You will notice ICD-10 codes on the account received from you medical service provider. These codes are used to indicate the condition for which you were treated. Medical schemes use these codes to assess which conditions have been treated, in order to ensure the correct claim payments from the correct benefit, be it chronic, day to day or dental.
The ICD-10 is a shortened version of the very long name for the code – International Classification of Disease and Related Health Problems 10th Revision. The World Health Organisation issued the code system to enable standardized descriptions for medical information.
When you joined a medical aid, you will contribute towards a specific benefit plan / option offered by your scheme. With these codes it is possible for the scheme to get accurate information regarding the exact condition diagnosed and treated and for payment according to the terms and conditions applying to payment for the specific condition and treatment plan.
These codes are very important to ensure that PMB treatments are paid. The standardized codes used on your account is an indication to the scheme whether the condition is a PMB or not. If an incorrect code is used on the account, it can lead to non-payment by your medical aid. Then the client have to go back to their service provider and obtained the correct ICD-code for the specific treatment and the service provider have to resubmit the account again for processing.
No other person are allowed to request a medical practitioner to disclose the ICD-code. The code stands for a specific condition or treatment and is confidential information regarding the patient.