10 codes is available from BHF.
Z01.3
Z32.1
Z76.9
Z76.8
Z76.0
Z30.4
U98.0
U98.1
Z76.8
ICD10
Code
ICD10 short reference list – June 2005
ICD10 PHARMACY SHORT REFERENCE LIST
Psoriasis, unspecified
Rash and other nonspecific skin eruption
Scabies
Sneezing
Other symptoms and signs concerning food and fluid intake
State of emotional shock and stress, unspecified
Unspecified contact dermatitis, unspecified cause
Unspecified haemorrhoids without complication
Urticaria, unspecified
Wheezing
ICD10 PHARMACY SHORT REFERENCE LIST
Dysuria
L40.9
Eczema herpeticum
R21
Fever, unspecified
B86
Flatulence and related conditions
R06.7
Functional diarrhoea
R63.8
Gout, unspecified, site unspecified
R45.7
Headache
L25.9
Heartburn
I84.9
Irritable bowel syndrome without diarrhoea
L50.9
Localized swelling, mass and lump of skin and subcutaneous tissue
R06.2
Immunisation/Vaccination
Need for immunization against cholera alone
Need for immunization against typhoid-paratyphoid alone [TAB]
Need for immunization against tuberculosis [bcg]
Need for immunization against tetanus alone
Need for immunization against diphtheria alone
Need for immunization against pertussis alone
Need for immunization against poliomyelitis
Need for immunization against arthropod-borne viral encephalitis
Need for immunization against rabies
Need for immunization against rubella alone
Need for immunization against viral hepatitis
Need for immunization against mumps alone
Need for immunization against influenza
Need for immunization against measles alone
Need for immunization against cholera with typhoid-paratyphoid [Cholera + TAB]
Need for immunization against diphtheria-tetanus-pertussis, combined [DTP]
Need for immunization against diphtheria-tetanus-pertussis with typhoid-paratyphoid
[DTP + TAB]
Need for immunization against diphtheria-tetanus-pertussis with poliomyelitis [DTP +
polio]
Need for immunization against measles-mumps-rubella [MMR]
Disclaimer – June 2005
These codes are a subset of the full list of ICD10 codes. Additional codes may be applicable outside of those listed.
The PSSA and the ICD10 Technical Task Team do not accept any responsibility for the interpretation of these codes.
A CD with the complete list of ICD10 codes is available from BHF.
Z27.3
Z27.4
Z27.2
Z23.0
Z23.1
Z23.2
Z23.5
Z23.6
Z23.7
Z24.0
Z24.1
Z24.2
Z24.5
Z24.6
Z25.0
Z25.1
Z24.4
Z27.0
Z27.1
R30.0
B00.0
R50.9
R14
K59.1
M10.99
R51
R12
K58.9
R22.9