Compensation for Occupational Injuries and Diseases Act, 1993 (Act No. 130 of 1993)

CODE

DESCRIPTION

RAND

1.

General Wards

H001

Surgical cases: per day

3977.01

H002

Thoracic and neurosurgical cases (including laminectomies and spinal fusion): per day

3977.01

H004

Medical and neurological cases: per day

3977.01

H007

Day admission which includes all patients discharged by 23:00 on date of admission

1702.11

1.1

Special Care Units

Hospitals shall obtain a doctor's report stating the reason for accommodation in an intensive care unit or a high care ward from the attending medical practitioner, and such report including the date and time of admission and discharge from the unit shall be forwarded to the Commissioner together with the account. Pre-drafted and standard certificates of authorisation will not be acceptable.

H201

Intensive Care Unit:  per day

26658.59

H215

High Care Ward:  per day

13757.07

2.

Theatres and Emergency Unit

2.1

Theatre and Emergency fees are inclusive of all consumables and equipment. The after hours fee are included in the normal theatre fee

Rule: Emergency fee - excluding follow-up

H301

For all emergencies including those requiring basic nursing input, e.g. BP measurement, urine testing, application of simple bandages, administration of injections

954.66

H302

For all emergencies which require the use of a procedure room, e.g. for application of plaster, stitching of wounds.

1936.81

H303

Follow-up visits: The Compensation Fund will imburse hospitals for all materials used during follow-up visits.  No consultation or facility fee is chargeable. The account is to be billed as for fee for service

H105

Resuscitation fee charged only if patient has been resuscitated and intubated in a trauma unit which has been approved by the Board of Healthcare Funders.

7579 06

2.2

Minor Theatre Fee

A facility where simple procedures which require limited instrumentation and drapery, minimum nursing input and local anaesthetic procedures are carried out. No sophisticated monitoring is required but resuscitation equipment must be available.

The exact time of admission to and discharge from the minor theatre shall be stated, upon which the minor theatre charge shall be calculated as follows:

H071

Charge per minute

115.02

2.3

Major Theatre

The exact time of admission to and discharge from the theatre shall be stated, upon which the theatre charge shall be calculated as follows:

H081

Charge per minute

340.35

3.

Prosthesis

Prosthesis Pricing:

Note: A ceiling price of R1556.81 per prosthesis is included in the theatre tariff. The combined value of all the components including cement in excess of R1556.81 should be charged separately.

A prosthesis is a fabricated or artificial substitute for a diseased or missing part of the body, surgically implanted, and shall be deemed to include all components such as pins, rods, screws, plates or similar items, forming an integral part of the device so implanted, and shall be charged as a single unit.

Reimbursement will be at the lowest available manufacturer's price (inclusive of VAT).

H286

Internal Fixators (surgically implanted)

Reimbursement will be at the lowest available manufacturer's price inclusive of VAT.

Hospitals/unattached operating theatre units shall show the name and reference number of each item. The suppliers' invoices, each containing the manufacturer's name, should be attached to the account and the components specified on the account should appear on the invoice.

External Fixators

Reimbursement will be at 33% of the lowest available manufacturer's price inclusive of VAT.

3.1

Medical artificial items (non-prosthesis)

Hospitals/unattached operating theatre units shall show the name and reference number of each item. The suppliers' invoices, each containing the manufacturer's name, should be attached to the account and the components specified on the account should appear on the invoice.

H287

Examples of items included hereunder shall be artificial limbs, wheelchairs, crutches and excretion bags. Copies of invoices shall be supplied to the Commissioner. Reimbursement will be at the lowest available manufacturer's price inclusive of VAT.

Further Non-Prosthetic Medical Artificial items:

Sheepskins

Abdominal Binders

Orthopaedic Braces (ankle, knee, wrist, arm)

Anti-Embolism Stockings

Futuro Supports

Corsets

Crutches

Clavicle Braces

Toilet Seat Raisers

Walking Aids

Walking Sticks

Back Supports

Elbow/Hand Cradles

4.

Serious Burns

Billed at normal fee for service.

The following items are applicable and must be accompanied by a written motivation from the treating doctor.

H289

Serious Burns: Fee for service (Inclusive of all services e.g. accommodation, theatre, etc.) except medication whilst hospitalised.

-

H290

Serious Burns: Item for medication used during hospitalisation excluding the TTO's.

-

Note : TTO's should be charged according to item H288

5.

Psychiatric Hospitals : Practice 55

H008

General Ward for Psychiatric Hospitals (Inclusive fee: Ward fee, Pharmaceuticals, Occupational Therapy)

3098.27

6.

TTO

H288

TTO scripts will be reimbursed by the Commissioner for a period of two (2) weeks. A script that covers a period of more than two (2) weeks must have a doctor's motivation attached. Applicable to 49, 55, 57/58, 59 and 79

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