HEALTHMAN GENERAL SURGERY COSTING GUIDE 2014

Transcription

1 s s Consultations: See the Notes below for All s 0109 Hospital follow-up visit Prolonged first/follow-up consultation : 15 min Telephone consultation (all hours) Repeat Script Writing of special motivations Consultation : Away from doctor's room Unscheduled consultation: Emergency (cons.room) Unscheduled consultation:emergency(not cons.room) Pre-anaesthetic assessment: 10 and 20 minutes Hospital Consultation Hospital Consultation 30 1, Hospital Consultation 45 1, Consultation Consultation 30 1, Consultation 45 1, Chronic Medicine Forms Procedures 0257 Drainage of major hand/ foot infection: Drainage of major abscess with necrosis of tissue 87 3, Large skin grafts, composite skin grafts, large full thickness free skin grafts 234 8, , , , , Stitching of soft-tissue injuries: Deep laceration involving limited muscle damage 64 2, Stitching of soft-tissue injuries: Deep laceration involving extensive muscle damage 128 4, , , , , Major debridement of wound, sloughectomy or secondary suture 50 1, Excision and repair by direct suture; excision nail fold or other minor procedures of similar magnitude Each additional small procedure done at the same time Excision of large benign tumour (more than 5 cm) 55 1, Extensive resection for malignant soft tissue tumour including muscle , , , , , Requiring repair by large skin graft or large local flap or other procedures of similar magnitude 104 3, , , , , Requiring repair by small skin graft or small local flap or other procedures of similar magnitude 55 1, Biopsy or excision of cyst, benign tumour, aberrant breast tissue, duct papilloma , , , Sub-areolar cone excision of ducts of wedge excision of breast 90 3, Wedge excision of breast and axillary dissection 225 7, , , , , Total mastectomy 155 5, , , , , Total mastectomy with axillary gland dissection 275 9, , , , , Trans-abdominal anterior exposure of the spine for spinal fusion only if done by a second surgeon 160 5, , , , ,

2 s s 1204 Intensive care: Category 1: Cases requiring intensive monitoring : Per day 30 1, Intensive care: Category 2: Cases requiring active system support: First day 100 3, , , , , Intensive care: Category 2: Cases requiring active system support : Subsequent days, per day 50 1, Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients : First day 137 4, , , , , Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients: First day 58 2, Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients : Subsequent days 50 1, Ventilation: Subsequent days, per day 50 1, Insertion of central venous line via subclavian or jugular veins Hyperalimentation (daily tariff) Abdominal aorta and iliac artery: Unruptured , , , , , Aorta bi-femoral graft, including proximal and distal endarterectomy and preparation for anastomosis , , , , , Prosthetic grafting 255 9, , , , , Vein grafting proximal to knee joint , , , , , Vein grafting distal to knee joint , , , , , Endarterectomy when not part of another specified procedure 264 9, , , , , Carotid endarterectomy , , , , , Embolectomy: Peripheral embolectomy transfemoral 168 5, , , , , Suture major blood vessel (artery or vein) - trauma 264 9, , , , , Placement of Hickman catheter or similar 91 3, Combined procedure for varicose veins:, multiple ligation including perforating veins : Unilateral 141 4, , , , , Combined procedure for varicose veins: Ligation of saphenous vein stripping: Bilateral 247 8, , , , , Splenectomy (in all cases) , , , , , Excision of lymph node for biopsy: Neck or axilla 65 2, Radical excision of lymph nodes of neck: Total: Unilateral , , , , , Radical excision of lymph nodes of axilla 160 5, , , , , Partial parotidectomy , , , , , Hiatus hernia and diaphragmatic hernia repair: With anti-reflux procedure , , , , , Hiatus hernia and diaphragmatic hernia repair: With Collis Nissen oesophageal lengthening procedure , , , , , fee: Gastroplasty , , , , , Hiatus hernia and diaphragmatic repair: Revision after previous repair , , , , , Oesophageal motility (4 channel + pneumograph) 100 3, , , , , Oesophageal motility (6 Channel + pneumograph + ph pull-through) 110 3, , , , , hour oesophageal ph studies: Hire fee 55 1, Upper gastro-intestinal endoscopy: Using hospital equipment , Gastrostomy or Gastrotomy , , , , , Suture of perforated gastric or duodenal ulcer, wound or injury 200 7, , , , , Partial gastrectomy , , , , , Operation for relief of intestinal obstruction 240 8, , , , ,

3 s s 1639 Resection of small bowel with enterostomy or anastomosis , , , , , Entero-enterostomy or entero-colostomy for bypass , , , , , Suture of intestine (small or large): Perforated ulcer, wound or injury , , , , , Excision of lesion of mesentery , , , , , Total colonoscopy: With hospital equipment (including biopsy) 90 3, , Plus removal of polyps: ADD to colonoscopy (item 1653) 30 1, Left-sided colonoscopy 60 2, Right or left hemicolectomy or segmental colectomy , , , , , Reconstruction of colon after Hartman s procedure , , , , , Total colectomy , , , , , Colostomy or ileostomy isolated procedure 196 6, , , , , Colostomy: Closure , , , , , Appendicectomy 160 5, , , , , Flexible sigmoidoscopy (including rectum and anus): Using hospital equipment , Anterior resection of rectum performed for carcinoma of rectum incl excision of any part of 1687 proximal colon , , , , , Total mesorectal excision with colo-anal anastomosis and defunctioning enterostomy or 1688 colostomy , , , , , Abdomino-perineal resection of rectum: Abdominal surgeon , , , , , Repair of prolapsed rectum: Abdominal: Roscoe Graham Moskovitz , , , , , Repair of prolapsed rectum: Abdominal: Perineal 150 5, , , , , Drainage of ischio-rectal abscess 87 3, Excision of pelvi-rectal fistula 200 7, , , , , Excision of fistula-in-ano 105 3, , , , , Operation for fissure-in-ano , Haemorrhoidectomy 120 4, , , , , Multiple procedures (haemorrhoids, fissure, etc.) 90 3, Hemi-hepatectomy: Right , , , , , Partial or segmental hepatectomy , , , , , Liver transplant , , , , , Cholecystectomy 225 7, , , , , Cholecystectomy and operative cholangiogram 255 9, , , , , Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopy + catheterisation of 1778 pancreas duct , , , , , Pancreatico-duodenectomy , , , , , ADD to open procedure where procedure was performed through a laparoscope 45 1, Laparotomy 196 6, , , , , Radical removal of retro-peritoneal malignant tumours (including sacro-coccygeal and presacral) , , , , ,

4 s s 1815 Drainage of other intraperitoneal abscess (excluding appendix abscess): Transabdominal , , , , , Inguinal or femoral hernia: Adult 125 4, , , , , Inguinal or femoral hernia: Child under 14 years old 90 3, Inguinal hernia: Infant under 1 year 100 3, , , , , Recurrent inguinal or femoral hernia 155 5, , , , , Strangulated hernia or femoral hernia 238 8, , , , , Epigastric hernia , Umbilical hernia: Adult 140 4, , , , , Incisional hernia , , , , , Implantation of mesh or other prosthesis for incisional or ventral hernia repair 77 2, Allo-transplantation of kidney , , , , , Circumcision: Surgical excision other than by clamp or dorsal slit, any age 60 2, Diagnostic laparoscopy (excluding after-care) , , , Removal of ovarian tumour or cyst 187 6, , , , , Cervical sympathectomy: Bilateral 268 9, , , , , Lobectomy: Total 200 7, , , , , Thyroidectomy: Subtotal 266 9, , , , , Thyroidectomy: Total 279 9, , , , , Exploration of parathyroid glands for hyperparathyroidism including removal 275 9, , , , , Selective first order catheterisation, arterial or venous, with angiogram/venogram 95 3, , , , Selective third order catheterisation, arterial or venous, with angiogram/venogram 122 4, , , , , * Ultrasound examination includes whole abdomen and pelvic organs 60 6, Routine HBO table (2-2,5 ATA x min): Technical component , , , , , Percutaneous transluminal angioplasty: Sub-popliteal sub-brachial 232 8, , , , , Stent insertion: Iliac/subclavian/AV fistula including percutaneous transluminal angioplasty 5060 (PTA) 232 8, , , , , Carotid ultrasound vascular study:b mode, pulsed & colour Doppler; bilateral, internal, external 5110* & common carotid flow & anatomy 128 1, , , , , Full ultrasonic and colour Doppler evaluation of entire extracranial vascular tree: Carotids, 5111 vertebral and subclavian vessels 206 7, , , , , Peripheral arterial ultrasound vascular study: B mode, pulsed and colour Doppler; per limb 117 4, , , , , Peripheral venous ultrasound vascular study; B mode, pulsed and colour Doppler; to evaluate 5113 deep vein thrombosis 117 4, , , , , Peripheral venous ultrasound vascular study; B mode, pulsed and colour Doppler; in erect and 5114 supine position, bilaterally 178 6, , , , ,

5 s s Note: 1. s, Descriptors and Unit Values have been extracted from the SAMA Electronic Medical Doctors Coding Manual (emdcm) previously known as the SAMA Doctors Billing Manual (DBM). 2. s may differ due to rounding 3. Above codes are the most frequently used codes and is not all inclusive of all the codes 4. Increases from 2013 are as follow: a. = 2013 Scheme +3.34% for consultations and +6% for procedures b. Health = % c. = % d. Fedhealth = % e. The has been fixed at a maximum of R This is based on updated costing studies for Paediatricians in 2011/12. Also note this is 13.65% higher than the Executive rate for procedures. 6. Premier A Procedure Rates have NOT been split between In-Hospital & Out-Hospital. Use as appropriate. 7. The Healthman tariff for codes that relate to equipment have been retained at rate* 8. All s are inlcusive of VAT Disclaimer: The above schedule is based on information avaiable to and will NOT be held responsible for any losses incurred by practitioners resulting from the use of this schedule. Legend: = Health = Direct Payment Arrangement Prem = Premier R = Rand = Rand Conversion Factor (Rand Value per Unit) VAT = Value Added Tax

6 Payment Arrangments Consultations: Units R R Prem A In Hosp. Prem A Out Hosp. Prem B Classic Rate Exec Rate 137% 162% 147% 217% 300% 165% 210% R R R R R R R See the Notes below for All s 0109 Hospital follow-up visit Prolonged first/follow-up consultation : 15 min Telephone consultation (all hours) Repeat Script Writing of special motivations Consultation : Away from doctor's room Unscheduled consultation: Emergency (cons.room) Unscheduled consultation:emergency(not cons.room) Pre-anaesthetic assessment: 10 and 20 minutes Hospital Consultation Hospital Consultation 30 1, Hospital Consultation 45 1, Consultation Consultation 30 1, Consultation 45 1, Chronic Medicine Forms , Procedures 0257 Drainage of major hand/ foot infection: Drainage of major abscess with necrosis of tissue 87 3, Large skin grafts, composite skin grafts, large full thickness free skin grafts 234 8, Stitching of soft-tissue injuries: Deep laceration involving limited muscle damage 64 2, Stitching of soft-tissue injuries: Deep laceration involving extensive muscle damage 128 4, Major debridement of wound, sloughectomy or secondary suture 50 1, Excision and repair by direct suture; excision nail fold or other minor procedures of similar magnitude Each additional small procedure done at the same time Excision of large benign tumour (more than 5 cm) 55 1, Extensive resection for malignant soft tissue tumour including muscle , Requiring repair by large skin graft or large local flap or other procedures of similar magnitude 104 3, Requiring repair by small skin graft or small local flap or other procedures of similar magnitude 55 1, Biopsy or excision of cyst, benign tumour, aberrant breast tissue, duct papilloma , Sub-areolar cone excision of ducts of wedge excision of breast 90 3, Wedge excision of breast and axillary dissection 225 7, Total mastectomy 155 5, Total mastectomy with axillary gland dissection 275 9, Trans-abdominal anterior exposure of the spine for spinal fusion only if done by a second surgeon 160 5, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,524.00

7 Payment Arrangments Units R R 1204 Intensive care: Category 1: Cases requiring intensive monitoring : Per day 30 1, Intensive care: Category 2: Cases requiring active system support: First day 100 3, Intensive care: Category 2: Cases requiring active system support : Subsequent days, per day 50 1, Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients : First day 137 4, Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients: First day 58 2, Intensive care: Category 3: Cases with multiple organ failure or Category 2 patients : Subsequent days 50 1, Ventilation: Subsequent days, per day 50 1, Insertion of central venous line via subclavian or jugular veins Hyperalimentation (daily tariff) Abdominal aorta and iliac artery: Unruptured , Aorta bi-femoral graft, including proximal and distal endarterectomy and preparation for anastomosis , Prosthetic grafting 255 9, Vein grafting proximal to knee joint , Vein grafting distal to knee joint , Endarterectomy when not part of another specified procedure 264 9, Carotid endarterectomy , Embolectomy: Peripheral embolectomy transfemoral 168 5, Suture major blood vessel (artery or vein) - trauma 264 9, Placement of Hickman catheter or similar 91 3, Combined procedure for varicose veins:, multiple ligation including perforating veins : Unilateral 141 4, Combined procedure for varicose veins: Ligation of saphenous vein stripping: Bilateral 247 8, Splenectomy (in all cases) , Excision of lymph node for biopsy: Neck or axilla 65 2, Radical excision of lymph nodes of neck: Total: Unilateral , Radical excision of lymph nodes of axilla 160 5, Partial parotidectomy , Hiatus hernia and diaphragmatic hernia repair: With anti-reflux procedure , Hiatus hernia and diaphragmatic hernia repair: With Collis Nissen oesophageal lengthening procedure , fee: Gastroplasty , Hiatus hernia and diaphragmatic repair: Revision after previous repair , Oesophageal motility (4 channel + pneumograph) 100 3, Oesophageal motility (6 Channel + pneumograph + ph pull-through) 110 3, hour oesophageal ph studies: Hire fee 55 1, Upper gastro-intestinal endoscopy: Using hospital equipment , Gastrostomy or Gastrotomy , Suture of perforated gastric or duodenal ulcer, wound or injury 200 7, Partial gastrectomy , Operation for relief of intestinal obstruction 240 8, Prem A In Hosp. Prem A Out Hosp. Prem B Classic Rate Exec Rate 137% 162% 147% 217% 300% 165% 210% R R R R R R R , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,286.30

8 Payment Arrangments Units R R 1639 Resection of small bowel with enterostomy or anastomosis , Entero-enterostomy or entero-colostomy for bypass , Suture of intestine (small or large): Perforated ulcer, wound or injury , Excision of lesion of mesentery , Total colonoscopy: With hospital equipment (including biopsy) 90 3, Plus removal of polyps: ADD to colonoscopy (item 1653) 30 1, Left-sided colonoscopy 60 2, Right or left hemicolectomy or segmental colectomy , Reconstruction of colon after Hartman s procedure , Total colectomy , Colostomy or ileostomy isolated procedure 196 6, Colostomy: Closure , Appendicectomy 160 5, Flexible sigmoidoscopy (including rectum and anus): Using hospital equipment , Anterior resection of rectum performed for carcinoma of rectum incl excision of any part of 1687 proximal colon , Total mesorectal excision with colo-anal anastomosis and defunctioning enterostomy or colostomy , Abdomino-perineal resection of rectum: Abdominal surgeon , Repair of prolapsed rectum: Abdominal: Roscoe Graham Moskovitz , Repair of prolapsed rectum: Abdominal: Perineal 150 5, Drainage of ischio-rectal abscess 87 3, Excision of pelvi-rectal fistula 200 7, Excision of fistula-in-ano 105 3, Operation for fissure-in-ano , Haemorrhoidectomy 120 4, Multiple procedures (haemorrhoids, fissure, etc.) 90 3, Hemi-hepatectomy: Right , Partial or segmental hepatectomy , Liver transplant , Cholecystectomy 225 7, Cholecystectomy and operative cholangiogram 255 9, Endoscopic Retrograde Cholangiopancreatography (ERCP): Endoscopy + catheterisation of pancreas duct , Pancreatico-duodenectomy , ADD to open procedure where procedure was performed through a laparoscope 45 1, Laparotomy 196 6, Radical removal of retro-peritoneal malignant tumours (including sacro-coccygeal and presacral) , Prem A In Hosp. Prem A Out Hosp. Prem B Classic Rate Exec Rate 137% 162% 147% 217% 300% 165% 210% R R R R R R R 3, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,708.90

9 Payment Arrangments Units R R 1815 Drainage of other intraperitoneal abscess (excluding appendix abscess): Transabdominal , Inguinal or femoral hernia: Adult 125 4, Inguinal or femoral hernia: Child under 14 years old 90 3, Inguinal hernia: Infant under 1 year 100 3, Recurrent inguinal or femoral hernia 155 5, Strangulated hernia or femoral hernia 238 8, Epigastric hernia , Umbilical hernia: Adult 140 4, Incisional hernia , Implantation of mesh or other prosthesis for incisional or ventral hernia repair 77 2, Allo-transplantation of kidney , Circumcision: Surgical excision other than by clamp or dorsal slit, any age 60 2, Diagnostic laparoscopy (excluding after-care) , Removal of ovarian tumour or cyst 187 6, Cervical sympathectomy: Bilateral 268 9, Lobectomy: Total 200 7, Thyroidectomy: Subtotal 266 9, Thyroidectomy: Total 279 9, Exploration of parathyroid glands for hyperparathyroidism including removal 275 9, Selective first order catheterisation, arterial or venous, with angiogram/venogram 95 3, Selective third order catheterisation, arterial or venous, with angiogram/venogram 122 4, * Ultrasound examination includes whole abdomen and pelvic organs 60 6, Routine HBO table (2-2,5 ATA x min): Technical component , Percutaneous transluminal angioplasty: Sub-popliteal sub-brachial 232 8, Stent insertion: Iliac/subclavian/AV fistula including percutaneous transluminal angioplasty (PTA) 232 8, Carotid ultrasound vascular study:b mode, pulsed & colour Doppler; bilateral, internal, external 5110* & common carotid flow & anatomy 128 1, Full ultrasonic and colour Doppler evaluation of entire extracranial vascular tree: Carotids, 5111 vertebral and subclavian vessels 206 7, Peripheral arterial ultrasound vascular study: B mode, pulsed and colour Doppler; per limb 117 4, Peripheral venous ultrasound vascular study; B mode, pulsed and colour Doppler; to evaluate deep vein thrombosis 117 4, Peripheral venous ultrasound vascular study; B mode, pulsed and colour Doppler; in erect and supine position, bilaterally 178 6, Prem A In Hosp. Prem A Out Hosp. Prem B Classic Rate Exec Rate 137% 162% 147% 217% 300% 165% 210% R R R R R R R 3, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,737.00