GoodX Manage for Medical | Dental Practices

Why are Rules used in the coding Structure?

The rules for medical coding ensure that processes are properly followed and that information on the accounts is accurate and correct. It also ensures that the patient's records are accurate and the claim is sent with the correct codes.

Here are a few rules but the complete list can be found in the MDCD

Rule B: Normal and after hours:

• When non-emergency, elective visits/consultation falls outside of the normal practice hours and is requested by patient for their own convenience, refer to item 0148
  
• Bona fide emergency consultation/visit (21:00 - 06:00 daily), refer to item 0149
  

Please note: patients will be personally responsible for payment of the applicable items if these services fall outside the medical scheme benefits.

Rule D: Cancellation of appointments

• Unless timely steps are taken to cancel an appointment for a consultation, the relevant consultation item may be charged. In case of a general practitioner "timely" shall mean two hours and in case of a specialist one calendar day prior to the appointment. Each case shall, however, be considered on merit and, if circumstances warrant, no consultation shall be charged. If a patient has not turned up for a procedure, each member of the surgical team is entitled to charge for a visit at or away from medical doctor's rooms as the case may be.
  

Rule E: Pre-operative visits

• The appropriate consultation may be charged for all pre-operative visits with the exception of a routine pre-operative visit at the hospital since that routine pre-operative visit is included in the global surgical period for the procedure.
  

Rule G: Post-operative care

• Unless otherwise stated, the units in respect of an operation or procedure shall include normal aftercare for period not exceeding FOUR WEEKS (after-care is excluded from pure diagnostic procedures during which no therapeutic procedures were performed)
  
• If the normal after-care is delegated to any other registered health professional and not completed by the surgeon, it shall be his/her own responsibility to arrange for the service to be rendered without extra charge.
  
• When post-operative care/treatment of a prolonged or specialised nature is required, the benefits, as may be agreed upon between the surgeon and the scheme or patient (in case of a private account), may be used.
  
• Normal after-care refers to an uncomplicated postoperative period not requiring any further incisions.
  
• A complication or exacerbation of an underlying co-morbidity that requires care other than normal aftercare for the particular operation, will qualify for a follow-up consultation item. Treatment of conditions such as postoperative pneumonia, pyrexia, wound complications, prolonged ileus (>5 days), DVT, etc, is not considered as part of normal aftercare.