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

DIAGNOSTIC PROCEDURES

General Rules

Rule

Rule Description

001

Note: Items 015, 029, 031, 033, 037, 065, 071, 075, 077, 079, 081, 087, 089, 115, 117, 119, 121, 129, 135, 137, 139 and 167 should be only be paid on condition that the radiographer submits the name of the supervising clinician and his/her BHF practice number.

002

Radiographer invoices will only be paid on condition that there is a referral letter from a treating practitioner.

Modifier

Modifier Description Standards

Rand

Addition

Modifier (AM)

This modifier will add a value by using a percentage value or a unit value to a procedure code. The modifier should be quoted on a separate line with its own value instead of adding its value to the code.

Compound

Modifiers (CM)

The modifier should be quoted on a separate line with its own value at the end of the invoice instead of adding its value to the code. It should be indicated on each procedure code where the modifier is applicable.

Reduction

Modifiers (RM)

This modifier reduces the value of a procedure code/s by using a percentage or unit value. It should be quoted on the procedure codes where the modifier is applicable.

Information

Modifier (IM)

This modifier provides additional information to a procedure code and carries no financial value. It should be indicated on each procedure codes where the modifier is applicable.

M0001

AM: Emergency fee

75.80

M0021

IM: Services rendered to hospital patients: Quote modifier 0021 on all accounts for services performed on hospital or day clinic patients.

M0080

IM: Multiple examinations: Full fees

M0081

IM: Repeat examinations: No reduction

M0084

IM: Film Cost: The cost of film is included in the comprehensive procedure

codes and is not billed separately

Tariff Codes

Code

Code Description

Rand

1.

Skeleton

1.1

Limbs

39001

Finger, toe

268.45

39201

Limb per region, e.g. Shoulder, (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

377.86

39202

Limb per region, e.g. Elbow (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

340.86

39203

Limb per region, e.g. Knee (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

360.57

39204

Limb per region, e.g. Foot, (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

303.97

39205

Limb per region, e.g. Hand (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

334.43

39206

Limb per region, e.g. Wrist (an adjacent part which does not require an

additional set of views should not be added, e.g. wrist or hand)

345.08

39207

Limb per region: Ankle (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

360.57

39208

Limb per region: Scaphoid (an adjacent part which does not require an

additional set of views should not be added, e.g. wrist or hand)

358.47

39209

Limb per region: Radius and ulna (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

319.36

39210

Limb per region: Humerus (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

319.36

39211

Limb per region: Acromio-Clavicula joint (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

340.86

39212

Limb per region: Clavicle (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

330.43

39213

Limb per region: Scapula (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

330.43

39214

Limb per region: Calcaneus (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

297.54

39215

Limb per region: Tibia and Fibula (an adjacent part which does not require an additional set of views should not be added,e.g. wrist or hand}

319.36

39216

Limb per region: Patella (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

300.81

39217

Limb per region: Femur (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

319.36

39218

Limb per region: Hip (an adjacent part which does not require an additional set

of views should not be added, e.g. wrist or hand)

345.08

39219

Limb per region: Sesamoid Bone (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

303.97

39005

Smith-Petersen or equivalent control, in theatre

Use once per sitting

894.91

39007

Stress studies, e.g. joint

339.37

39009

Length studies per right and left pair of long bones

Only use once for both pair of bones

463.13

39220

Limb per region: Acromio-Clavicula joint (an adjacent part which does not require an additional set of views should not be added, e.g. wrist or hand)

262.75

1.2

Spinal Column

39017

Per region, e.g. cervical, sacral, coccygeal, one region thoracic

Code can be used multiple times for different anatomical sites of the spine

185.93

39301

Cervical Spine - 2 or more views

501.81

39302

Per region, e.g. Sacral

471.51

39303

Per region, e.g. Coccygeal

471.51

39304

Thoracic Spine 2 Views

376.28

39305

Lumbar Spine - 2 or more views

522.68

39021

Stress studies

66.87

39027

Pelvis (sacro-iliac or hip joints only to be added where an extra set of views is required)

384.09

Myelography

39029

Lumbar

286.76

39031

Thoracic

266.70

39033

Cervical

395.17

39035

Multiple (lumbar, thoracic, cervical): Same fee as for first segment (no additional introduction of contrast medium) Refer to general rule 001.

-

39037

Discography (Refer to general rule 001)

209.37

1.3

Skull

39039

Skull studies

404.81

39041

Paranasal sinuses

384.09

39043

Facial bones and/or orbits

412.27

39045

Mandible

384.09

39047

Nasal bone

250.80

39049

Mastoid: Bilateral

753.06

1.3.1

Teeth

39051

One quadrant

209.81

39053

Two quadrants

265.49

39055

Full mouth

248.50

39057

Rotation tomography of the teeth and jaws

425.97

39059

Temporo-mandibular joints: Per side

373.35

39061

Tomography: Per side

202.68

39063

Localisation of foreign body in the eye

373.35

39065

Ventribulography

(Refer to general rule 001)

248.83

39067

Post-nasal studies: Lateral neck

167.71

39069

Maxillo-facial cephalometry

173.60

39071

Dacryocystography (Refer to general rule 001)

156.20

2.

Alimentary Tract

39075

Pharynx and oesophagus (Refer to general rule 001)

151.60

39077

Oesophagus, stomach and duodenum (control film of abdomen included) and limited follow through (Refer to general rule 001).

209.37

39079

Small bowel meal (control film of abdomen included, except when part of tariff code 39081) (Refer to general rule 001).

184.26

39081

Barium meal and dedicated gastro-intestinal tract follow through (including control film of the abdomen, oesophagus, duodenum, small bowel and colon) (Refer to general rule 001).

314.05

39087

Gastric/oesophageal/duodenal intubation control (Refer to general rule 001)

138.23

3.

Chest

39105

Larynx (tomography included)

282.04

39107

Chest (tariff code 39167 included)

405.47

39109

Chest and cardiac studies (tariff code 39167 included)

153.57

39111

Ribs

452.28

39113

Sternum or sterno-clavicular joints

530.21

3.1

Bronchography

39115

Unilateral (Refer to general rule 001)

215.18

39117

Bilateral. Cannot be used with tariff code 39115 (Refer to general rule 001)

375.98

39119

Pleurography (Refer to general rule 001)

104.46

39121

Laryngography (Refer to general rule 001)

104.46

39123

Thoracic inlet

268.34

4.

Abdomen

39125

Control films of the abdomen (not being part of examination for barium meal, pyelogram, etc.).

348.25

39127

Acute abdomen or equivalent studies

562.22

5.

Urinary Tract

39129

Control film included and bladder views before and after micturition (Refer to general rule 001)

445.70

39135

Cystography only or urethrography only (retrograde)

(Refer to general rule 001 )

250.03

5.1

Cysto-Urethrography

39137

Retrograde (Refer to general rule 001)

220.11

39139

Retrograde-prograde pyelography (Refer to general rule 001)

282.04

39143

Tomography of renal tract: Add to item for examination performed

127.48

6.

Tomography and Cinematography

39151

Tomography (conventional except where otherwise specified): Add 100% provided that if it is more than one dimension. fees shall be charged for the additional investigation at 50% of the rate with a maximum of two additional investigations.

-

39153

Tomography (multi-dimensional in motion): Add 150%

-

7.

Computed Tomography

Modifier governing this specific section of the Tariffs

Modifier

Modifier Description

M0089

RM: The number of sections of each examination and the matrix number must be specified. A full series of sections would be 8 or more for brain examinations, 12 or more for chest examinations, and 16 or more for abdomen examinations.Fees for examinations on a matrix number of less than 250 shall be reduced by 50%.

39155

Head, single examination, full series

1 747.06

39157

Head, repeat examination at the same visit, after contrast, full series

599.60

39159

Chest

2 019.78

39161

Abdomen (including base of chest and/or pelvis)

2 347.54

39163

Multiple examinations: For an additional part, the lesser fee shall be reduced to 50%

546.00

39165

Limbs and other limited examinations

546.00

8.

Miscellaneous

39167

Fluoroscopy: Per half hour: Add to item for examination performed (not applicable to tariff code 39107 and 39109) (Refer to Rule 001)

Reflect time on the invoice.

142.50

39169

Where a C-arm portable x-ray unit is used in hospital or theatre: Per half hour: Add to item for examination performed Reflect time on the claim or invoice.

196.76

39179

Attendance at operation in theatre or at radiological procedure performed by a surgeon or physician in x-ray department except 005: Per 1/2 hour: Plus fee for examination performed

Reflect time on the claim or invoice.

117.07

39181

Setting of sterile trays

Use tariff code 39181 once per sitting regardless of the number of procedures done.

19.95

39300

X-Ray films

(Refer to modifier 0084)

-

Attendance In Catheterlsation Laboratory

Use codes 191 to 192 to charge for radiographer input where that is not included in cathlab facility fee.

39191

Preparation in catheterisation laboratory for purposes of  invasive intravascular procedures.

285.99

39192

Post-processing in catheterisation laboratory for purposes of invasive intravascular procedures.

285.99

39199

Vascular Study per 30 minutes or part thereof provided that such part comprises 50% or more of the time

Reflect time on the claim or invoice.

285.99

Rules

Z

No fee to be subject to more than one reduction

9.

Portable Unit Examinations

39185

Where portable x-ray unit is used in the hospital or theatre: Add  to tariff code for examination performed.

129.02

39187

Theatre investigations with fixed installation: Add to tariff code for examination performed.

55.14