ITAP MANAGED CARE WORKING GROUP. TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL s) GLAUCOMA

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1 ITAP TT1 MC - Glaucoma Sept 17 ITAP MANAGED CARE WORKING GROUP TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL s) GLAUCOMA Explanatory note to the Managed Care minimum reporting data specification (excel spreadsheet) The aim of the project is to measure the value added by managed care organisations, by means of capturing, measuring and reporting on clinical 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. 1

2 ITAP TT1 MC - Glaucoma Sept 17 Meetings and discussions were held with industry representatives and subject matter experts prior to finalising the minimum data specification. 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 fee structure for those services, e.g. screening, medication, procedures etc. 2

3 ITAP TT1 MC - Glaucoma Sept 17 The minimum required fields for the effective collection of appropriate data to demonstrate the value of the managed care interventions 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 Glaucoma o Closed Angle Glaucoma o Open Angle Glaucoma Investigations o Tonometry o Fundus examination o Gonooiscopy o Disc and Nerve Fibre layer analysis o Disc Photography o Optical coherence tomography o Central corneal thickness measurement Discipline Type The service providers must be registered with their relevant statutory bodies and as indicated by discipline coded list provided by 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 3

4 ITAP TT1 MC - Glaucoma Sept 17 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 the value 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 site 6) Reporting (MCO and Scheme) *Definitions will be the same utilised within the Annual statutory returns see Circular 10 of For full details All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to the service rendered by your organisation. 4

5 ITAP TT1 MC - Glaucoma Sept 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 Under 1 1 to 4 4 to 9 10 to to to to to 34 Actual number of beneficiaries registered for Glaucoma on the Pharmacy Benefit and or Active disease management program (Longer than 6 months on program) Number of new registrations in the period Number of beneficiaries who left program * Male Female Male Female Male Female 5

6 ITAP TT1 MC - Glaucoma Sept to to to to to to to to to to and above Total *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 beneficiaries treated with medication only Total Number of Beneficiaries that had surgery (Laser / Drainage Surgery) Total Number of Beneficiaries identified with 2 or more comorbidities Age Groups Under 1 1 to 4 4 to 9 10 to 14 Female Male Female Male Male Female 6

7 ITAP TT1 MC - Glaucoma Sept to to to to to to to to to to to to to to and above Total Co-morbidities o Hypertension o Diabetes o Eye Injury o 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: 7

8 ITAP TT1 MC - Glaucoma Sept 17 o All cause admissions o Glaucoma admissions - Hospital Category o Day Admission o Long Stay o 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. 8

9 ITAP TT1 MC - Glaucoma Sept 17 a) Hospital Category: Day Case Scheme Total number of admissions (All Cause) Total number of admissions (Glaucoma) Related Admission per category Surgical Medical Paediatric Emergency Room (Only) Mortality (Exit Codes = Expire) Claimed amount Risk paid amount Male Female Male Female Male Female Male Female b) Hospital Category: Long Stay Scheme Total number of admissions (All Cause) Total number of related admissions (Glaucoma) Admission per category Surgical Medical Paediatric Emergency Room (Only) Mortality (Exit Codes = Expire) Claimed amount Risk paid amount Male Female Male Female Male Female Male Female c) Hospital Category: Re-admission Scheme Total number of admissions (All Cause) Total number of related admissions (Glaucoma) Admission per category Surgical Medical Paediatric Emergency Room (Only) Mortality (Exit Codes = Expire) Claimed amount Risk paid amount Male Female Male Female Male Female Male Female 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 9

10 Entry and Verification Process Indicators Disease Management Program Algorithm Outcomes Data Spec ICD10 Description ATC Class ATC Class Investigation Tariff Code Tariff Description Program Algorithm Outcome Data specs H40 Glaucoma S01E Antiglaucoma preparations and miotics Initial Diagnosis Date of Diagnosis CDL Algorithm No of hosp admissions (All Cause) Membership H40.0 Glaucoma suspect 3009 Basic capital equipment used in own rooms by ophthalmologists. Only to be charged at first and follow-up consultations. Not to be charged for post-operative follow-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 both eyes) 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 or item 3012) Numer of beneficiaries that underwent surgery Member No H40.3 Glaucoma secondary to eye 3002 trauma Gonioscopy Dependent code H40.4 Glaucoma secondary to eye inflammation 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 eye 3027 disorders Fundus 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 surgery H40.8 Other glaucoma 3017 Retinal threshold test inclusive of computer disc storage for Delta of Statpak programs - annual Claims H40.9 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 service H42.8 Glaucoma in other diseases classified elsewhere Cost of drops before surgery versus cost of drops after surgery Doctor type Q15.0 Congenital glaucoma Management 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 N H42 Glaucoma in diseases classified 3028 elsewhere Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye Tariff Code / UPFS H42.0 Glaucoma in endocrine, nutritional and metabolic diseases 3018 Retinal threshold trend evaluation (additional to item 3017) (Annually) Nappi codes Glaucoma Surgery 3020 Special eye investigations: Pachymetry: Only when own instrument is used, 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 be charged at first and follow-up consultations. Not to be charged for post-operative follow-up consultations. (x3 per year) CPT Code 3014 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 or item 3012) (x3 per year) Claimed Amount 3003 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 or item 3012) (x3 per year) Benefit Amount 3002 Gonioscopy. (x3 per year) Member Amount 3017 Retinal threshold test inclusive of computer disc storage for Delta of Statpak programs. (x2 per year) Length of Stay Level of Care Surgery Exit Reason code 3021 Special eye investigations: Retinal function assessment including refraction after ocular surgery (within four months), maximum two examinations. (x2 per year) 3080 Examination of eyes under general anaesthetic where no surgery is done. (x4 per year) Clinical results FEV Drainage operation 3062 Implantation of aqueous shunt device/seton in glaucoma (additional to item 3061) 3063 Cyclocryotherapy or cyclodiathermy Program 3064 Laser trabeculoplasty Date of Diagnosis 3065 Removal of blood from anterior chamber Date of Registration 3067 Goniotomy 3149 Iridectomy or iridotomy by open operation as isolated procedure 3153 Iridectomy or iridotomy by laser or photocoagulation as isolated procedure (maximum one procedure) 3157 Division of anterior synechiae as isolated procedure 3158 Repair iris as in dialysis: Anterior chamber reconstruction 3199 Repair of conjunctiva by grafting 3196 Diamond knife: Use of own diamond knife during intraocular surgery 3201 Laser apparatus (ophthalmic): Hire fee for one or both eyes done in one sitting (Not to be used with IOL Master)

11 CPT Code Description Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series) Fistulisation of sclera for glaucoma; trephination with iridectomy Fistulisation of sclera for glaucoma; thermocauterisation with iridectomy Fistulisation of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy Fistulisation of sclera for glaucoma; iridencleisis or iridotasis Fistulisation of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery Fistulisation of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

12 ITAP TT1 MC - Haemophilia _Sept 2017 ITAP MANAGED CARE WORKING GROUP TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL s) HAEMOPHILIA Explanatory note to the Managed Care minimum reporting data specification (excel spreadsheet) The aim of the project is to measure the value added by managed care organisations, by means of capturing, measuring and reporting on clinical 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. 1

13 ITAP TT1 MC - Haemophilia _Sept 2017 Meetings and discussions were held with industry representatives and subject matter experts prior to finalising the minimum data specification. 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 fee structure 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 care interventions for the below mentioned categories are detailed by way of process indicators (see attached spreadsheet). 2

14 ITAP TT1 MC - Haemophilia _Sept 2017 Diagnosis The diagnosis of Haemophilia is made by the specified registered practitioner. Distinguish between hereditary and acquired haemophilia Investigations Pathology (Blood) o Factor VIII related antigen o Coagulation factors: Quantitative o Full blood count o Platelet count o Fibrinogen titre o Partial thromboplastin time o Prothrombin index o Therapeutic drug level: Dosage o Bleeding time o Blood volume, dye method o Coagulation factor inhibitor assay Screening Due to continuation treatment and receiving plasma product, beneficiaries to be screened for o HIV o 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 provided by BHF. 4) Treatment Haemophilia 3

15 ITAP TT1 MC - Haemophilia _Sept 2017 ATC Description B02AA02 B02BD02 B02BD03 B02BD08 B02BD04 B02BD06 H01BA H01BA02 Tranexamic acid Coagulation factor VIII Factor VIII inhibitor bypassing activity Eptacog Alfa (Activated) Coagulation factor IX Von Willebrand factor and coagulation factor VIII in combination Vasopressin and analogues Desmopressin * Please note these recommendations do not replace the published algorithms, PMB entitlements etc. It is a means of measuring the value 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 4

16 ITAP TT1 MC - Haemophilia _Sept 2017 All-cause mortality * Information in regards to ICD-10 coding may be found on the following site 6) Reporting (MCO and Scheme) *Definitions will be the same utilised within the Annual statutory returns see Circular 10 of For full details All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to the service 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 beneficiaries registered for Haemophilia on the Pharmacy Benefit and or Active disease management program (Longer than 6 months on Number of new registrations in the period Number of beneficiaries who left program * 5

17 ITAP TT1 MC - Haemophilia _Sept 2017 Under 1 1 to 4 4 to 9 10 to to to to to to to to to to to to to to to and above Total program) Male Female Male Female Male Female *Left the program This may include various reason codes i.e. left the scheme, death, suspensions etc. b) Clinical Management 6

18 ITAP TT1 MC - Haemophilia _Sept 2017 Year: Annual Number of beneficiaries with Minor /Major Bleeds admissions Number of beneficiaries with target joints Number of beneficiaries treated with Radio-Isotopes Total Number of Beneficiaries identified with 2 or more comorbidities Age Groups Female Male Female Male Female Male Male Female Under 1 1 to 4 4 to 9 10 to to to to to to to to to to to to to to to and above Total 6.2 Management in Hospital - Time period: 1 January to 31 December (Service dates / financial year), define per quarter 7

19 ITAP TT1 MC - Haemophilia _Sept Per benefit option - Per Scheme - Hospital Admissions: o All cause admissions o Haemophilia admissions - Hospital Category o Day Admission o Long Stay o 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. 8

20 ITAP TT1 MC - Haemophilia _Sept 2017 a) Hospital Category: Day Case Scheme Total number of admissions (All Cause) Total number of admissions (Haemophilia Related) Admission per category Surgical Medical Paediatric Emergency Room (Only) Mortality (Exit Codes = Expire) Claimed amount Risk paid amount Male Female Male Female Male Female Male Female b) Hospital Category: Long Stay Scheme Total number of admissions (All Cause) Total number of related admissions (Haemophilia) Surgical ICU / SICU / HC Admission per category Medical Paediatric Emergency Room (Only) Mortality (Exit Codes = Expire) Claimed amount Risk paid amount Male Female Male Female Male Female Male Female Male Female c) Hospital Category: Re-admission Scheme Total number of admissions (All Cause) Total number of related admissions (Haemophilia) Admission per category Surgical Medical Paediatric Emergency Room (Only) Mortality (Exit Codes = Expire) Claimed amount Risk paid amount Male Female Male Female Male Female Male Female 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 9

21 Entry and Verification Process Indicators Disease Management Program Algorithm Outcomes Data Spec ICD10 Description - Haemophilia ATC Class ATC Class Investigation Tariff Code Tariff Description Program Algorithm Outcome Data specs D66 Hereditary factor VIII deficiency Haemophilia (Hereditary) Diagnostic Date of Diagnosis CDL Alogrithm No of hosp admissions (All Cause) Membership D67 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 activity Platelet function studies 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 Von Willebrand 3758 B02BD04 Coagulation factor IX factor Factor VIII related antigen (determine severity) (initial workup) Number of Radio Isotopes (frequency) Date of birth B02BD06 H01BA02 Von Willebrand factor and coagulation factor VIII in combination Desmopressin Factor XIII 3757 Number of beneficiaries with 'complications' (See secondary codes Quantitive Coagulation factors: Quantitative tab) per system Gender Factor XIII Qualitative 3744 Fibrin stabilizing factor (urea test) Number of beneficairies with target joints PTT 3837 Partial thromboplastin time (Mixing studies x3) Claims Radio Isotopes See attached Thrombin time 3841 Thrombin time (screen) ATC codes Number of beneficiaries treated with radio-isotopes Date of service Ristocetin cofactor 3857 Ristocetin Cofactor Doctor type INR 3805 Prothrombin index Practice number Drug Levels 3806 Therapeutic drug level: Dosage ICD -10 Code D-Dimer (qualitative) 3854 XDP (Dimer test or equivalent latex slide test) DSP: Y or N D- Dimer (Quantatitive) 3856 D-Dimer (quantitative) Tariff Code / UPFS FDP 3853 Fibrin degeneration products (latex slide) Nappi codes ATC Class Radiology X-rays Fractures / target joint CPT Code MRI On motivation Claimed Amount Benefit Amount Management Member Amount INR 3724 Coagulation factor inhibitor assay Length of Stay FBC 3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) Level of Care Platelets 3797 Platelet count Arthropathy Exit Reason code INR 3805 Prothrombin index Factor XIII 3757 Quantitive Coagulation factors: Quantitative (per algorithm) Clinical results Factor XIII Qualitative 3744 Fibrin stabilizing factor (urea test) FEV1 Screening (Plasma products given hence screening) - Annually HIV antibodies 3932 Antibodies to human immunodeficiency virus (HIV): ELISA Program Liver Function 3999 Albumin Date of Diagnosis Test (annual) 4001 Alkaline phosphatase Date of Registration 4131 Alanine aminotransferase (ALT) 4009 Bilirubin: Total 4010 Bilirubin: Conjugated 4117 Protein: Total 4130 Aspartate aminotransferase (AST) 4134 Gamma glutamyl transferase (GGT) 4531 Hepatitis: Per antigen or antibody Hepatitis 3942 Hepatitis Rapid Viral Ab Genetic testing (Factor 8 and 9) - Once off (Maternity to be screened) Genetic councellor Dental Screening (Bi Oral examination 8102 Comprehensive oral examination Physiotherapy - Rehabilitation Nurse (88) Home RX 030 Rehabilitation where the pathology requires the undivided attention of the physiotherapist. Rule 008 does not apply. Duration: 30min. Hydrotherapy where the pathology requires the undivided attention of the physiotherapist. Rule 008 does not apply. Duration: 30min. Nursing - 88 practice Where a consultation was not performed and the nurse attended to or visited the patient with the sole purpose of administering intramuscular or intravenous medication. The route of administration of medication to be stated, as well as the name of the medication. Oral, rectal, vaginal medication excluded as well as the application of topical medicine. Target joint Note: * first 20 exposures to be performed in a facility with emergency facilities A target joint is a joint in which 3 or more spontaneous bleeds have occurred within a consecutive 6-month period.

22 Tariff CodeTariff Description 3641 Tracer test 3642 Repeat of further tracer tests for same investigation: Half of above fee If both tracer and therapeutic procedures are done, half fee of tracer test to be charged 3643 plus therapeutic fee 3645 Other organ scanning with use of relevant radio isotopes WHOATC Description V09 Diagnostic radiopharmaceuticals V09A Central nervous system V09AA Technetium (99mTc) compounds V09AA01 Technetium (99mTc) exametazime V09AA02 Technetium (99mTc) bicisate V09AB Iodine (123I) compounds V09AB01 Iodine iofetamine (123I) V09AB02 Iodine iolopride (123I) V09AB03 Iodine ioflupane (123I) V09AX Other central nervous system diagnostic radiopharmaceuticals V09AX01 Indium (111In) pentetic acid V09AX02 Fludeoxyglucose (18F) V09AX03 Iodine (124I) 2beta-carbomethoxy-3beta-(4 iodophenyl)-tropane V09AX04 Flutemetamol (18F) V09AX05 Florbetapir (18F) V09AX06 Florbetapen (18F) V09B Skeleton V09BA Technetium (99mTc) compounds V09BA01 Technetium (99mTc) oxidronic acid V09BA02 Technetium (99mTc) medronic acid V09BA03 Technetium (99mTc) pyrophosphate V09BA04 Technetium (99mTc) butedronic acid V09C Renal system V09CA Technetium (99mTc) compounds V09CA01 Technetium (99mTc) pentetic acid V09CA02 Technetium (99mTc) succimer V09CA03 Technetium (99mTc) mertiatide V09CA04 Technetium (99mTc) gluceptate V09CA05 Technetium (99mTc) gluconate V09CA06 Technetium (99mTc) ethylenedicysteine V09CX Other renal system diagnostic radiopharmaceuticals V09CX01 Sodium iodohippurate (123I) V09CX02 Sodium iodohippurate (131I) V09CX03 Sodium iothalamate (125I) V09CX04 Chromium (51Cr) edetate V09D Hepatic and reticulo endothelial system V09DA Technetium (99mTc) compounds V09DA01 Technetium (99mTc) disofenin V09DA02 Technetium (99mTc) etifenin V09DA03 Technetium (99mTc) lidofenin

23 V09DA04 Technetium (99mTc) mebrofenin V09DA05 Technetium (99mTc) galtifenin V09DB Technetium (99mTc), particles and colloids V09DB01 Technetium (99mTc) nanocolloid V09DB02 Technetium (99mTc) microcolloid V09DB03 Technetium (99mTc) millimicrospheres V09DB04 Technetium (99mTc) tin colloid V09DB05 Technetium (99mTc) sulfur colloid V09DB06 Technetium (99mTc) rheniumsulfide colloid V09DB07 Technetium (99mTc) phytate V09DX Other hepatic and reticulo endothelial system diagnostic radiopharmaceuticals V09DX01 Selenium (75Se) tauroselcholic acid V09E Respiratory system V09EA Technetium (99mTc), inhalants V09EA01 Technetium (99mTc) pentetic acid V09EA02 Technetium (99mTc) technegas V09EA03 Technetium (99mTc) nanocolloid V09EB Technetium (99mTc), particles for injection V09EB01 Technetium (99mTc) macrosalb V09EB02 Technetium (99mTc) microspheres V09EX Other respiratory system diagnostic radiopharmaceuticals V09EX01 Krypton (81mKr) gas V09EX02 Xenon (127Xe) gas V09EX03 Xenon (133Xe) gas V09F Thyroid V09FX Various thyroid diagnostic radiopharmaceuticals V09FX01 Technetium (99mTc) pertechnetate V09FX02 Sodium iodide (123I) V09FX03 Sodium iodide (131I) V09FX04 Sodium iodide (124I) V09G Cardiovascular system V09GA Technetium (99mTc) compounds V09GA01 Technetium (99mTc) sestamibi V09GA02 Technetium (99mTc) tetrofosmin V09GA03 Technetium (99mTc) teboroxime V09GA04 Technetium (99mTc) human albumin V09GA05 Technetium (99mTc) furifosmin V09GA06 Technetium (99mTc) stannous agent labelled cells V09GA07 Technetium (99mTc) apcitide V09GB Iodine (125I) compounds V09GB01 Fibrinogen (125I) V09GB02 Iodine (125I) human albumin V09GX Other cardiovascular system diagnostic radiopharmaceuticals V09GX01 Thallium (201Tl) chloride V09GX02 Indium (111In) imciromab V09GX03 Chromium (51Cr) chromate labelled cells V09GX04 Rubidium (82RB) chloride V09H Inflammation and infection detection V09HA Technetium (99mTc) compounds V09HA01 Technetium (99mTc) human immunoglobulin

24 V09HA02 Technetium (99mTc) exametazime labelled cells V09HA03 Technetium (99mTc) antigranulocyte antibody V09HA04 Technetium (99mTc) sulesomab V09HB Indium (111In) compounds V09HB01 Indium (111In) oxinate labelled cells V09HB02 Indium (111In) tropolonate labelled cells V09HX Other diagnostic radiopharmaceuticals for inflammation and infection detection V09HX01 Gallium (67Ga) citrate V09I Tumour detection V09IA Technetium (99mTc) compounds V09IA01 Technetium (99mTc) anticarcinoembryonicantigen antibody V09IA02 Technetium (99mTc) antimelanoma antibody V09IA03 Technetium (99mTc) pentavalent succimer V09IA04 Technetium (99mTc) votumumab V09IA05 Technetium (99mTc) depreotide V09IA06 Technetium (99mTc) arcitumomab V09IA07 Technetium (99mTc) hynic-octreotide V09IA08 Technetium (99m Tc) etarfolatide V09IA09 Technetium (99m Tc) tilmanocept V09IB Indium (111In) compounds V09IB01 Indium (111In) pentetreotide V09IB02 Indium (111In) satumomab pendetide V09IB03 Indium (111In) antiovariumcarcinoma antibody V09IB04 Indium (111In) capromab pendetide V09IX Other diagnostic radiopharmaceuticals for tumour detection V09IX01 Iobenguane (123I) V09IX02 Iobenguane (131I) V09IX03 Iodine (125I) CC49-monoclonal antibody V09IX04 Fludeoxyglucose [18F] V09IX05 Fluorodopa (18F) V09IX06 sodium fluoride (18F) V09IX07 Fluoromethylcholine (18F) V09IX08 Fluoroethylcholine (18F) V09IX09 Gallium (68Ga) edotreotide V09IX10 Fluoroethyl-L-tyrosine (18F) V09IX11 Fluoroestradiol (18F) V09IX12 Fluciclovine (18F) V09X Other diagnostic radiopharmaceuticals V09XA Iodine (131I) compounds V09XA01 Iodine (131I) norcholesterol V09XA02 Iodocholesterol (131I) V09XA03 Iodine (131I) human albumin V09XX Various diagnostic radiopharmaceuticals V09XX01 Cobalt (57Co) cyanocobalamine V09XX02 Cobalt (58Co) cyanocobalamine V09XX03 Selenium (75Se) norcholesterol V09XX04 Ferric (59Fe) citrate V10 V10A Therapeutic radiopharmaceuticals Antiinflammatory agents

25 V10AA Yttrium (90Y) compounds V10AA01 Yttrium (90Y) citrate colloid V10AA02 Yttrium (90Y) ferrihydroxide colloid V10AA03 Yttrium (90Y) silicate colloid V10AX Other antiinflammatory therapeutic radiopharmaceuticals V10AX01 Phosphorous (32P) chromicphosphate colloid V10AX02 Samarium (153Sm) hydroxyapatite colloid V10AX03 Dysprosium (165Dy) colloid V10AX04 Erbium (169Er) citrate colloid V10AX05 Rhenium (186Re) sulfide colloid V10AX06 Gold (198Au) colloidal V10B Pain palliation (bone seeking agents) V10BX Various pain palliation radiopharmaceuticals V10BX01 Strontium (89Sr) chloride V10BX02 Samarium (153Sm) lexidronam V10BX03 Rhenium (186Re) etidronic acid V10X Other therapeutic radiopharmaceuticals V10XA Iodine (131I) compounds V10XA01 Sodium iodide (131I) V10XA02 Iobenguane (131I) V10XA53 Tositumomab/iodine (131I) tositumomab V10XX Various therapeutic radiopharmaceuticals V10XX01 Sodium phosphate (32P) V10XX02 Ibritumomab tiuxetan[90y] V10XX03 Radium (223 Ra) dichloride

26 Discipline Sub-discipline Discipline-description Sub-Discipline description Nutritionist Accredited Blood and Blood Product Couriers Chiropractors Homoeopaths Ambulance Service Basic Life Support Service Ambulance Service Intermediate Life Support Service Ambulance Service Advance Life Support Service Ambulance Service Provincial Ambulance Service Anaesthetists Dermatology General Medical Practice Specialist Family Medicine Independent Practice Specialist Obstetrics and Gynaecology Independent Practice Sub Specialist Obstetrics and Gynaecology Critical Care Independent Practice Sub Specialist Obstetrics and Gynaecology Gynaecological Oncology Independent Practice Sub Specialist Obstetrics and Gynaecology Medical Genetics Independent Practice Sub Specialist Obstetrics and Gynaecology Maternal and Foetal Medicine Independent Practice Sub Specialist Obstetrics and Gynaecology Reproductive Medicine Independent Practice Sub Specialist Obstetrics and Gynaecology Infectious Diseases Pulmonology Independent Practice Specialist Medicine Independent Practice Subspecialist Medicine Clinical Haematology Independent Practice Subspecialist Medicine Nephrology Independent Practice Subspecialist Medicine Cardiology Independent Practice Subspecialist Medicine Endocrinology Independent Practice Subspecialist Medicine Pulmonology Independent Practice Subspecialist Medicine Critical Care Independent Practice Subspecialist Medicine Geriatric Medicine Independent Practice Subspecialist Medicine Medical Genetics Independent Practice Subspecialist Medicine Infectious Diseases Independent Practice Subspecialist Medicine Gastroenterology Independent Practice Subspecialist Medicine Medical Oncology Independent Practice Subspecialist Medicine Rheumatology Gastroenterology Neurology Cardiology Cardiology Independent Practice Sub Specialist Medicine Cardiology Independent Practice Sub Specialist Paediatrics Cardiology Independent Practice Sub Specialist Special Merit Psychiatry Medical Oncology Independent Practice Specialist Neurosurgery Independent Practice Sub Specialist Neurosurgery Critical Care Nuclear Medicine Ophthalmology Clinical Haemotology Clinical Haematology Independent Practice Sub Specialist Pathology (Haematological) Clinical Haematology Paediatrics Clinical Haematology Medicine Orthopaedics Occupational Medicine Independent Practice Specialist

27 Otorhinolaryngology Rheumatology Paediatrics Independent Practice Specialist Paediatrics Independent Practice Sub Specialist Neurology Paediatrics Independent Practice Sub Specialist Developmental Paediatrics Paediatrics Independent Practice Sub Specialist Medical Oncology Paediatrics Independent Practice Sub Specialist Infectious Diseases Paediatrics Independent Practice Sub Specialist Medical Genetics Paediatrics Independent Practice Sub Specialist Endocrinology Paediatrics Independent Practice Sub Specialist Gastroenterology Paediatrics Independent Practice Sub Specialist Neonatology Paediatrics Independent Practice Sub Specialist Pulmonology Paediatrics Independent Practice Sub Specialist Rheumatology Paediatrics Independent Practice Sub Specialist Nephrology Paediatrics Independent Practice Sub Specialist Critical Care Paediatrics Independent Practice Sub Specialist Cardiology Paediatrics Independent Practice Sub Specialist Clinical Haematology Physical Medicine Emergency Medicine Independent Practice Specialist Plastic and Reconstructive Surgery Medical technology Medical technology Blood Transfusion Technology Medical technology Cardiology Medical technology Chemical Pathology Medical technology Clinical Pathology Medical technology Cytotechnology Medical technology Forensic Pathology Medical technology Haematology Medical technology Histopathological Technique Medical technology Lung Function Medical technology Microbiology Medical technology Parasitology Medical technology Pharmacology Medical technology Virology Medical technology Immunology Medical technology Radio-Isotope Technology Diagnostic Radiology Radiography Radiography Diagnosis Radiography Therapy Radiography Nuclear Medicine Radiography Ultrasound Independent Practice Specialist Radiation Oncology Surgery Independent Practice Specialist Surgery Independent Practice Sub Specialist Vascular Surgery Surgery Independent Practice Sub Specialist Critical Care Surgery Independent Practice Sub Specialist Gastroenterology Surgery Independent Practice Sub Specialist Trauma Surgery Cardio Thoracic Surgery Urology Drug & Alcohol Rehab (Department of Health) Drug & Alcohol Rehab (Welfare)

28 Travel Clinic Sub-Acute Facilities General Care Sub-Acute Facilities Psychiatry Sub-Acute Facilities Physical Rehab Sub-Acute Facilities All Services Sub-Acute Facilities Post Natal Unit Sub-Acute Facilities Psychiatric/Post Natal Sub-Acute Facilities Rehab/Post Natal Sub-Acute Facilities Specialised Psychiatric Unit Only Group practices Group Practice Primary Care Delayed Children Development Clinic WELFARE & DOH Group practices/hospitals Pathology Independent Practice Specialist Pathology Independent Practice Sub-Specialist Anatomy Pathology Independent Practice Sub-Specialist Chemical Pathology Independent Practice Sub-Specialist Clinical Pathology Independent Practice Sub-Specialist Forensic Pathology Independent Practice Sub-Specialist Medical Genetics Pathology Independent Practice Sub-Specialist Microbiology Pathology Independent Practice Sub-Specialist Infectious Diseases Pathology Independent Practice Sub-Specialist Virology General Dental Practice Mental Health Institutions Provincial Hospitals Provincial Hospitals District Hospital Provincial Hospitals Regional Hospital Provincial Hospitals Tertiary/Academic Hospital Provincial Hospitals DOH Oral healthcare Centre Provincial Hospitals Primary Care Provincial Hospitals DOH Orthotics & Prosthetics Centre Provincial Hospitals Central Hospital Provincial Hospitals Specialised Hospital Provincial Hospitals Small District Hospital Provincial Hospitals Medium District Hospital Provincial Hospitals Large District Hospital Private Hospitals ('A' - Status) Private Hospitals ('A' - Status) +ICU +Theatre Less than 100 beds Private Hospitals ('A' - Status) #NAME? Private Hospitals ('A' - Status) #NAME? Private Hospitals ('A' - Status) #NAME? Private Hospitals ('A' - Status) #NAME? Private Hospitals ('A' - Status) #NAME? Private Hospital Lesotho #NAME? Private Hospitals ('A' - Status) Mine Hospilals Private Hospitals ('A' - Status) State subsidised Private Hospitals ('B' - Status) Private Rehab Hospital (Acute) Pharmacies Pharmacies Consultant Pharmacy Pharmacotherapist Maxillo-facial and Oral Surgery

29 Orthodontics Occupational Therapy Art Therapists Podiatry Medical Scientist Clinical Biochemist Medical Scientist Genetic Councillor Medical Scientist Medical Biological Scientist Medical Scientist Medical Physicist Optometrists Supplementary Optometrists Visual Science,Ocular Pathology & Dispensing of Spectacles Optical dispensers Supplementary Optical dispensers No limitations Physiotherapists Masseurs Orthoptists Clinical technology Clinical technology Cardio-Vascular Perfusion Clinical technology Pulmonology Clinical technology Nephrology Clinical technology Reproductive biology Clinical technology Neurophysiology Clinical technology Critical Care Clinical technology Cardiology Unattached operating theatres / Day clinics Approved U O T U / Day clinics Blood transfusion services Hospices Hospices SA Cancer Associations Nursing Agencies/Home Care Services Registered Counsellors Speech therapy and Audiology Speech Therapy Only Audiology Only Hearing Aid Acoustician Dieticians Psychometry Psychologists Psychologists Clinical Psychologists Counselling Psychologists Educational Psychologists Industrial Psychologists Neuropsychologists Orthotists & Prosthetists Registered nurses Registered nurses Midwife only Registered nurses Psychiatric only Registered nurses Primary Care Social workers Clinical services Clinical services Oxygen Supplier Clinical services Wheelchairs Supplier Clinical services Ear & Voice Prosthetic Supplier

30 Clinical services Eye Prosthetic Supplier Clinical services Breast Prosthetic Supplier Clinical services Cardiac Prosthetic Supplier Clinical services Stomal/appliances Supplier Clinical services Medical General Supplier Clinical services FAMSA (family and marriage counselling) Clinical services Oncology units (not owned by hospital) Clinical services Diabetes Appliances Clinical Services Compression Bandaging & Bone Healing System Clinical Services Parenteral Nutrition (TPN) - homecare Biokinetics Periodontics Dental Technician Prosthodontic Dental therapy Community dentistry Independent Practice Specialist Public Health Medicine Oral pathology Naturopathy Osteopathy Phytotherapy Ayurveda Ayurveda Practitioner Ayurveda Primary Healthcare Advisor Ayurveda Yoga Therapist Acupuncturist Therapeutic Aromatherapist Therapeutic Massage Therapist Therapeutic Reflexologist Unani-Tibb Clinical Pharmacokineticist Radiopharmacist Independent Practice Specialist Clinical Pharmacology Oral Hygiene Paediatric Surgery Independent Practice Specialist Medical Genetics

31 Haemophilia Related Complications Respiratory Haemorrhage from respiratory passages R04.0 Epistaxis Haemorrhage from respiratory passages R04.1 Haemorrhage from throat Haemorrhage from respiratory passages R04.2 Haemoptysis Haemorrhage from respiratory passages R04.8 Haemorrhage from other sites in respiratory passages Haemorrhage from respiratory passages R04.9 Haemorrhage from respiratory passages, unspecified Joint M25.0 Haemarthrosis M25.00 Haemarthrosis, multiple sites M25.01 Haemarthrosis, shoulder region M25.02 Haemarthrosis, upper arm M25.03 Haemarthrosis, forearm M25.04 Haemarthrosis, hand M25.05 Haemarthrosis, pelvic region and thigh M25.06 Haemarthrosis, lower leg M25.07 Haemarthrosis, ankle and foot M25.08 Haemarthrosis, other site M25.09 Haemarthrosis, site unspecified Dental Gingivitis and periodontal diseases K05 Gingivitis and periodontal diseases Gingivitis and periodontal diseases K05.0 Acute gingivitis Gingivitis and periodontal diseases K05.1 Chronic gingivitis Gingivitis and periodontal diseases K05 Gingivitis and periodontal diseases Gingivitis and periodontal diseases K05.0 Acute gingivitis Gingivitis and periodontal diseases K05.1 Chronic gingivitis Dental caries K02 Dental caries Dental caries K02.0 Caries limited to enamel Dental caries K02.1 Caries of dentine Dental caries K02.2 Caries of cementum Dental caries K02.3 Arrested dental caries Dental caries K02.4 Odontoclasia Dental caries K02.5 Caries with pulp exposure Dental caries K02.8 Other dental caries Dental caries K02.9 Dental caries, unspecified GIT Vascular disorders of intestine K55.2 Angiodysplasia of colon Peptic ulcer, site unspecified K27.0 Peptic ulcer, site unspecified, acute with haemorrhage Peptic ulcer, site unspecified K27.2 Peptic ulcer, site unspecified, acute with both haemorrhage and perforation Peptic ulcer, site unspecified K27.4 Peptic ulcer, site unspecified, chronic or unspecified with haemorrhage Peptic ulcer, site unspecified K27.6 Peptic ulcer, site unspecified, chronic or unspecified with both haemorrhage and perforation Other diseases of digestive system K92.1 Melaena Other diseases of digestive system K92.0 Haematemesis Genitourinary Recurrent and persistent haematuria N02 Recurrent and persistent haematuria Recurrent and persistent haematuria N02.0 Recurrent and persistent haematuria, minor glomerular abnormality Recurrent and persistent haematuria N02.1 Recurrent and persistent haematuria, focal and segmental glomerular lesions Recurrent and persistent haematuria N02.2 Recurrent and persistent haematuria, diffuse membranous glomerulonephritis Recurrent and persistent haematuria N02.3 Recurrent and persistent haematuria, diffuse mesangial proliferative glomerulonephritis Recurrent and persistent haematuria N02.4 Recurrent and persistent haematuria, diffuse endocapillary proliferative glomerulonephritis Recurrent and persistent haematuria N02.5 Recurrent and persistent haematuria, diffuse mesangiocapillary glomerulonephritis Recurrent and persistent haematuria N02.6 Recurrent and persistent haematuria, dense deposit disease Recurrent and persistent haematuria N02.7 Recurrent and persistent haematuria, diffuse crescentic glomerulonephritis Recurrent and persistent haematuria N02.8 Recurrent and persistent haematuria, other Recurrent and persistent haematuria N02.9 Recurrent and persistent haematuria, unspecified Pregnancy Antenatal screening Z36.2 Other antenatal screening based on amniocentesis 5026 Ultrasound guided amniocentesis 2611 Chorion villus sampling (excluding after-care) Pain Systemic disorders of connective tissue in dis M36.2 Haemophilic arthropathy (D66-D68+)

32 ABBREVIATIONS apcc Activated prothrombin complex concentrate aptt Activated partial thromboplastin time BA Bethesda Assay BC Buffered Citrol 1 Coagulation Control Level 1 BDDRFVIII B-domain-deleted recombinant factor VIII BNPP Buffered Normal Pooled Plasma BU/mL Bethesda unit per millilitre CFC Clotting factor concentrate Citrol 1 Dade Citrol 1 Coagulation Control Level 1 CI Confidence interval CV Coefficient of variation ECAT External quality Control of diagnostic Assays and Tests Foundation FEIBA Factor Eight Inhibitor Bypassing Activity FLRFVIII Full-length recombinant factor VIII FVIII Factor VIII FIX Factor IX HCCC Haemophilia Comprehensive Care Centre ITI Immune tolerance induction LTA Low-titre FVIII inhibitor assay NA Nijmegen modification of the Bethesda Assay NBU/mL Nijmegen-Bethesda unit per millilitre NPP Normal Pooled Plasma pdfviii Plasma-derived factor VIII PPP Platelet poor plasma PTP Previously treated patients PUP Previously untreated patients QC Quality control RCF Relative centrifugal force rfviia Recombinant activated Factor VII rfviii Recombinant factor VIII