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February 2019 Vol. 146

Informed consent

Informed consent is legislated under the:
- National Health Act;
- National Patients’ Rights Charter;
- Health Professions Act;
- Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act;
- Ethical and philosophical principles, such as the right to individual autonomy and

Practitioners are required to inform patients about the cost of services or treatment provided as part of seeking informed consent from patients. As far as practically possible, this information should be provided to a patient before the anticipated services or treatment.

The majority of complaints against practitioners received by the Health Professions Council of South Africa (HPCSA) are related to fees and most of these complaints arise because patients were not informed about the costs of treatment or services rendered by practitioners.

The HPCSA's view is that informing patients regarding the cost of services should not be separated from clinical decision-making processes as it may impact upon decisions made on available treatment options. The information should be contextualised within a clinical consultation and be an interactive process between a practitioner and the patient, especially where clinical decisions may have a significant impact upon financial decisions.

Guidance on informed consent and cost estimate forms are available on the HPCSA website:



Frequently asked questions for COID/WCA

Can I bill for a telephonic consultation?
No, there is no such code listed in the COID Government Gazette.

Can I bill for the writing of reports, when it was requested from the Funder?
No, there is no such code listed in the COID Government Gazette. Procedure code 0136 may be claimed if a special medical examination was requested by the Funder.

May a follow up consultation be charged after a procedure was performed?
For a period of 4 months from the procedure date, follow up consultations (0109 and 0184) may not be claimed. Only in cases of burn wounds / complications of the procedure, may code 0109 be billed.

How do I claim modifier 0011 for emergencies?
Modifier 0011 may only be charged on one procedure code.
It may only be charged after business hours, which are:

Weekdays 08h00 – 17h00;
Saturdays 08h00 – 13h00;
Or on;
Sundays and public holidays, any time.

When will I need to apply for a re-opening request?
Exactly 2 years from the date of accident, 1 day before the accident date, the Compensation Fund automatically closes a claim.
Should the patient require further treatment after the 2 year period, a request for re-opening of the claim must be completed by the primary treating Doctor.
Please note that the Compensation Fund generally does not re-open claims for conservative treatment such as investigations, x-rays, diagnostic tests, consultations etc.


Healthcare Cyberattacks

These cyberattacks have plagued the healthcare industry in the last year with identities of tens of millions of clients and patients been exposed around the world.

The loss associated with such exposure was estimated at more than 1 billion US dollars.

Although attackers are getting more sophisticated with new exploits, the industry is still seeing attackers use old exploits in clever new ways.

The defence against the majority of cyberattacks always boils down to a handful of recommendations:

1. Educate your resources. Security awareness is critical to empower yourself and your
practice staff with what they need to look out for;

2. Backup all your important data. This includes backups of all devices such
as desktops, laptops and mobile devices;

3. Keep your devices and security software up-to-date;

4. Replace unsupported hardware and software.
Vendors stop supporting and releasing security updates for legacy
Examples are all Windows versions before 10 (8.1, 7 XP), Apple Mac OS
before the El Capitan, all Office versions before 2013;

5. Keep your passwords private, up-to-date and renew them regularly.


Coding Corner

Coding Chronic Obstructive Pulmonary Disease (COPD) /
Chronic Obstructive Airways Disease (COAD) and Emphysema

Code COPD / COAD and Emphysema separately when coding both, Chronic Obstructive Pulmonary Disease (COPD) / Chronic Obstructive Airways Disease (COAD) and Emphysema.

COPD / COAD and Emphysema have different aetiologies and treatments and cannot be coded using one code only.

The primary code would be determined by the main condition treated.

Example 1:

Patient admitted with COPD and Emphysema

PDX: J44.9 Chronic obstructive pulmonary disease, unspecified
SDX: J43.9 Emphysema, unspecified

Example 2:

Patient admitted with chronic bronchitis with emphysema

PDX: J44.8 Other specified chronic obstructive pulmonary disease

Guidelines to take into consideration when determining the appropriate ICD-10 code:

Take note of the inclusion and exclusion notes below J43 and J44 in the tabular list (ICD-10 volume 1).

Emphysema with chronic bronchitis will be coded to J44.–.


J20 Acute bronchitis versus J40 Bronchitis not specified as acute or chronic:

Bronchitis not specified as acute or chronic in those under 15 years of age can be assumed to be of acute nature and should be classified to J20.–.

Avian Flu

Code Z25.8: Need for immunization against other specified single viral diseases is the appropriate code to use to indicate vaccination for Avian flu.


Morphology codes

Recently the SpesNet Healthcare Helpline has been receiving calls from practices regarding the requirement of a Morphology code on an account.

Morphology codes are codes that indicate the characteristics of a tumour and were to be implemented as part of compulsory coding on 1 July 2014.

Please note that the implementation of this has been postponed indefinitely and was in fact never actioned.

No medical scheme can decline payment of an account due to the Morphology code not added to the account.

If there is a valid ICD-10 code on the account, the scheme should accept the code that was submitted.

Many schemes still have a warning on the remittance advice regarding the omission of a Morphology code, however, it should not be the reason for rejecting a claim.

If any practice experiences difficulty regarding this, please forward the detail to the Healthcare Helpline at and include the name of the scheme, the query number and name of the contact person in order for SpesNet to take this up with the specific scheme.


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