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2 No. 31249 GOVERNMENT GAZETTE, 21 JULY 2008

CONTENTS , , Page Gazette ^°- No. No.

PROCLAMATION R. 29 Road Accident Fund Amendment Act

(19/2005): Commencement of sections 6, 7, 8, 9, 10, 11, 12 and 13 3 31249

GOVERNMENT NOTICES

Transport, Department of

Government Notices

R. 769 Road Accident Fund Act (56/1996): Regulations 5 31249

R. 770 do.: Road Accident Fund Regulations, 2008 6 31249

R. 771 do.; do,: Notice of tariffs 119 31249

INHOUD ^ Bladsy Koerant

No. No.

PROKLAMASIE

R. 29 Wysigingswet op die Padongeluksfonds (19/2005): Inwerkingtreding van artikels 6, 7, 8, 9, 10, 11, 12 en 13 4 31249

GOEWERMENTSKENNISGEWINGS

Vervoer, Departement van

Goewermentskennisgewings

R. 769 Road Accident Fund Act (56/1996): Regulations 5 31249

R. 770 Padongelukfondswet (56/1996): Pad-ongelukfondsregulasies, 2008 62 31249

R. 771 do.: do.: Kennisgewing van tariewe 363 31249

STAATSKOERANT, 21 JULIE 2008 No. 31249 3

PROCLAMATION by the

President of the Republic of South Africa

No. R. 29, 2008

ROAD ACCrDENT FUND AMENDMENT ACT, 2005 (ACT 19 OF 2005)

In temis of section 13 of the Road Accident Fund Amendment Act, 2005 (Act No. 19 of 2005), I detemiine 01 August 2008 as the date upon which sections 6,7,8,9,l0,11,l2,andl3 wiil comd into operation.

Given under my Hand and Seal of the Republic of South Africa at Pretoria on day of 9th July Two-thousand and Eight.

MR. TM MBEKI PRESIDENT

By order of the President

MR IRJTRADEBE MINISTER OF TRANSPORT


pROKLAMASIE

van die

President van die Republielt van Suid-Afrilia

No. R. 23, 2008

Kragtens arbkel 13 van die Wysigingsv/et op die Padongeluksfbnds, 2005 (Wet No. 19 van 2005), bepaal ek hiemee dat 01 August 2008 dis datum is waarop artikels 0,7,8,S,' 0,'t'i,1I2,©:513 In wefidng tree.

Gegee onder my Hand en die Seel van die Republiek van Suid-Afrika te Pretoria op hede 9 Julie Tweeduisend-en-agt.

DATUM:

OMIST [: OF T^WSPOC^T DATUM:


GOVERNMENT NOTICES

GOEWERMENTSKENNISGEWINGS

DEPARTMENT OF TRANSPORT DEPARTEMENT VAN VERVOER

No. R. 769 21 July 2008

ROAD ACCIDENT FUND ACT, 1996 (ACT No. 56 OF 1996),

REGULATIONS

I, Jeffrey Thamsanqa Radebe, Minister of Transport, acting in terms

of Section 26 of the Road Accident Fund Act, 1996 (Act No. 56 of

1996), make the regulations in the schedule.

These Regulations are published for General information and

Compliance and will come into operation on the 01 August 2008

/^^^A^ J.T. RADEBE MP

MINISTER OF TRANSPORT

DATE: 7/07/2008


No. R. 770 21 July 2008

ROAD ACCIDENT FUND ACT, 1996

ROAD ACCIDENT FUND REGULATIONS, 2008

The Minister of Transport has, under section 26 of the Road Accident Fund

Act, 1996 (Act No. 56 of 1996), made the Regulations in the Schedule hereto.

SCHEDULE

1 Definitions

In these Regulations, unless the context otherwise indicates-

(i) "appeal tribunal" means the tribunal constituted in tenns of regulation

3(8);


(ii) "AMA Guides" means the American Medical Association's Guides to the

Evaluation of Permanent Impainvent, Sixth Edition, or such edition

thereof as the Fund may from time to time give notice of in the Gazette;

(iii) "dispute resolution form" means a duly completed form RAF5, attached

hereto as annexure E, or such amendment or substitution thereof as the

Fund may from time to time give notice of in the Gazette.

(iv) "day" means any day other than a Saturday, Sunday or public holiday;

(v) "fiscal year" means the period commencing on the first day of March of a

given year and ending on the last day of February of the subsequent

year;

(vi) "health care provider" means a health care provider, as defined In the

National Health Act, 2003 (Act No. 61 of 2003).

(vii) "health practitioner" means a practitioner of a profession registrable in

terms of the Health Professions Act, 1974 (Act No. 56 of 1974);

(viii) "medical practitioner" means a person registered as such under the

Health Professions Act, 1974 (Act No. 56 of 1974);


(ix) "Registrar" means the Registrar of the Health Professions Council of

South Africa established in terms of section 2 of the Health Professions

Act, 1974 (Act No. 56 of 1974).

(x) "serious injury assessment report" means a duly completed fornn RAF4,

attached hereto as annexure D, or such amendment or substitution

thereof as the Fund may from time to time give notice of in the Gazette.

2 Further provision for liability of Fund in terms of section 17(1 )(b)

(1) (a) A claim for compensation referred to in section 17(1)^6) of the Act

shall be sent or delivered to the Fund in accordance with the

provisions of section 24 of the Act, within two years from the date

upon which the cause of action arose.

(b) A right to claim compensation from the Fund under section 17(1)Ci))

of the Act in respect of loss or damage arising from the driving of a

motor vehicle in the case where the identity of neither the owner nor

the driver thereof has been established, shall become prescribed

upon the expiry of a period of two years from the date upon which

the cause of action arose, unless a claim has been lodged in tenns

of paragraph (a).


(c) In the event of a claim having been lodged in terms of paragraph (a)

such claim shall not prescribe before the expiry of a period of five

years from the date upon which the cause of action arose.

(2) Notwithstanding anything to the contrary contained in any law a claim for

compensation referred to in section 17(1)(ibj of the Act shall be sent or

delivered to the Fund within two years from the date upon which the

cause of action arose irrespective of any legal disability to which the third

party concerned may be subject.

3 Assessment of serious injury in terms of section 17(1 A)

(1) (a) A third party who wishes to claim compensation for non-pecuniary

loss shall submit himself or herself to an assessment by a medical

practitioner in accordance with these Regulations.

(b) The medical practitioner shall assess whether the third party's injury

is serious in accordance with the following method:

(i) The Minister may publish in the Gazette, after consultation with

the Minister of Health, a list of injuries which are for purposes

of section 17 of the Act not to be regarded as serious injuries

and no injury shall be assessed as serious if that injury meets

the description of an injury which appears on the list.


(ii) If the injury resulted in 30 per cent or more Impairment of the

Whole Person as provided in the AMA Guides, the injury shall

be assessed as serious.

(iii) An injury which does not result in 30 per cent or more

Impairment of the Whole Person may only be assessed as

serious if that injury:

(aa) resulted in a serious long-term impairment or loss of a

body function;

(bb) constitutes permanent serious disfigurement;

(cc) resulted in severe long-term mental or severe long-term

behavioural disturbance or disorder; or

(dd) resulted in loss of a foetus.

(iv) The AMA Guides must be applied by the medical practitioner

in accordance with operational guidelines or amendments, if

any, published by the Minister from time to time by notice in

the Gazette.

(v) Despite anything to the contrary in the AMA Guides, in

assessing the degree of impairment, no number stipulated in


the AMA Guides is to be rounded up or down, regardless of

whether the number represents an initial, an intermediate, a

combined or a final value, unless the rounding is expressly

required or permitted by the guidelines issued by the Minister.

(vi) The Minister may approve a training course in the application

of the AMA Guides by notice in the Gazette and then the

assessment must be done by a medical practitioner who has

successfully completed such a course.

(2) (a) Unless otherwise provided In these Regulations, the costs of an

assessment shall be borne by the Fund or an agent only if the third

party's injury is found to be serious and the Fund or the agent

attracts overall liability in tenns of the Act.

(b) The Fund or an agent may at its cost, at the request of a third party,

make available to the third party the services of, or, alternatively,

refer the third party to-

(i) a medical practitioner for purposes of an assessment in

accordance with these Regulations; and

(ii) a health care provider, for purposes of collecting and collating

information to facilitate such an assessment


if the Fund decides that there is a reasonable prospect that a

medical practitioner may assess the injury to be serious and the

third party lacks sufficient funds to obtain an assessment.

(3) (a) A third party whose injury has been assessed in terms of these

Regulations shall obtain from the medical practitioner concerned a

serious injury assessment report.

(b) A claim for compensation for non-pecuniary loss in terms of section

17 of the Act shall be submitted in accordance with the Act and

these Regulations, provided that:

(i) the serious injury assessment report may be submitted

separately after the submission of the claim at any time before

the expiry of the periods for the lodgement of the claim

prescribed in the Act and these Regulations; and

(ii) where maximal medical improvement, as provided in the AMA

Guides, in respect of the third party's injury has not yet been

reached and where the periods for lodgement of the claim

prescribed in terms of the Act and these Regulations will

expire before such improvement is reached, the third party

shall, notwithstanding anything to the contrary contained in the

AMA Guides, submit himself or herself to an assessment and


lodge the claim and the serious injury assessment report prior

to the expiry of the relevant period.

(c) The Fund or an agent shall only be obliged to compensate a third

party for non-pecuniary loss as provided in the Act if a claim is

supported by a serious injury assessment report submitted in terms

of the Act and these Regulations and the Fund or an agent is

satisfied that the injury has been correctly assessed as serious in

terms of the method provided in these Regulations.

(d) If the Fund or an agent is not satisfied that the injury has be'en

con-ectly assessed, the Fund or an agent must:

(i) reject the serious injury assessment report and furnish the

third party with reasons for the rejection; or

(ii) direct that the third party submit himself or herself, at the cost

of the Fund or an agent, to a further assessment to ascertain

whether the injury is serious, in terms of the method set out in

these Regulations, by a medical practitioner designated by the

Fund or an agent.

(e) The Fund or an agent must either accept the further assessment or

dispute the further assessment in the manner provided in these

Regulations.


(4) If a third party wishes to dispute the rejection of the serious injury

assessment report, or in the event of either the third party or the Fund or

the agent disputing the assessment performed by a medical practitioner

in terms of these Regulations, the disputant shall:

(a) within 90 days of being informed of the rejection or the assessment,

notify the Registrar that the rejection or the assessment is disputed

by lodging a dispute resolution form with the Registrar;

(b) in such notification set out the grounds upon which the rejection or

the assessment is disputed and include such submissions, medical

reports and opinions as the disputant wishes to rely upon; and

(c) if the disputant is the Fund or agent, provide all available contact

details pertaining to the third party.

(5) (a) If the Registrar is not notified that the rejection or the assessment is

disputed in the manner and within the time period provided for in

subregulation (4), the rejection or the assessment shall become

final and binding unless an application for condonation is lodged

with the Registrar as well as sent or delivered to the other party to

the dispute.


(b) A written response to the application for condonation may be

submitted with the Registrar within 15 days after receipt of the

application for condonation and a reply thereto may be lodged

within 10 days.

(c) Every application for condonation, response and reply shall-

(i) be clear and succinct and to the point;

(ii) furnish fairly all such information as is necessary to enable the

appeal tribunal to decide the application; and

(iii) deal with the merits of the dispute only insofar as is necessary

for the purpose of-explaining and Supporting the grounds for or

against condonation.

(d) The Registrar shall refer the application for condonation together

with any response and reply to the appeal tribunal.

(e) The appeal tribunal when considering the application for

condonation may call for the submission of-

(i) further infomriation; or

(ii) any additional documentation;

and the party concerned shall lodge with the Registrar the requested

further information and documents within the period stipulated by the

appeal tribunal.


(f) If either party fails to comply with the direction given by the appeal

tribunal, the appeal tribunal may dispose of the application in its

incomplete form without having regard to the further information or

documents called for.

(g) The appeal tribunal shall decide whether or not to condone the late

notification of a dispute and inform the parties accordingly.

(h) If late notification is not condoned, the rejection or the assessment

shall become final and binding.

(6) The Registrar shall within 15 days of having been notified of a dispute in

terms of subregulation (4), or notified that condonation is granted to a

disputant in terms of subregulation (5), inform in writing the other party of

the dispute and provide copies of all the submissions, medical reports

and opinions submitted by the disputant to the other party.

(7) After being informed in tenns of subregulation (6), the other party may:

(a) in writing and within 60 days notify the Registrar which submissions,

medical reports and opinions are placed in dispute; and

(b) attach to such notification the submissions, medical reports and

opinions relied upon.


(8) (a) After receiving the notification from the other party or the expiry of

the 60 day period, referred to in subregulation (6), the Registrar

shall refer the dispute for consideration by an appeal tribunal paid

for by the Fund.

(b) The appeal tribunal consists of three independent medical

practitioners with expertise in the appropriate greas of medicine,

appointed by the Registrar, who shall designate one of them as the

presiding officer of the appeal tribunal.

(c) The Registrar may appoint an additional independent health

practitioner with expertise in any appropriate health profession to

assist the appeal tribunal in an advisory capacity.

(9) (a) The Registrar shall in writing inform the parties who the persons are

that he or she has appointed in terms of subregulation (8).

(b) (i) If a party is aggrieved by any one or more of the appointments

made by the Registrar in tenns of subregulation (8), such party

shall within 10 days deliver a written motivation to the

Registrar and the other party, setting forth grounds upon which

the party objects to the appointment made.

G08-073649 —B


(ii) The other party may respond in writing v ithin 10 days by

delivering a response to the Registrar and the aggrieved party.

(iii) The Registrar may, upon receipt of a v\/ritten motivation, and a

response thereto, if any, either confirm the appointment made

in terms of subregulation (8) or substitute any one or more of

the initial appointments made, and such decision by the

Registrar shall be final.

(10) (a) If it appears to the majority of the members of the appeal tribunal

that a hearing for the purpose of considering legal arguments may

be warranted, the presiding officer of the appeal tribunal shall notify

the Registrar to this effect in writing, stating reasons.

(b) When the Registrar receives the notification he or she shall request

the chairperson of the bar council, alternatively the chairperson of

the law society, of the jurisdictional area concerned, to appoint an

advocate of the High Court of South Africa, or an attorney of the

High Court of South Africa, with at least five years of experience in

practice.

(c) The advocate or attorney, once appointed, shall consider the

reasons submitted to the Registrar by the presiding officer of the

appeal tribunal and shall within 10 days of his or her appointment


make a recommendation in writing on whether a hearing is

warranted.

(d) The appeal tribunal shall consider the recommendation made by

the advocate or attorney and determine, in writing, whether the

nature of the dispute warrants a hearing for the purpose of

considering legal arguments.

(e) If the appeal tribunal determines that a hearing is warranted, the

appointed advocate or attorney shall preside at the hearing and the

Registrar shall-

(i) inform the parties to the dispute that a hearing will be held at a

place and time determined by the appointed advocate or

attorney;

(ii) inform the parties that they are entitled to legal representation,

at their own cost, at the hearing and to present legal

arguments at the hearing; and

(iii) Inform the parties of any additional procedures adopted by the

advocate or attorney appointed to preside at the hearing.

(f) The appointed advocate or attorney shall within 10 days of

concluding the hearing make written recommendations to the


appeal tribunal in relation to the legal issues arising from the

hearing.

(g) The appeal tribunal shall consider the recommendations made by

the said advocate or attorney and determine, in writing, the legal

issues.

(h) If the appeal tribunal determines in temns of paragraph (d) that the

nature of the dispute does not warrant a hearing or, if it determines

that such a hearing is warranted and the legal issfcigs arising from

the hearing have been determined in terms of paragraph (g), the

functions of the appointed advocate or attorney shall cease and the

appeal tribunal shall thereafter exercise any of the powers provided

for In subregulation (11).

(11) The appeal tribunal shall have the following powers:

(a) Direct that the third party submit himself or herself, at the cost of the

Fund or an agent, to a further assessment to ascertain whether the

injury is serious, in terms of the method set out in these

Regulations, by a medical practitioner designated by the appeal

tribunal.

(b) Direct, on no less than five days written notice, that the third party

present himself or herself in person to the appeal tribunal at a place


and time indicated in the said notice and examine the third party's

injury and assess whether the injury is serious in terms of the

method set out in these Regulations.

(c) Direct that further medical reports be obtained and placed before

the appeal tribunal by one or more of the parties.

(d) Direct that relevant pre- and post-accident medical, health and

treatment records pertaining to the third party be obtained and

made available to the appeal tribunal.

(e) Direct that further submissions be made by one or more of the

parties and stipulate the time frame within which such further

submissions must be placed before the appeal tribunal.

C9 Refuse to decide a dispute until a party has complied with any

direction in paragraphs (a) to (e) above.

(g) Determine whether in its majority view the injury concerned is

serious in terms of the method set out in these Regulations.

(h) Confirm the assessment of the medical practitioner or substitute its

own assessment for the disputed assessment performed by the

medical practitioner, if the majority of the members of the appeal

tribunal consider it appropriate to substitute.


(i) Confirm the rejection of the serious injury assessment report by the

Fund or an agent or accept the report, if the majority of the

members of the appeal tribunal consider it is appropriate to accept

the serious injury assessment report.

(12) Unless there has not been compliance with directions issued in terms of

subregulation (11) 3^ to (e) above, the appeal tribunal shall notify the

Registrar of its findings within 90 days after the referral of the dispute in

terms of subregulation (8), or such additional period as the Registrar may

on application from the appeal tribunal authorise in writing.

(13) The Registrar shall inform the parties of the findings of the appeal

tribunal, which findings shall be final and binding.

(14) (a) The Fund shall bear the reasonable costs of the Health Professions

Council of South Africa arising from subregulations (4) to (13), as

agreed between the Fund and the said Council, or, failing such

agreement, as determined by the Minister after consultation with the

Minister of Health.

(b) The Fund shall bear the reasonable fees and expenses, as

determined or approved by the Fund, of the persons appointed in

terms of subregulations (8) and {^0){b).


4 Further provision in respect of claim for loss of income or support

in terms of section A7{A)(c)

In proportionately calculating the annual loss of income or support referred

to in section 17(4)^cj of the Act, such loss shall be calculated per fiscal

year.

5 Medical tariffs in terms of section 17(4B)

(1) The liability of the Fund or an agent contemplated in section M(4B)(a) of

the Act, shall be determined in accordance with the Uniform Patient Fee

Schedule for fees payable to public health establishments by full-paying

patients, prescribed under section 90{1)(b) of the National Health Act,

2003 (Act No. 61 of 2003), as revised from time to time.

(2) The liability of the Fund or an agent contemplated in section M{4B)(b) of

the Act shall be detemnined in accordance with the tariff published by the

Fund from time to time in the Gazette and such tariff shall apply only in

the case of the immediate, appropriate and justifiable medical evaluation,

treatment and care required in an emergency situation in order to

preserve the person's life or bodily functions, or both.

(3) The liability of the Fund or an agent, in circumstances other than

contemplated in subregulations (1) and (2), including but not limited to

the costs of alterations to a building or premises, or modification of a


motor vehicle, shall be based on any reasonable quotation either

submitted to or obtained by the Fund or an agent.

6 Further provision for procedural matters contemplated in section 24

(1) Any reference in section 24(1)(b) of the Act to the Fund's principal,

branch or regional office, or to an agent's registered office or local

branch office, shall for the purposes of compliance with that section, refer

to such principal, branch or regional office of the Fund, or registered

office or local branch office of an agent, as the case may be-

(a) which is situated nearest to the location where the occurrence from

which the claim arose took place; or

(b) which is situated nearest to the location where the third party

resides.

(2) (a) The Fund or an agent shall at any time after having received a

claim for compensation referred to in s 17(1) of the Act, be entitled

to require the third party concerned to submit to questioning by the

Fund or an agent at a place indicated by the Fund or an agent or to

make a further sworn statement regarding the circumstances of the

occurrence concerned or any aspect of it.


(b) In the event of the Fund or an agent requiring the third party to

submit to questioning or to make a sworn statement, or both, in

ternis of paragraph (a), no claim shall be enforceable by legal

proceedings commenced by a summons served on the Fund or an

agent before the third party has submitted himself or herself to

questioning or has made the sworn statement, or both.

7 Forms

(i) A claim for compensation and accompanying medical report referred^o

in section 24(1 ) a of the Act, shall be in the fomi RAF 1 attached as

Annexure A to these Regulations, or such amendment or substitution

thereof as the Fund may from time to time give notice of in the Gazette.

(2) A claim by a supplier referred to in section 24(3) of the Act shall be in the

form RAF 2 attached as Annexure B to these Regulations, or such

amendment or substitution thereof as the Fund may from time to time

give notice of in the Gazette.

(3) The particulars and statements referred to in section 22{^)(a) of the Act

shall be furnished to the Fund in the form RAF 3, attached as Annexure

C to these Regulations, or such amendment or substitution thereof as

the Fund may from time to time give notice of in the Gazette.


8 Transitional arrangement, and repeal of regulations

(1) These Regulations shall not apply to any claim for compensation under

section 17 of the Act in respect of which the cause of action arose prior

to the date on which these Regulations came into operation, and any

such claim shall be dealt with as if these Regulations had not come into

operation.

(2) Subject to subregulation (1) the Regulations promulgated by

Government Notice No. R. 609 of 25 April 1997 are hereby repealed.

9 Commencement

These Regulations shall come into operation on 1 August 2008.

STAATSKOERANT, 21 JULIE 2008 N o . 3 1 2 4 9 27

THIRD PARTY CLAIM FORM

2 DETAILS OF PERSON CLAIMING IN REPRESENTATIVE CAPACITY

Are you claiming compensation on behalf of someone Your Name(s) & Surname: else?

QvEsD NO Your ID / Passport Number

If you answered YES kindly furnish the following Information: In what capacity you are acting

1 PERSONAL DETAILS OF CLAIMANT

J Title Surname Postal Address

Name

Home telephone number Date of birth

"; V :"^l'•r^^•;i:DZ "; V :"^l'•r^^•;i:DZ Work telephone number ID Number / Passport Number: (Note: A certified legible copy of your identity document must be attached to this claim form) Cellular number

Residential Address Email

How would you prefer us to contact you?

Email i 1 SMS i 1 Post 1 1

Tel (H) [_J Tel (W)| | Cell \_\

3 BANK ACCOUNT DETAILS OF CLAIMANT

If your claim is successful the RAF will pay you directly. Please provide bank account details for payment of compensation due to you.

Bank (Name) Account Number

Branch number Name of Account holder

page1



4 BANK ACCOUNT DETAILS OF THE CLAIMANT'S LEGAL REPRESENTATIVE

If costs become due, please provide details of the account into which you want the costs to be paid.

Account Number Bank Name

Branch Code Name of account holder

Kindly attach one of the following documents to the claim form to enable the RAF to verify the banking details: a cancelled cheque or a certified legible copy/original statement of account which clearly indicates the account holder's name, account and branch number, or an original letter from the bank (on an official letterhead) which confinns the account holder's name, account and branch number.

5 MOTOR VEHICLE ACCIDENT DETAILS

Date of accident

-'Y-'Y/MM/DD

In the accident were you (or the injured / deceased)

Time of accident

HH/Mi/I

Place of accident (street number and name, suburb, town, province)

Address of SAPS station where the accident was reported

Driver

Motorcyclist

Motorcycle passenger

Passenger

Cyclist

Pedestrian

I | i * complete paragraph 7

I | i * complete paragraph 7

i#- complete paragraph 6

w^ complete paragraph 6

M- complete paragraph 6

• ^ complete paragraph 6

Accident report number In an affidavit, to be attached to this claim form, please describe how the accident occurred.

6 PASSENGERS, PEDESTRIANS & CYCLISTS

What is the registration number of the vehicle on or in Driver's physical address: which you / injured / deceased was a passenger?

What is the driver's name and surname? Driver's contact number: Driver's contact number:

If you were a cyclist or a pedestrian, what is the registration number(s) of the other vechicle(s) involved in What is the driver's name and surname?

page 2



7 DRIVER / MOTOR CYCLIST

What is the registration number of the motor vehicle / Cell number

motorcycle driven by you (or the injured / deceased)?

Physical address: Physical address:

the motor vehicle / motorcycle kindly furnish the following information in respect of the owner -the motor vehicle / motorcycle kindly furnish the following information in respect of the owner -

Name and Surname

Telephone number:

8 DETAILS OF OTHER VEHICLES IN THE ACCIDENT

Please provide details of any other vehicles Involved in this accident. (Pedestrians and cyclists, must also answer this question by providing details of the vehicles involved.)

Registration number Driver's contact No

Registration number Driver's contact No

Was this a "hit-and-ain" accident?

D v«.n No

9 PARTICULARS OF DECEASED (IF APPLICABLE)

Name Date of death

V-T-YY/MM/DD

Surname What is your relationship to the deceased?

ID Number Kindly attach a copy of the death certificate, inquest report or charge sheet

Date of birth

1 0 SAFETY MEASURES

Kindly indicate whether you (or the injured) were wearing a seatbelt at the time of the accident?

Yes I I No j I OR

Kindly indicate whether you (or the injured) were wearing a helmet at the time of the accident?

Yes D "-n

pages



11 DETAILS OF WORKMAN'S COMPENSATION

The Compensation for Occupational Injuries and Diseases Act gives workers the right to claim compensation if they are injured during work.

Did the motor vehicle accident give rise to a claim{s) under the Compensation for Occupational Injuries and Diseases Act

Yes D No n If you answered YES kindly furnish the following information. Did you lodge a claim with the Compensation Fund.

Yes D No D

If YES furnish the Compensation Fund's reference number

State the amount of compensation received to date

Indicate whether the compensation received represents the final award

Yes D No D

1 2 WITNESSES

Were there any witness(es) to the accident?

If you answered YES kindly furnish the following information in respect of such witness(es):

Name and Surname

Address

Telephone No Cell No

Name and Surname

Address

Telephone No Cell number

(Should this claim form not provide enough space to list all the witnesses kindly list the remaining witnesses and their details on a separate page to be attached to this claim form)

1 3 EMPLOYMENT STATUS

What was the injured's / deceased's employment status Self employed at the time of the accident?

Employed Unemployed D

page 4


Was the claimant or / the injured required to take time off If you answered YES to the previous question, what was work due to injuries sustained in the accident the nature of the payment received from the employer

Yes D No D If you answered YES, please furnish the following details

Dates not at work -

sick leave I gratuitous or other

If you answered OTHER, please indicate the nature of the payment

W v-Vi-v' .b;

Number of work days the injured was not at work

Did the injured receive payment from the employer while not at work

Yes D No D If you answered YES, please indicate the amount received

rm^ '-^-^qk

Please provide the following details regarding the injured's / deceased's employment.

Name of employer

Employee number

Postal Address

Kindly indicate the basis of employment -

J I I Permanent | | Temporary

D Casual • Contract

Telephone number

If the employment is (or was) on a temporary/ casual or contractual basis please indicate:

Date of commencement Date of expiry

Contact person

To assist the RAF with the processing of the claim , for past and / or future loss of income, please indicate the documents you can provide to confirm the injured's / deceased's earnings.

Payslips

Most rece

Printout of payments from employer

I I Bank statements

I I Other. Please specify:

None of the above

Most recent tax return (Kindly attach copies of the documents identified by you to this claim form). Tax reference Number

page 5



1 7 SELF EMPLOYED CLAIMANTS

the Injured / deceased was self employed please complete the following details:

Business name:

Nature of business:

Business address:

Identify the applicable legal entity in respect of the

injured / deceased business-

sole trader partnership trust

j other - specify

If applicable, kindly furnish the Company / Close Corporation / Trust registration number of the business

Has the injured / deceased / business lodged tax returns during last 3 financial years

n»- n No

If you answered YES, please attach copies of those tax returns to this claim form

If you answered NO, please attach income and expenditure statements / bank statements for the business, for the past 3 years or for such shorter period that the injured / deceased has been In business.

D close corporation D company

1 8 CLAIMS FOR LOSS OF SUPPORT

Please furnish the requested details of all the persons who, at the time of death, were dependent on the deceased for support

Dependant 1

Name

Date of birth

ID Number

Relationship

Reason for dependence

Dependant 2

Name

Date of birth

ID Number

Relationship


Dependant 3

Name

Date of birth

ID Number

Relationship


Dependant 4

Name

Date of birth

ID Number

Relationship


Dependant 5

Name

Date of birth

ID Number

Relationship

/IV1ivi/DD


Note: As proof of the relationship between the deceased and the particular dependent please attach certified copies of the relevant documentation, i.e. marriage certificate, unabridged birth certificate, adoption court order, etc.

(Should this claim fomn not provide enough space to list all the dependants kindly list the remaining dependants on a separate page to be attached to this claim form)

page 6


1 9 COMPENSATION CLAIIVIED

Kindly indicate with an "X", in the space provided, the type(s) of compensation claimed as well as the exact amount claimed in respect of each type

Type(s) of Compensation Claimed

I I Emergency medical treatment

I I Non-emergency medical treatment

I I Future medical expenses

I I Past loss of income

I I Future loss of income

I I Past loss of support

Future loss of support

Funeral expenses (attach specified invoices)

a Non- pecuniary loss (general damages) *

Amount Claimed

Total Amount Claimed R

* If this claim Includes a claim for non-pecuniary loss (general damages) please furnish the RAF with a serious injury assessment report as prescribed in the regulations.

2 0 SUBSTANTIAL COMPLIANCE

Please complete the following information to validate your claim for substantial compliance with Section 24 of the RAF Act.

1. The identity (of the injured.) - (paragraph 1).

2. The date and place of accident (paragraph 5)

3. Identify the insured motor vehicles (paragraph 6 / 7 and 8).

4. A completed statutory medical report (paragraph 22);

5. Amount claimed as compensation (paragraph 19);

6. Attach accounts, vouchers, invoices etc. to support your claim for medical expenses;

7. Complete this fonn as prescribed in Section 24 of the RAF Act.

8. In the event that loss of support or funeral expenses are claimed provide documentary proof of the death of the deceased; and

9. Should the space provided in this claim form be insufficient to answer any question you are welcome to attach a further page to this claim form in which such further information can be provided to the RAF.

10. Should you require any assistance with the completion of this claim form please feel free to contact the RAF on ShareCall number 0860 2355 23.

page 7

G08-073649 —C

34 N o . 3 1 2 4 9 GOVERNMENT GAZETTE, 21 JULY 2008


2 1 DECLARATION AND CONSENT

The Consent granted to the Road Accident Fund (RAF) in this paragraph authorises the RAF to obtain copies of any records and to access any information which relates to this claim for compensation and to contact any person or entity for purposes of obtaining or verifying such information and /or documentation.

I, (name and surname of claimant), declare that, to the best of my knowledge, the information provided in this Third Party Claim Form is tme and coaect in every respect; and

I confirm that I am claiming compensation:

In my personal capacity as a result of injuries I sustained In the accident; alternatively

in my personal and / or representative capacity as _ (state capacity) on behalf of _ sustained iejuries in the accident; alternatively

in my personal and / or representative capacity as of "

. (name and surname of injured) who

. (state capacity) , (state name of the deceased) who died as a result of

the injuries sustained in the accident.

(Indicate, and if applicable complete, the applicable statement above)

I hereby consent to the release, to the Road Accident Fund, of copies of all documentation and /or information, including, but not limited to, documentation and /or information of a medical or financial nature, in the possession of any person or entity, which documentation or information, in any way, relates to this claim for compensation arising from the motor vehicle accident detailed in the claim form

I further consent to, and authorise, the Road Accident Fund to contact any person or entity for purposes of obtaining or verifying such information and /or documentation.

Signature of the Claimant Signature of the Witness

pages

STAATSKOERANT. 21 JULIE 2008 No 31249 35

rrum p^mrv SI.A\II*/I .mim ^i?

^ ftinsusiVL \?mm Section 24(2)(a) provides that this report shall be completed by the medical practitioner who treated the injured or deceased person for the bodily injuries sustained by him/her in the accident from which this claim arises

1. DETAILS OF PATIENT

Name

ID Number

Surname

Date of birth

2. PAST EMERGENCY MEDICAL TREATMENT

Note that, In terms of the regulations, emergteqcy medical treatment is defined as "...the immediate, appropriate and justifiable medical evaluation, treatment and care required in an emergency situation in order to preserve the person's life or bodily functions, or both"

Did the patient receive emergency medical treatment, as defined

• YesQ No If you answered YES, please furnish the following information in respect of such treatment-

What was the nature of the treatment?

1 1 I j Emergency transport

I I Hospital care

I 1 ICU n L _i Other, if other please indicate nature of the treatment ;

ICD 10 Code Treatment plan

Kindly furnish the ICD 10 codes applicable to the emergency medical treatment provided to the patient and motivate why the treatment is viewed as emergency medical treatment. Should the space provided in this claim form be insufficient to answer any question attach a further page(es) to this claim forrn n which such further information can be provided to the RAF.

page 9

36 No.31249 GOVERNMENT GAZETTE, 21 JULY 2008


MEDICAL REPORT

'3. PAST NON-EMERGENCY MEDICAL TREATMENT

Note that all medical evaluations and treatment that fall outside the prescribed definition of emergency medical treatment, is non-emergency medical treatment.

Did the patient receive non-emergency medical treatment?

D "D No

If you answered YES, please furnish the following information in respect of sucii treatment. In the schedule below, kindly identify the specific ICD 10 code(s) applicable and describe the treatment administered


4. PRE-EXISTING MEDICAL CONDITIONS

Did the patient suffer from any pre-existing condition(s) (injury, illness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment).

• Yesn No

If you answered YES, please identify the pre-existing condition(s), furnish the applicable ICD 10 code(s) (if such a code exists) and describe the impact of the injury(ies) sustained in the accident on such pre-existing condition(s)

Pre-existing condition ICD 10 Code Impact of accident

page 10

STAATSKOERANT, 21 JULIE 2008 No.31249 37


MEDICAL REPORT

5. FUTURE MEDICAL TREATMENT

Is the patient cun'enlly receiving ongoing medical treatment for the Injury(jes) sustained in the accident, or Is it foreseen that the patient would require future medical treatment for such injury(ies)

D -»n No

If you answered YES, please furnish the name{s) and contact number(s) of the service provider(s) who will be rendering treatment, future treatment.

6. MEDICAL TREATMENT IN MEDICAL FACILITY/HOSPITAL

Was the patient admitted to a medical facility / hospital as a result of the injury(ies) sustained in the accident, or did the patient receive treatment at a medical facility / hospital for such Injury(ies)

D v„n No

If you answered YES, please furnish the name(s) and contact number(s) of the hospital / facility, and if admitted, the date admitted and date discharged

Name of Hospital / Facility Contact number Date admitted Date discharged

Yv'YY/MiM/DD \y\yibAU!DO

YV>'Y/lMM/DD Y'VYY'M.M/DD

YY\'Y/MM/DO YVYY/MM/DD

YYYY/f,rM/DD rYYY/lvif>/i./DD

7. MEDICAL PRACTITIONERS DETAIL'S

Name Cell number

Surname Postal Address

Qualifications

Practice Number (HPCSA and/or BHF) Physical Address

Telephone number Facsimile number

page 11

38 N o . 3 1 2 4 9 GOVERNMENT GAZETTE, 21 JULY 2008


DECLARATION

I hereby declare that to the best of my knowledge and belief the information set out In this medical report is true and correct in every respect.

Signature of medical practitioner

Signed At

Date

IC^AL STAMP

vvY'MM/DD

page 12


SUPPLIER CLAIM FORM

•] SUPPLIER DETAILS

Supplier name Postal Address

Practice number (BHF/HPCSA)

Tax reference Number Telephone number

Physical Address Facsimile number

Cellular number

How would you prefer us to contact you?

Email [ ^ SMS Q Post Q Tel [ ^

Cell [ ^

2 SUPPLIER'S BANK ACCOUNT DETAILS

If your claim is sucessful the RAF will pay you directly. Please provide bank account details for payment of compensation due to you.

Bank (Name) Account Number

Branch number Name of Account holder

3 BANK ACCOUNT DETAILS OF THE SUPPLIER REPRESENTATIVE

If the suppliers claim is successful, the RAF will pay the compensation to the supplier directly and cost (if due) to the supplier's representative. Please provide details of the account into which you want the costs to be paid.

Account Number Bank Name

Branch Code Name of account holder

Kindly attach one of the following documents to the claim form to enable the RAF to verify the banking details: a cancelled cheque or a certified legible copy/original statement of account which clearly indicates the account holder's name, account- and branch number, or an original letter from the bank (on an official letterhead) which confirms the account holder's name, account- and branch number.

page 1


SUPPLIER CLAIM FORM

4 MOTOR VEHICLE ACCIDENT DETAILS

In order for the RAF to assess this claim please provide the following information.

Date of accident

Time of accident

HH/fvitv! Place of accident (street number and name, suburb, town, province)

SAPS station where the accident was reported

Accident report number

Kindly attach to this claim forni a copy of the accident report or a statement by the injured describing the events leading up to the accident.

5 INJURED'S / DECEASED'S DETAILS

Title Surname Postal Address

Name

Date of birth Home telephone number

YVYY/.MM'DD

ID Number: Work telephone number

Tax reference Number Cell number

Residential Address Email

(Please attach a copy of the injured's identity document c r, if applicable, a copy of the deceased's death certificate

6 COMPENSATION CLAIMED

What are you claiming for?

Category of claim Amount Claimed 1 1 Emergency medical treatment (attach original invoice) R

1 1 Non-emergency medical treatment (attach original invoice) R


1 1 Emergency medical treatment (attach original invoice) R



1 1 Emergency medical treatment (attach original invoice) R



page 2


SUPPLIER CLAIM FORM

7 PAST EMERGENCY iVlEDICAL TREATMENT

Note that, in terms of the regulations, emergency medical treatment is defined as '...the immediate, appropriate and justifiable medical evaluation, treatment and care required in an emergency situation in order to preserve the person's life or bodily functions, or both"

Did the patient receive emergency medical treatment, as defined,

n Y^^n No If you answered YES, please furnish the following infonmation in respect of such treatment-

What was the nature of the treatment?

1 I Emergency transport

(_ I Hospital care

• icu. D.

other, if other please indicate nature of the treatment


Kindly furnish the ICD 10 codes applicable to the emergency medical treatment provided to the patient and motivate why the treatment is viewed as emergency medical treatment Should the space provided in this claim form be insufficient to answer any question you are welcome to attach a further page(es) to this claim fomi in which such further information can be provided to the RAF.

pages

42 No. 31249 GOVLRNMENT GAZETTE, 21 JULY 2008

mJ^^^^J^^ S;.>iUM ^3^n

'• MV'

^ Note that alf medical evaluations and treatmert that fall outside the prescribed definition of emergency medical treatment, is non-emergency medical treatment.

Did the patient receive non-emergency medical treatment.

I Yes No

If you answered YES, please furnish the following information in respect of such treatment

What was the nature of the treatment? f T

I Transport

J Hospital care

[ j Other, if other piease indicate nature of the treatment

In the schedule below, kindly identify the specific ICD 10 code(s) applicable to the evaluation(s) / treatment provided to the patient and describe the treatment administered, (attach detailed invoice + medical investigation reports)


i h

•i 1-

t I

.J I.

^ ' ' ' " Did the patient suffer from any pre-existing condition(s) (injury, 'Ilness, sickness, disease, or other physical, medical, mental or nervous condition, disorder or ailment) that existed at the time of the accident

! Yes ' No L__ 1 _ _ , . - . :

If yes, please provide detaiis.

page 4


SUPPLIER CLAIM FORM

1 0 MEDICAL TREATMENT IN MEDICAL FACILITY/HOSPITAL

Name of Hospital / Facllitiy Contact number Date admitted Date discharge

V '- -'>vlivi/ij;j

••• ' ^ :-:^K.A:l-D

V ' ' ^ ' • i ;:v:IVi/DD

r /"V\ /MM/DD

•f r v i /MM/DD

Y •'T-i /KMv1/DD

Y YY> /MM/DD

Y' i'r-i ;r,'lM/DD

Y' A'Y /MFvS/DD

-••: >"v'^,];vi;?D

V' -"T;HM.i:,D

"r"'r-;'V/:.i;,.i/DD

•'"•;;• v7K4ri4/DD

V Y •;MM'DD

y - • 7 M M ; D D

> • • • r 7MM/DD

Y ' •-,,- '/fi'iiVi/C'D

r'v'YY;'VlM/GD

1 1 DECLARATION

I hereby declare that:

1) To the best of my knowledge and belief the information set out in this form is true and correct in every respect;

2) The accommodation in a hospital or nursing home and the treatment, or goods supplied, referred to herein, were supplied to the injured person; and

3) I have not / the supplier has not received payment from any other source, in respect of the accommodation in a hospital or nursing home and the treatment, or goods supplied, referred to in this claim form, and should I / the supplier receive any payment in respect thereof from any other source I / the supplier shall disclose full details thereof to the Road Accident Fund.

Signature of supplier, supplier's duly authorised representative or agent. Where the supplier is a legal entity attach written proof of the authorisation in terms of which the signatory is authorised to sign this claim form. Where the supplier is represented by an agent attach written proof of the agent's mandate.

Signed at

Date

• J w l / />! Wir

1 2 SUBSTANTIAL COMPLIANCE

Please complete the following information to validate your claim for substantial compliance to Section 24 of the RAF Act.

1. The identity of the injured/deceased - (paragraph 5). 2. The date and place of accident (paragraph 4) 3. A precise indication of the amounts claimed as compensation (paragraph 6); 4. Attach specified accounts, vouchers, original invoices etc. to support your claim for medical expenses; 5. Complete this form as prescribed in Section 24 of the RAF Act. 6. Should the space provided in this claim form be insufficient to answer any question you are welcome to

attach a further page(es) to this claim form in which such further information can be provided to the RAF. 7. Should you require any assistance with the completion of this claim form please feel free to contact the FIAF

on ShareCall number 0860 2355 23

page 5

44 No. 31249 G O V E R N M E N T GAZETTE, 21 JULY 2008

ACCIDENT REPORT FORM (SECTIONS 22(1)(a) OF ACT NO. 56 OF 1996

1) When any person has been injured or killed as a result of the driving of a motor vehicle, the owner and / or the driver of that motor vehicle must report that accident to the Fund on this form within 14 days, failing which the compensation paid to the third party may be recovered from that owner or driver.

2) Should the space provided in this claim form be insufficient to answer any question you are welcome to attach a further page(es) to this claim form in which such further information can be provided to the RAF.

3) Should you require any assistance with the completion of this claim fctn please feel free to contact the RAF on ShareCall number 0860 2355 23

Postage will be paid by the Addressee

No postage necessary if posted in the Republic of

South Africa

CHIEF EXECUTIVE OFFICER P 0 80X2743 PRETORIA 0001

PARTICULARS OF THE DRIVER OF THE VEHICLE

Name(s) Physical address

Surname

ID Number/Passport Number Postal address

Citizenship

Telephone Drivers License Number

Facsimile Date issued

^-:•YV"vi /DD

Cell Numtier Endorsements, if« any

E-mail address Physical / mental defects, if any

State whether you are also the owner of the vehcile

page 1



PARTICULARS OF THE OWNER OF THE VEHICLE -COMPLETE WHERE THE DRIVER WAS NOT THE OWNER

4 PARTICULARS OF OTHER MOTOR VEHICLES INVOLVED IN THE ACCIDENT

Name(s) Cell number

Surname E-mail address

ID Number/Passport Number Physical address

Citizenship

Telephone number Postal address

Facsimile nuftiber

3 PARTICULARS OF THE MOTOR VEHICLE

Registration number Make

Body (i.e. sedan, trucic, bus etc.) Model

Color Year

Vehicle 1

Registration number

Vehicle?

Registration number

Name(s) and surname of driver Mame(s) and sumame of driver

Telephone number/Cell number Telephone number/ Cell number

Name(s) and sumame of owner ^ame(s) and sumame of owner

Physical address Physical address

Postal address Postal address

1 page 2

46 No .31249 GOVERNMENT GAZETTE, 21 JULY 2008

,\»^^ ',S0-i-9^. i

f»ssr^0^^^M^^^^^MM| i

''^'Y'M i

?p

Vehicle 3

Rpgistratinn niimhpr r Rgistratinnniimher

Namp/fi) anrj gMmnmH nf rlrlver Namp(s)anrifiiimampnfrlrivRr

TRiephnne number/ Csll r umhp.r Telephone number/CP-II number

f^ame(s) and surname of owner Name(s} and surname of owner

P hysical address Physical address

Postal address Postal address,

r

What was the date of the accidenf At which police station was the accident reported?

What was the time of the accident? What is the police reference number?

Where did the accident take place?

Witness 1

Name(s)

Cell number

Surname

_i E-mail address

I Physical address

ID Number/ Passport Number

I Telephone number

, Postal address

Facsimile number

page 3


ACCIDENT REPORT FORM (SECTIONS 22(1 )(a) OF ACT NO. 56 OF 1996

<55i

6 PARTICULARS OF WITNESS(ES) TO THE ACCIDENT

r^Witness 2 Cell number

Name(s)

b-mall address

Surname . ,,_. — — ..

Physical address

ID Number/Passport Number

Telephone number

Postal address

Facsimile number

6 PARTICULARS OF WITNESS(ES) TO THE ACCIDENT

f^Witness3 Cell number

Name(s)

E-mail address

Surname

Physical address ID Number/ Passport Number

Telephone number

Postal address Facsimile number Facsimile number

page 4

48 No .31249 GOVERNMENT GAZETTE, 21 JULY 2008

7 pfi^mcuijmmmBB&m.. Person 1

Name(s) E-mail address

h'hysical address Surname


Postal address Telephone number

Facsimile number

Cell Number State whether the injured / deceased was a driver, passenger, cyclist or pedestrian.

7 WRTIGUlJ^RSOH^PERis6Nl)llpiiiilM

Person 2

Name(s) E-mail address

Physical address Surname


Postal address Telephone number

Facsimile number

Cell Number State whether the injured / deceased was a driver, passenger, cyclist or pedestrian.

8 CONDITIONS ATTHE TIMEiOHS^BBfiJEeiElEB

Time of day (i.e. davm, day, dusl<, night) Street lights - on or off

Weather conditions (i.e. sunny, misty, cloudy, raining, etc.) Own vehicle's lights - off, dim, bright

Visibility (i.e. good, reasonable, bad, etc.) Other vehicle's lights - off, dim, bright Other vehicle's lights - off, dim, bright

Road surface (I.e. gravel, sand, tar, etc.) Speed of own vehicle at time of accident

1 pages



9 SKETCH PLAN OF THE SCENE OF THE ACCIDENT

W

1 0 DETAILED DESCRIPTION OF THE ACCIDENT

page 6

G08-073649 —D



11 DECLARATION

[ 1 / we hereby declare that to the best of my / our Signature of owner knowledge and belief the infomiation set out In this fonn is tme and correct in every respect.

Signature of driver Signed at Signed at

Date YYYY/MW.'DD Date YYYY/MW.'DD

page?


SERIOUS INJURY ASSESSMENT REPORT

(a) A claim for non-pecuniary loss ("general damages" or "pain and suffering") will not be considered unless this report is duly completed and submitted.

(b) The Road Accident Fund Act (Act No. 56 of 1996) requires this report to be compiled by a medical practitioner, registered in temns of the Health Professions Act (Act No. 56 of 1974).

(c) The assessment of the serious injury should be conducted in terms of the method provided in the Regulations promulgated under the Road Accident Fund Act.

(d) Submissions, medical reports and opinions may he submitted as annexures to this report. (e) If any section of the form is not applicable, mark that section "N/A". (f) The impairment evaluation reports for Upper Extremities, Lower Extremities and Spine and Pelvis are annexed.

If the Injury caused an impainment to another body part or system, attach the report specified in the AMA Guides (6th Ed).

(g) In completing this report, refer to the figures, tables and page numbers from the AMA Guides (6th Ed).

1 DETAILS OF PATIENT

Name and Surname Date of assessment

YYYY/MM/DD

ID Number Date of accident

YYYY/MM/DD

Claim number (if available)

Contact number

2 DETAILS OF MEDICAL PRACTIONER

Name & Surname Telephone number

Practice Numtier (HPCSA and/or BHF) =-mail address

3 LIST OF NON-SERIOUS INJURIES

In terms of the Road Accident Fund Act (Act No. 56 of 1996) and Regulation 3(1)(b)(i) promulgated thereunder, the Minister may publish in the Gazette, after consultation with the Minister of Health, a list of injuries which are for aurposes of section 17 of the Act not to be regarded as serious injuries and no injury shall be assessed as serious if that injury meets the description of an injury which appears on the list. Once published, this part must be completed with reference to the list. A copy of the latest version of the list is available at www.raf.co.za. For more information contact the Road Accident Fund at ShareCall-number 0860 235 5523.

Number Description of injury

page 1



AMA IMPAIRMENT RATING: NON-SERIOUS INJURIES

TO BE COMPLETED IF INJURY IS NOT ON LIST OF

4.1 Describe the nature of the motor vehicle accident

4.2 Medical Treatment rendered from date of accident to present

4.3 Cun-ent symptoms and complaints

4.4 Diagnosis

4.5 Conclusion regarding Physical Examination

4.6 Conclusion regarding Clinical Studies. (Review and document actual studies and findings from relevant

diagnostic studies. Imaging including X-rays, CT.MRI.etc)

4.7 Medical History

4.8 Social and Personal history

page 2



AWIA IMPAIRMENT RATING: TO BE COMPLETED IF INJURY IS NOT ON LIST OF NON-SERIOUS INJURIES

4.9 Educational and Occupational history

4.10 Has the patient reached MMI?

4.11 Specify details regarding apportionment, If any

4.12 A clear, accurate, and complete report must be provided to support a rating of impairment with

reference to clinical evaluation analysis of findings and discussion of how the impairment rating was calculated.

The following impairment evaluation reports are annexed:

•Annexure A: Upper Extremities (Chapter 15)

•Annexure B: Lower Extremities (Chapter 16)

•Annexure C: Spine and Pelvis (Chapter 17)

4.13 Exceptions

SERIOUS INJURY: THE NARRATIVE TEST

If the injury is not on the list of non-serious injuries and did not result in 30 per cent Whole Person Impairment, as provided in the AMA Guides, consider whether the injury resulted in any of the consequences set out below. Provide full details. If necessary, support the opinion with reports attached as annexures.

5.1 Serious long-term impairment or loss of a body function

5.2 Pennanent serious disfigurement

5.3 Severe long-term mental or severe long-term behavioural disturbance or disorder

5.4 Loss of a foetus

page 3



6 DECLARATION

r I declare that to the best of my knowledge and belief the Information and opinions set out in this report are true and correct in every respect.

Signature of Medical Practitioner

Signed at

Date

OFFICIAL STAMP

'vYY/MM/DD

page 4

STAATSKOERANT, 21 JULIE 2008 No .31249 55

ANNEXURE A - UPPER EXTREMITY IMPAIRMENT EVALUATION

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page 5


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page 6


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page?


NOTIFICATION OF DISPUTE

1 TO BE COMPLETED WHERE THIRD PARTY REQUESTS DISPUTE RESOLUTION:

Title Surname

Name

Date of birth

YVYY/MM/DD

Sex Male Female • n ID Number/ Passport Number

Residential Address

Postal Address

Home telephone number

Work telephone number

Fax number

Cell

Email

2 TO BE COMPLETED WHERE THE FUND REQUESTS DISPUTE RESOLUTION:

' Complete available details of the third party: Postal Address

Home telephone number

Date of birth Sex Male Female

YYYY/MM/DD n n Work telephone number

ID Number / Passf )ort number -ax number

Residential Address Cell phone number

Email



2 TO BE COMPLETED WHERE THE FUND REQUESTS DISPUTE RESOLUTION:

3 INDICATE NATURE OF DISPUTE RESOLUTION:

Dispute of assessment - complete paragraphs 4 and 6.

I I Dispute of rejection of serious injury assessment report - complete paragraphs 5 and 6.

Details of Fund contact person: Telephone number

Title Surname Fax number Fax number

Name Email Email

Postal Address Postal Address Reference Reference

4 ASSESSMENT DETAILS:

Who performed the assessment?

When was the assessment performed?

YVry/MM/DD

When were you advised of the outcome of the assessment?

r/YY/MM/DD

(Please attach the serious injury assessment report - RAF4)

5 REJECTION DETAILS:

When was the serious injury assessment report rejected?

YYYY/M^VOO When were you advised that the report has been rejected?

rYTvviM/D;)

(Please attach reasons furnished by the Fund)

Page 2


DETAILS OF DISPUTE

Set out the grounds upon which you are disputing the assessment / rejection of the serious injury assessment report Attach ail submissions, medical reports and opinions that you rely upon.

Signature of the person requesting dispute resolution

Date

PLEASE SEND THIS NOTICE TO THE REGISTRAR OF THE HPCSA. P O Box 205 Pretoria 0001 OR facsimile 012 328 5120 OR [email protected].

(IMPORTANT: Kindly RETAIN PROOF OF WHEN this notice was posted per registered post, faxed or sent per e-mail)

Pages



NOtlFICATION OF DISPUTE IN RELATION TO THE ASSESSMENT OF A SERIOUS INJURY

HOW DISPUTE RESOLUTION WILL HELP YOU?

In tenns of the Act and the Regulations your claim for non-pecuniary loss must be supported by a serious injury assessment report, indicating that the injury has been assessed as serious by a medical practitioner and the Fund must be satisfied that the injury has been con-ectly assessed as serious.

What disputes are covered by ihe dispute resolution service?

Dispute resolution helps you if:

the medical practitioner has assessed yourinjury as'not serious"; or

if the Fund has rejected a seriousinjury assessment report by a medical practitioner in terms of which your injury has been assessed as "serious'.

You must indicate on the form whether you wish to dispute the assessment of the medical practitioner or the rejection of the report by the Fund. If you disagree with either of these, you may lodgp a dispute with the Registrar of the Heath Professions Council of South Africa (the HPCSA").

When must a dispute be lodged?

Within 90 days of being notified of the outcome of the assessment or being notified of the rejection of the serious injury assessment reJMrt and the reasons therefore, failing which you may apply to the Registrar of the HPCSA for approval (condonation) forlate notification.

How does the dispute resolution process work?

a) Your notification must be lodged with the Registrartogether with all the submissions (argument), medical reports or opinions (expert advice) that you want to rely on.

b) After you lodge your dispute, the Registrar must then inform the Fund of the dispute and give the Fund copies of all the documentation submitted by you.

c) The Fund then has 60 days to answer your case by giving the Registrar their submissions, medical reports or opinions.

d) After this, the Registrar will then inform you about the names of the medical practioners appointed to decide your dispute. Youmayobjecttotheseappointmentsifyouwishtodoso.

e) If asl<ed to do so, the appeal tritxjnal may say that legal arguments should be made on certain Issues and an attorney or advocate will then be appointed to hear such argument

f) The appeal tribunal is given extensive powers under the regulations to enable them to deal with the dispute:

The tribunal may tell you that you have to undergo another assessment by a medical practitionerfbr which the Fund will pay.. The tribunal may say that you must appear before them so that they can examine yourinjury for themselves. The tribunal may ask you for further submissions or medical records.

g) If asked to do one of the above, you should comply with the request otherwise the appeal tribunal may refuse to decide yourdispute.

h) Ultimately, the appeal tribunal will decide yourdispute and you will be informed of the outcome by the Registrar. The Fund will be obliged to accept the findings of the appeal tribunal.

How long will it take?

The appeal tribunal, appointed by the Registrar of the HPCSA to consider your dispute, must publish its findings within 90 days ft^om the date that the dispute is referred to it, which will normally be done after the Fund has answered your case.

Forfurther information please phone the Road Accident Fund on ShareCall-numben 0860 235 5523

Page 4


No. R. 770 21 Julie 2008

PADONGELUKFONDSWET, 1996

PADONGELUKFONDSREGULASIES, 2008

Die Minister van Vervoer het, l<ragtens artil<el 26 van die

Padongelukfondswet, 1996 (Wet No. 56 van 1996) die Regulasies in die

Bylae hiertoe uitgevaardig.

BYLAE

1 Definisies

In hierdie Regulasies, tensy die konteks andersins aandui, beteken-

(i) "appeltribunaal" die tribunaal saamgestel in terme van regulasie

3(8);

(ii) "AMA Guides" die American Medical Association se Guides to the

Evaluation of Permanent Impainnent, Sesde Uitgawe, of sodanige

uitgawe daarvan as wat die Ponds van tyd tot tyd in die

Staatsl<oerant kennis van mag gee;


(iii) "dag" enige dag anders as 'n Saterdag, Sondag of openbare

vakansiedag;

(iv) "ernstige besering assesseringsverslag" 'n belioorlike voltooide

vorm, RAF4, hiertoe aangeheg as aanhangsel D, of sodanige

wysiging of vervanging daarvan as wat die Fonds van tyd tot tyd in

die Staatskoerant kennis van mag gee;

(v) "fiskale jaar" die tydperk beginnende op die eerste dag van Maart

van 'n gegewe jaar en eindigende op die iaaste dag van Februarie

van die daaropvolgende jaar;

(vi) "geneesheer" 'n persoon geregistreer as sodanig kragtens die Wet

op Gesondheidsberoepe, 1974 (Wet No. 56 van 1974);

(vii) "geskilbeslegtingsvorm" 'n behoorlike voltooide vorm RAF5, hiertoe

aangeheg as aanhangsel E, of sodanige wysiging of vervanging

daarvan as wat die Fonds van tyd tot tyd in die Staatskoerant

kennis van mag gee;

(viii) "gesondheidspraktisyn" 'n praktisyn van enige professie

registreerbaar ingevolge die Wet op Gesondheidsberoepe, 1974

(Wet No. 56 van 1974);


(Ix) "gesondheidsorgverskaffer" 'n "health care provider", soos

gedefinieer in die "National Health Act", 2003 (Wet No. 61 van

2003);

(x) "Registrateur" die Registrateur van die Raad vir

Gesondheidsberoepe van Suid-Afrika daargestel ingevolge artikel 2

van die Wet op Gesondheidsberoepe, 1974 (Wet No. 56 van 1974).

2 Verdere voorsiening vir aanspreekiikheid van Fonds ingevolge

artikel 17(1)(fe;

(1) (a) 'n Els vir skadevergoeding verwys na in artikel ^7{^)(b) van die Wet

meet aan die Fonds gestuur of gelewer word, ooreenkomstig die

bepalings van artikel 24 van die Wet, binne twee jaar vanaf die

datum waarop die eisoorsaak ontstaan het.

(b) 'n Reg om skadevergoeding van die Fonds te els kragtens artikel

^7{^)(b) van die Wet ten opsigte van verlies of skade

voortspruitende uit die bestuur van 'n motorvoertuig in die geval

waar die identiteit van nog die eienaar nog die bestuurder daarvan

vasgestel is, verjaar by verstryking van 'n periode van twee jaar

vanaf die datum waarop die eisoorsaak ontstaan het, tensy 'n eis

ingevolge paragraaf (a) ingedien is.


(c) In die geval waar 'n eis ingevolge paragraaf (a) ingedien is verjaar

so 'n eis nie voor die verstryking van 'n periode van vyf jaar vanaf

die datum waarop die eisoorsaak ontstaan het nie.

(2) Nieteenstaande enigiets tot die teendeel in enige wet moet 'n eis vir

skadevergoeding verwys na in artikel ^7{^)(b) van die Wet aan die

Fonds gestuur of gelewer word binne twee jaar vanaf die datum waarop

die eisoorsaak ontstaan het ongeag enige regsbelemmernis waaraan die

betrokke derde party onderhewig mag wees.

3 Assessering van ernstige besering ingevolge artikel 17(1 A)

(1) (a) 'n Derde party wat vergoeding vir nie-geldelike verlies wil eis, moet

homself of haarself onderwerp aan 'n assessering deur 'n

geneesheer ooreenkomstig hierdie Regulasies.

(b) Die geneesheer moet assesseer of die derde party se besering

ernstig is, ooreenkomstig die volgende metode:

(i) Die Minister mag, na oorleg met die Minister van Gesondheid,

'n lys van beserings in die Staatskoerant publiseer weike

beserings vir doeieindes van artikel 17 van die Wet nie beskou

word as ernstige beserings nie en geen besering moet

assesseer word as ernstig indien daardie besering voldoen

aan die beskrywing van 'n besering wat op die lys verskyn nie.

G08-073649—E


(ii) Indien die besering 30 persent of meer "Impairment of the

Whole Person", veroorsaak het, soos voorsien in die AMA

Guides, moet die besering as ernstig assesseer word.

(iii) 'n Besering wat nie 30 persent of meer "Impairment of the

Whole Person" veroorsaak het nie, mag slegs as ernstig

assesseer word indien daardie besering:

(aa) 'n ernstige, iang-termyn aantasting of verlies van 'n

liggaamlike funksie veroorsaak het;

(bb) neerkom op permanente ernstige ontsiering;

(cc) 'n hewige, Iang-termyn verstandeiike of 'n hewige Iang-

termyn gedragsteurnis of gedragsaandoening

veroorsaak het; of

(dd) die verlies van 'n fetus veroorsaak het.

(iv) Die AMA Guides moet deur die geneesheer toegepas word

ooreenkomstig operasionele riglyne of wysigings, indien enige,

gepubliseer deur die Minister van tyd tot tyd deur

kennisgewing in the Staatskoerant.


(v) Nieteenstaande enigiets tot die teendeel vervat in die AMA

Guides, mag tydens die assessering van die graad van

aantasting, geen syfer aangedui in die AMA Guides op- of

afgerond word nie, ongeag of die syfer 'n aanvanklike, 'n

intermedi^re, 'n gekombineerde of 'n finale waarde

verteenwoordig, tensy die ronding uitdruklik vereis of gemagtig

word deur die riglyne uitgereik deur die iVIinister.

(2) (a) Tensy anders bepaal in hierdie Reguiasies, word die koste van 'n

assessering slegs deur die Fonds of 'n agent gedra indien die derde

party se besering bevind word ernstig te wees en die Fonds of die

agent oorhoofse aanspreeklikheid ingevolge die Wet opdoen.

(b) Die Fonds of 'n agent mag, op sy koste, op versoek van 'n derde

party, aan die derde party die dienste beskikbaar stel van, of,

aiternatiewelik, die derde party verwys na-

(i) 'n geneesheer vir doeleindes van 'n assessering

ooreenkomstig hierdie regulasie; en

(ii) 'n gesondheidsorgverskaffer vir doeleindes van insameling en

sortering van inligting om so 'n assessering te fasiliteer

indien die Fonds besluit dat daar 'n redelike vooruitsig is dat 'n

geneesheer die besering as ernstig sal assesseer en die derde


party nie oor genoegsame fondse beskik om die assessering te

bekom nie.

(3) (a) 'n Derde party wie se besering assesseer is in terme van liierdie

Regulasies moet van die geneesheer 'n ernstige besering

assesseringsverslag bekom.

(b) 'n Eis vir vergoeding vir nie-geldelike verlies in terme van artikel 17

van die Wet moet ooreenkomstig die Wet en liierdie Regulasies

ingedien word, met dien verstande dat:

(i) die ernstige besering assesseringsverslag apart na die

indiening van die eis te enige tyd voor die verstryking van die

periodes vir die indiening van die eis voorgeskryf in die Wet en

hierdie Regulasies ingedien mag word; en

(ii) Waar maksimale mediese verbetering ("maximal medical

improvement"), soos voorsien in die AMA Guides, ten opsigte

van die derde party se besering, nog nie bereik is nie en waar

die periodes vir die indiening van 'n eis voorgeskryf deur die

Wet en hierdie Regulasies sal verstryk voordat sodanige

verbetering bereik sal word, moet die derde party

nieteenstaande enigiets tot die teendeel vervat in die AMA

Guides, homself of haarself onderwerp aan 'n assessering en

'n eis instel voor die verstryking van die relevante periode.


(c) Die Fond of 'n agent sal slegs verplig wees om 'n derde party vir

nie-geidelike verlies soos voorsien in die Wet te vergoed indien die

eis ondersteun word deur 'n ernstige besering assesseringsverslag

ingedien ooreenkomstig die Wet en hierdie Regulasies en indien

die Fonds of 'n agent tevrede is dat die besering korrek assesseer

is as emstig in terme van die metode voorsien in hierdie

Regulasies.

(d) Indien die Fonds of 'n agent nie tevrede is dat die besering kon ek

assesseer is nie, moet die Fonds of 'n agent:

(i) die ernstige besering assesseringsverslag verwerp en die

redes vir die verwerping aan die derde party verskaf; of

(ii) die derde party beveel om homself or haarself te onderwerp,

op die koste van die Fonds of 'n agent, aan 'n verdere

assessering om vas te stel of die besering emstig Is, in terme

van die metode uiteengesit in hierdie Regulasies, deur 'n

geneesheer aangewys deur die Fonds of 'n agent.

(e) Die Fonds of 'n agent moet of die verdere assessering aanvaar of

die verdere assessering betwis op die manier voorsien In hierdie

Regulasies.


(4) Indien die derde party die verwerping van die ernstige besering

assesseringsverslag wil betwis of in die geval waar of die derde party of

die Fonds of 'n agent 'n assessering uitgevoer deur 'n geneesheer

ingevolge hierdie Regulasies wil betwis, moet die disputant:-

(b) binne 90 dae na die verwittiging van die venwerping of die

assessering, die Registrateur in kennis stel dat die ven/verping of

die assessering betwis word, deur 'n geskilbeslegtingsvorm in te

dien by die Registrateur;

(c) in sodanige kennisgewing die gronde uiteensit waarop die

venA/erping of assessering betwis word en sodanige voorleggings,

mediese verslae en opinies insluit as waarop die disputant wil

steun; en

(d) as die disputant die Fonds of 'n agent is, alle beskikbare

kontakbesonderhede aangaande die derde party verskaf.

(5) (a) Indien daar nie aan die Registrateur kennis gegee word dat die

venwerping of die assessering betwis word op die manier en binne

die tydsperiode voorsien in subregulasie (4) nie, word die

venwerping of die assessering finaal en bindend tensy die disputant

'n aansoek om kondonasie indien by die Registrateur, asook stuur

of aflewer aan die ander party tot die dispuut.


(b) 'n Geskrewe antwoord op die aansoek om kondonasie mag

ingedien word by die Registrateur binne 15 dae na ontvangs van

die aansoek om kondonasie en 'n repliek hierop mag binne 10 dae

ingedien word.

(c) EIke aansoek om kondonasie, antwoord en repliek moet-

(i) duidelik en bondig en ter sake wees;

(ii) regverdiglik ai sodanige inligting verskaf as wat nodig is om die

appeltribunaal in staat te stel om die aansoek te beslis; en

(iii) met die meriete van die dispuut handel slegs in sover dit nodig

is ter verduideliking en ondersteuning van die gronde vir of

teen kondonasie.

(d) Die Registrateur moet die aansoek om kondonasie tesame met

enige antwoord en repliek verwys na die appeltribunaal.

(e) Die appeltribunaal kan by oorweging van die aansoek om

kondonasie die voorlegging verg van-

(i) verdere infomiasie; en

(ii) enige addisionele dokumentasie;

en die betrokke party moet die aangevraagde verdere informasie en

dokumente by die Registrateur indien binne die tydperk deur die

appeltribunaal bepaal.


(f) Indien enige van die partye nalaat om aan die aanwysing deur die

appeltribunaal gegee te voldoen, kan die tribunaal die aansoek in

sy onvolledige vorm afhandel sender inagneming van die gevergde

verdere informasie of dokumente.

(g) Die appeltribunaal nnoet besluit of laat kennisgewing kondoneer

word of nie en die partye dienooreenkomstig in kennis stel.

(h) Indien laat kennisgewing nie kondoneer word nie word die

assessering finaal en bindend.

(6) Die Registrateur moet binne 15 dae vanaf kennisgewing van 'n dispuut in

terme van subregulasie (4), of nadat kondonasie gegee is aan 'n

disputant in terme van subregulasie (5), die ander party skriftelik verwittig

van die dispuut en afskrifte van alle voorleggings, mediese verslae en

opinies voorgele deur die disputant aan die ander party verskaf.

(7) Na verwittiging in terme van subregulasie (7), mag die ander party-

fa^ skriftelik en binne 60 dae aan die Registrateur kennis gee weike

voorieggings, mediese verslae en opinies voorgel§ in dispuut

geplaas word; en

(b) tot sodanige kennisgewing die voorieggings, mediese verslae en

opinies aanheg waarop gesteun word.


(8) (a) Na ontvang van die kennisgewing van die ander party of die

verstryking van die 60 dae periode, vervat in subregulasie (6), moet

die Registrateur die dispuut venwys vir oorweging deur 'n

appeltribunaal deur die Fonds voor betaal.

(b) Die appeltribunaal bestaan uit drie onafhanklike geneeshere met

deskundigheid op die gepaste terreine van geneeskunde, aangestel

deur die Registrateur, wie een van hulle moet aanwys as die

voorsittende beampte van die appeltribunaal.

(c) Die Registrateur kan 'n addisionele onafhanklike

gesondheidspraktisyn met deskundigheid in enige gepaste

gesondheidsberoep aanstel om die appeltribunaal in 'n adviserende

hoedanigheid by te staan.

(9) (a) Die Registrateur moet skriftelik beide partye tot die dispuut verwittig

wie die persone is wat hy of sy aangestel het ingevolge

subregulasie (8).

(b) (i) Indien 'n party tot die dispuut veronreg is deur enige een of

meer van die aanstellings deur die Registrateur gemaak

ingevolge subregulasie (8), moet sodanige party binne 10 dae

'n skriftelike motivering wat die gronde uiteensit waarop die


party teen 'n aanstelling beswaar maak, aan die Registrateur

en die ander party \e\Ner.

(ii) Die ander party tot die dispuut mag skriftelik antwoord binne

10 dae deur aan die Registrateur en aan die veronregte party

'n antwoord te lewer.

(iii) Die Registrateur mag, by ontvangs van 'n skriftelike

motivering, en antwoord daarop, indien enige, of die

aanstelling gemaak irfgevolge subregulasie (8) bevestig of

enige een of meer van die aanvanklike aanstellings gemaak

vervang, en sodanige beslissing deur die Registrateur is finaal.

(10) (a) Indien dit vir die meerderheid van die lede van die appeltnbunaal

voorkom dat 'n aanhoring vir die doel van die oorweging van

regsargumente geregverdig mag wees, moet die voorsittende

beampte van die appeltnbunaal die Registrateur dienooreenkomstig

skriftelik en met opgawe van redes, in kennis stei.

(b) Wanneer die Registrateur die kennisgewing ontvang, moet hy of sy

die voorsitter van die balieraad, alternatiewelik die voorsitter van die

prokureursorde, van die betrokke jurisdiksionele gebied, versoek

om 'n advokaat van die Hoe Hof van Suid-Afrika, of 'n prokureur

van die Hoe Hof van Suid-Afrika, met ten minste vyf jaar se

praktyksondervinding, aan te stel.


(c) Die advokaat of prokureur, sodra aangestel, moet die redes gegee

aan die Registrateur oorweeg en moet binne 10 dae na sy of haar

aanstelling 'n skriftelike aanbeveiing maak of 'n aanhoring

geregverdig is.

(d) Die appeltribunaal moet die aanbeveiing gemaak deur die advokaat

of prokureur oorweeg en daarna 'n skriftelike beslissing maak oor of

die aard van die dispuut sodanig is dat dit 'n aanhoring vir die doel

van die oorweging van regsargumente regverdtg.

(e) Indien die appeltribunaal beslis dat 'n aanhoring geregverdig is,

moet die aangestelde advokaat of prokureur voorsit tydens die

verhoor en moet die Registrateur-

(i) die partye tot die dispuut venwittig dat 'n aanhoring gehou sal

word op 'n piek en tyd bepaal deur die aangestelde advokaat

of prokureur;

(ii) die partye venwittig dat hulle geregtig is op

regsverteenwoordiging, op hulle eie koste, tydens die

aanhoring en om die regsargumente aan te bied by die

aanhoring;


(iii) die partye in kennis stel van enige addisionele prosedures

deur die advokaat of prokureur aanvaar wat aangestel is om

by die aanhoring voor te sit.

(^ Die aangestelde advokaat of prokureur nrioet binne 10 dae na

afsluiting van die aanhoring skriftelike aanbevelings aan die

appeltribunaal maak in verband met die regskv\/essies wat uit die

aanhoring voortgespruit het.

(g) Die appeltribunaal moet die aanbevelings gemaak deur die

gemelde advokaat of prokureur oorweeg en daarna 'n skriftelike

beslissing maak oor die regskwessies.

(h) Indien die appeltribunaal ingevolge paragraaf (d) beslis dat die aard

van die dispuut nie 'n aanhoring regverdig nie of, indien dit beslis

dat 'n aanhoring geregverdig is, sodra die regskwessies wat uit die

aanhoring voortspruit ingevolge paragraaf (g) beslis is, kom die

funksies van die aangestelde advokaat of prokureur tot 'n einde en

die appeltribunaal mag daarna enige van die magte beoog in

subregulasie (11) uitoefen.

(11) Die appeltribunaal het die volgende magte:

(a) Gelas dat die derde party, op die koste van die Fonds of 'n agent,

homself of haarself onderwerp aan 'n verdere assessering ten einde


vas te stei of die besering ernstig is, in terme van die metode

uiteengesit in hierdie Regulasies, deur 'n geneesheer deur

appeltribunaal aangewys.

(b) Gelas, by nie minder nie as vyf dae skriftelike kennisgewing, dat die

derde party homself of haarself in persoon aan die appeltribunaal

presenteer op 'n piek en tyd aangedui in die gemelde kennisgewing

en die derde party se besering ondersoek en assesseer of die

besering ernstig is in terme van die metode uiteengesit in liierdie

Regulasies.

(c) Gelas dat verdere mediese verslae verkry en voor die

appeltribunaal geplaas moet word deur een of meer van die partye.

(d) Gelas dat relevante pre- en post-ongeluk mediese, gesondheids-

en behandelingsrekords met betrekking tot die derde party verkry

word en aan die appeltribunaal beskikbaar gemaak word.

(e) Gelas dat verdere voorleggings gemaak moet word deur een of

meer van die partye en die tydsraam bepaal waarbinne sodanige

verdere voorleggings voor die appeltribunaal geplaas moet word.

(f) Weier om die dispuut te besleg totdat 'n party voldoen aan enige

lasgewing in paragrawe (a) tot (e) hierbo.


(g) Beslis of in sy meerderheidsopinie die betrokke besering ernstig is

in terme van die metode uiteengesit in liierdie Regulasies.

(h) Bevestig die assessering van die geneesheer of vervang die

betwiste assessering met sy eie assessering indien die

meerderheid van die lede van die appeltribunaal van mening is dat

dit gepas is om te vervang.

(i) Bevestig die verwerping van die ernstige besering

assesseringsversiag deur die Fonds of 'n agent of aanvaar die

versiag, indien die meerderheid van die lede van die appeltribunaal

van mening is dat dit gepas is om die ernstige besering

assesseringversiag te aanvaar.

(12) Tensy daar nie aan 'n aanwysing in terme van subregulasie ^^(a) tot (e)

voldoen is, moet die appeltribunaal binne 90 dae vanaf die verwysing

van die dispuut in terme van subregulasie (8) of sodanige addisionele

periode as wat die Registrateur op aansoek van die appeltribunaal

skriftelik mag magtig, aan die Registrateur kennis gee van sy bevindings.

(13) Die Registrateur moet die partye verwittig van die bevindinge van die

appeltribunaal, weike bevindinge finaal en bindend sal wees.

(14) (a) Die Fonds moet die redelike koste van die Raad vir

Gesondheidsberoepe van Suid-Afrika voortspruitende uit


subregulasies (4) tot (13) dra, soos ooreengekom tussen die Fonds

en die gemelde Raad, of, by gebrek aan sodanige ooreenkoms,

soos bepaal deur die Minister na oorlegpleging met die Minister van

Gesondheid.

(b) Die Fonds moet die redelike fooie en uitgawes, soos bepaal of

goedgekeur deur die Fonds, van die persone aangestel kragtens

subregulasies (8) en {10)(b) dra.

4 Verdere voorsiening ten opsigte van eis vir verlies aan inkomste of

onderhoud ingevolge artikel 17(4)(b^

Wanneer die jaarlikse verlies aan inkomste of onderhoud verwys na in

artikel M{4)(c) van die Wet proporsioneel bereken word, word sodanige

verlies bereken per fiskale jaar.

5 Mediesetariewe ingevolge artikel 17(4B)

(1) Die aanspreeklikheid van die Fonds of 'n agent beoog in artikel M{4B)(a)

van die Wet word bepaal ooreenkomstig die Eenvormige

Pasientfooiskedule vir fooie betaalbaar aan openbare

gesondheidsinrigtings deur volbetalende pasiente, voorgeskryf kragtens

artikel 90{^)(b) van die Nasionale Gesondheidswet, 2003 (Wet No. 61

van 2003), soos hersien van tyd tot tyd.


(2) Die aanspreekiiklieid van die Fonds of 'n agent beoog in artlkel M{AB)(b)

van die Wet word bepaal ooreenkonnstig die tarief wat die Fonds van tyd

tot tyd in die Staatskoerant kennis van mag gee en sodanige tarief sal

slegs geld in geval van die onmiddellike, toepaslike en regverdigbare

mediese evaluering, behandeling en sorg benodig in 'n noodsituasie ten

einde die persoon se lewe of liggamsfunksies, of beide, te red,

(3) Die aanspreekiikheid van die Fonds of 'n agent in omstandighede anders

as beoog in subregulasies (1) en (2), insluitende maar nie beperk nie tot

die koste van veranderings aan 'n gebou of perseel, of aanpassing van

'n motorvoertuig, word gebaseer op enige redelike kwotasie hetsy

voorgele aan of bekom deur die Fonds of 'n agent.

6 Verdere voorsiening vir prosedureaangeleenthede beoog in artikel 24

(1) Enige verv/ysing in artikel 24(1)(7jj van die Wet na die Fonds se hoof-,

tak- of streekskantoor, of na 'n agent se geregistreerde kantoor of

plaaslike takkantoor, verwys vir die doeleindes van voldoening aan

daardie artikel na sodanige hoof-, tak- of streekskantoor van die Fonds,

of geregistreerde kantoor of plaaslike takkantoor van 'n agent, na gelang

van die geval,-

(a) wat gele§ is naaste aan die piek waar die voorval plaasgevind het

waaruit die eis voortgevloei het; of


(b) wat gelee is naaste aan die piek waar die derde party woon.

(2) (a) Die Fonds of 'n agent kan te eniger tyd nadat 'n eis vir

skadevergoeding verv\^s na in artikel 17(1) van die Wet ontvang is,

van die betrokke derde party vereis om liom of liaar te onderwerp

aan ondervraging deur die Fonds of die agent by 'n pIek deur die

Fonds of die agent aangedui of om 'n geswore verklaring af te ie

oor die omstandighede van die betrokke voorval of enige aspek

daarvan.

(b) In die geval waar die Fonds of 'n agent van die derde party vereis

om hom/haarself te onderwerp aan ondervraging of om 'n geswore

verklaring te maak, of beide, ingevolge paragraaf (a), is geen eis

afdwingbaar by wyse van hofverrigtinge ingestel deur 'n

dagvaarding beteken op die Fonds of die agent alvorens die derde

party horn- of haarself onderwerp het aan ondervraging of 'n

geswore verklaring gemaak het, of beide.

7 Vorms

(1) 'n Eis vir skadevergoeding en gepaardgaande mediese verslag verwys

na in artikel 24(1 )fa^ van die Wet moet wees in die vorm RAF 1

uiteengesit in Aanhangsel A tot hierdie Regulasies, of sodanige wysiging

of vervanging daarvan as wat die Fonds van tyd tot tyd in die

Staatskoerant kennis van mag gee.


(2) 'n Eis deur 'n verskaffer verwys na in artikel 24(3) van die Wet moet

wees in die vorm RAF 2 uiteengesit in Aaniiangsel B tot hierdie

Regulasies, of sodanige wysiging of vervanging daarvan as wat die

Fonds van tyd tot tyd in die Staatskoerant kennis van mag gee.

(3) Die besonderhede en verkiarings verwys na in artikel 22{1)(a) van die

Wet moet aan die Fonds verskaf word in die vorm RAF 3 uiteengesit in

Aanhangsel C tot hierdie Regulasies, of sodanige wysiging of vervanging

daarvan as wat die Fonds van tyd tot tyd in die Staatskoerant kennis

van mag gee.

8 Oorgangsreeling, en herroeping van regulasies

(1) Hierdie Regulasies is nie van toepassing nie op enige eis vir

skadevergoeding kragtens artikel 17 van die Wet ten opsigte waarvan

die eisoorsaak ontstaan het voor die datum waarop hierdie Regulasies in

werking getree het, en enige sodanige eis moet gehanteer word asof

hierdie Regulasies nie in werking getree het nie.

(2) Behoudens subregulasie (1) word die Regulasies gepromulgeer by v\/yse

van Goewermentskennisgewing No. R. 609 van 25 April 1997 hierby

herroep.


9 Inwerkingtreding

Hierdie Regulasies tree op 1 Augustus 2008 in werking.


DERDEPARTY EISVORM

1 PERSOONLIKE BESONDERHEDE VAN EISER

Titel Van Posadres

Naam

Huis felefoonnommer Huis felefoonnommer Geboortedatum

Werk telefoonnommer Werk telefoonnommer lu iNommer / f^aspoortnommer: (Neem kennis:'n gesertlflseerde leesbare afskrif van u dentiteitsdokumgnt moet by die eisvorm aangeheg word Selfoonnommer

-

3elasting verwysingsnommer E-pos

Huisadres

E-pos Q SMS [ ^ Pos [ ^

Tel(H) 1 1 Tel(W) | | Sel | |


Tel(H) 1 1 Tel(W) | | Sel | |


Tel(H) 1 1 Tel(W) | | Sel | |

2 BESONDEREDE VAN PERSOON WAT EIS IN VERTEENWOORDIGENDE HOEDANIGHEID

Eis u vergoeding namens iemand anders U Naam(e) & Van:

• JA • NEE U ID / Paspoortnommer-.

Indien u JA geantwoord het verskaf asseblief die volgende inligting: In weike hoedanigheid handel u:

3 BANKREKENING BESONDERHEDE VAN EISER

Indien u eis suksesvol is sal die RAF u direk betaal. Verskaf asseblief bankbesonderhede vir betaling van vergoeding verskuldig aan u.

Bank (Naam): Rekenlngnommer:

Takkode: Naam van rekeninghouer:

BL1


DERDEPARTY EISVORM RAF1

4 BANKBESONDERHEDE VAN EISER SE REGSVERTEENWOORDIGER

Indien kostes verskuldig raak, verskaf asseblief die besonderhede van die bankrekening waarin u wil he die koste betaal moet word.

Rekeningnommer: Bank Naani:


Geliewe een van die volgende dokumente by die eisvorm aan te heg ten einde die RAF in staat te stel om die bankbesonderhede te verifieer: 'n gekanseleerde fjek of'n leesbare gesertifiseerde afskrif/oorspronklike bankstaat wat die rekeninghouer se naarn en die rekenin^efi taknommer duidelik aandui of 'n oorspronklike brief van die bank (op 'n amptelike briefhoof) wat die rekeninghouer se naam en die rekening en taknommer bevestig.

5 MOTORVOERTUIGBOTSING BESONDERHEDE

Datum van ongeluk:

Tyd van ongeluk:

In die ongeluk was u (of die beseerde / oorledene) 'n:

Bestuurder

PIek van ongeluk (straat nommer en naam, buurt, dorp, provinsie):

Adres van die SARD stasie waar die ongeluk aangemeld is:

Motorfietsbestuurder

Motorfietspassasier

Passasier

Fietsryer

Voetganger

voltooi paragraaf 7

voltooi paragraaf 7

voltooi paragraaf 6

voltooi paragraaf 6

voltooi paragraaf 6

• • voltooi paragraaf 6

Botsingsverslag nommer:

In 'n beedigde verklaring, wat by die eisvorm aangeheg moet word, beskryf asseblief hoe die ongeluk plaasgevind het.

6 PASSASIERS, VOETGANGERS EN FIETSRYERS

Wat is die registrasienommer van die voertuig waarop of Bestuurder se fisiese adres: waarin u / of die beseerde / die oorledene 'n passasier

Bestuurder se kontaknommer: Wat is die bestuurder se naam en van? Bestuurder se kontaknommer:

Indien u 'n fiersryer of passasier was, wat is die registrasienommer van die ander voertuig(uie) wat in die botsing betrokke was?

Wat is die bestuurder se naam en van? Indien u 'n fiersryer of passasier was, wat is die registrasienommer van die ander voertuig(uie) wat in die botsing betrokke was?


DERDEPARTY EISVORM

7 BESTUURDER / MOTORFIETSRYER

Wat is die registrasienommer van die motorvoertuig / Telefoonnommer: motorfiets wat deur u (of die beseerde / oorledene) bestuur Is?

Selfoonnommer: Selfoonnommer:

As u (of die beseerde / oorledenel nie die eienaar van die motorvoertuig / motorfiets is nie versl<af assebleif die volqende inliqtinq ten opsiqte van die eienaar-

Fisiese adres:

Naamen Van

8 BESONDERHEDE VAN ANDER VOERTUIE BETROKKE IN DIE ONGELUK

Versl<af asseblief besonderhede van enige ander voertuie betrokke in die botsing (voetgangers en fietsryers moet ook die vraag beantwoord deur besonderhede te verskaf van die voertuie wat betrokke was.)

Registrasienommer Bestuurder se kontaknommer

Registrasienommer Bestuurder se kontaknommer Was die 'n "tref-en-trap" ongeluk,

I I Ja I I Nee

9 BESONDERHEDE VAN OORLEDENE (INDIEN VAN TOEPASSING)

As u begrafniskoste en / of verlies aan onderhoud els Datum van dood: verskaf asseblief die volgende inligting ten opslgte van die oorledene-

Wat is u venwantskap met die oorledene? Naam

Van: (Geliewe 'n afskrif van die doodsertiflkaat, of geregtelike doodsondersoek of klagstaat hierby aan te heg)

ID Nommer:

Geboortedatum:

lOVEILIGHEID MAATREELS

Geliewe aan te dui of u (of die beseerde) 'n sitplekgordel gedra het ten tye van die ongeluk?

Ja I I Nee | I OF

Geliewe aan te dui of u (of die beseerde) 'n valhelm gedra het ten tye van die ongeluk?

Ja • NeeQ


DERDEPARTY EISVORM

1 1 BESONDERHEDE VAN ONGEVALLE VERGOEDING

Die Wet op Vergoeding vir Beroepsbesenngs en Siektes Indien u JA geantwood het verskaf die Vergoedingsfonds gee aan werkers die reg om vergoeding te eis as hulle se verwysingsnommer -tydens werk beseer word.

Het die motorvoertuigbotslng aanleiding gegee tot 'n eis(e) Bevestig die bedrag vergoeding tot op datum ontvang -ingevolge die Wet op Vergoeding vir Beroepsbesenngs en | Siektes

eantw et u 'ni

n

Nee

Indien u ja geantwoord het geliewe die volgende inligting te verskaf. Het u 'n eis by die vergoedingsfonds ing^dien.

Ja Nee

• 'e die' 3dings

n

Dui of die vergoeding ontvan die finale toekenning is?

• NeeQ Ja

1 2 GETUIES

Was daar enige getuie(s) tot die ongeluk?

Ja 1 ^ Nee ' •

Indien u JA geantwoord het verskaf asseblief die volgende inligting ten opsigte van sodanige getuie(s):

Naam en Van

Naam en Van

Adres

Telefoonnommer Selfoonnommer Adres r r

Telefoonnommer Selfoonnommer

(Indien die verm nie genoegsame spasie toelaat om al die getuies te lys nie, geliewe die oorbiywende getuies te lys op 'n afsonderlike bladsy wat by die eisvorm aangeheg moetword)

1 3 BEROEPSTATUS

Wat was die beseerde / oorledene se beroepstatus ten In eie diens tye van die botsing?

Indians T i Werkloos

I]

BL3


DERDEPARTY EISVORM

1 4 BESONDERHEDE VAN EISERS IN DIENS

Was die eiser / beseerde verplig om tyd by die werk af te neem as gevolg van die beserings opgedoen in die ongelul<?

- D Nee D Indien u JA geantwoord het verskaf assebllef die volgende besonderhede:

Datums waarop u (of die beseerde) afwesig was by die werk-

Getal werksdae waaop u (of die beseerde) afwesig was by die werk-

Het u (of die beseerde) betaling ontvang van u (die beseerde) sewerkgewertydens die afwesigheid,

Ja • Nee D Indien u JA geantwoord het dui assebllef die bedrag ontvang aan-

Indien u JA geantwoord het op die voorafgaande vraag, wat is die aard van die betaling ontvang van diewerkgewerj.

I I siekteverlof gratis ofander

Indien u geantwoord het ANDER, dui assebllef die aard van die betaling aan-

1 5 WERKGEWER SE BESONDERHEDE

Verskaf assebllef die volgende besonderhede aangaande die beseerde / oorledene se werk.

Naam van werkgewer

Posadres van werkgewer

Telefoonnommer

Kontakpersoon

1 6 BEWYS VAN INKOWISTE

Om die RAF te help met die verwerking van die els, vir gelede- en/of toekomstige verlies aan inkomste, dui asseblief aan die dokumente wat u kan verskaf om die beseerde / oorledene se inkomste te bewys.

Salarisstrokie

Mees onlangse belastingopgawe

Drukstuk van betalings vanaf werkgewer

Werknememommer

Geliewe die basis van die werk te bevesfig-

I I Permanent | | Tydelik

Kontrak

Permanent

D - n Indien die werk op 'n tydelike / los of kontrak basis is (of was) dui asseblief aan:

Datum van aanvang Datum van verstryking

n • Bankstate

Ander. Spesifiseer asseblief:

Geen van bogenoemde.

(Geliewe afskrifte van die dokumentasie deur u geidentifiseer by hierdie eisvomi aan te heg).

Belasting verwysingsnommer

BL4


DERDEPARTY EISVORM

1 7 EISERS IN EIE DIENS

Indian die beseerde / oorledene in eie diens is voltooi asseblief die volgende besondertiede:

Indian toepsalik, verskaf asseblief die Maatskappy / Beslote Korporasie/Trustregistraslenommervandiebesigheid-

Besigheidsnaam:

Aard van besigheid:

Het die beseerde / oorledene / die besigheid) belastingopgawes ingedien vir die laaste 3 finanslele jare,

Besigheidsadres: n •' n N

Identlfiseer die toepsalike regsentiteif ten opsigte van die besserde / oorledene se besigheid-

indlen u JA geantwoord het heg asseblief afskrifte van daardie belastingopgawes by hierdie elsvorm aan.

Indian u NEE geantwoord het heg assetlief inkoste en uitgawe state / bankstate aan van die besigheid vir die afgelope 3 jaar of vir sodanige korter periode as wat die beseerde / oorledene in besigheid is.

D D

eenmansaak

trust

beslote korporasie vennootskap maatskappy

I I ander - speslfiseer;

1 8 EISEVIRVERLIESAANONDERHOUD

Verskaf asseblief die gevraagde besonderhede van al die persone wie, ten tye van sy/haar dood, afhanklik was van die oorledene vironderhoud:

Afhanklike 1

Naam

Geboortedatum

ID Nommer

Verwantskap

Rede vir afhanklikheid

Afhanklike 2

Naam

Geboortedatum

ID Nommer

Venwantskap

Afhanklike 4

Naam

Geboortedatum

ID Nommer

Verwantskap


Afhanklike 5

Naam

Geboortedatum

ID Nommer

Venwantskap



Afhanklike 3

Naam

Geboortedatum

ID Nommer

Verwantskap


Neem kennis: As bewys van die verwantskap tussen die oorledene en die spesifieke afhanklike heg asseblief hierby aan gesertifiseerde afskrifte van die relevante dokumentasie, d.w.s. huweliksertifikate, onverkorte geboortesertifikate, aannemingsbevele, ens.

(Indien die vorm nie genoegsame spasie toelaat om al die afhanklikes te lys nie, geliewe die oorblywende afhanklikes te lys op 'n afsonderlike bladsy wat by die eisvonn aangeheg moet word)

BL5

90 N o . 3 1 2 4 9 GOVERNIVIENT GAZETTE, 21 JULY 2008

DERDEPARTY EISVORM

1 9 VERGOEDING GEEIS

Geliewe met 'n "X", in die toepaslike ruimtes aan te dui, die tipe{s) vergoeding wat geeis word asook die presiese bedrag wat geeis word ten opsigte van eike tipe -

Tipe(s) Vergoeding Geeis Bedrag Geeis

I I Nood mediese behandeling R

I I Nie-nood mediese beliandeling R

I i Toekomstige mediese uitgawes R I I Gelede verlies aan verdienste R

I I Toekomstige verlies aan verdienste R

Gelede verlies aan onderhoud R

Toekomstige verlies aan onderhoud R

Begrafniskoste (heg gespesifiseerded rekening aan) R Nie-vermoenskade (algemene skade) * R

Totale Bedrag Geeis

* Indien die eis 'n eis vir nie-vermoenskade (algemene skade) insluit moet u die RAF voorsien van 'n emstige besering assesseringsyerslag sees voorgeskryf in die regulasies.

20SUBSTANTIEWE NAKOMING

Voltooi asseblief die volgende inligting ten einde aan die geldigheidsverelstes van Artikei 24 van die RAF Wet te voldoen.

1. Die identiteit van die beseerde - (paragraaf 1).

2. Die datum en piek van die ongeluk (paragraaf 5).

3. Identifiseer die versekerde motorvoertuie (paragraaf 6 / 7 en 8).

4. 'n Voltooide statutere mediese verslag (paragraaf 22);

5. 'n Presiese indikasie van die bedrae geeis as vergoeding (paragraaf 19);

6. Heg hierby aan gespesifiseerde rekeninge, kwitansies, fakture ens. cm u eis vir mediese uitgaw/es te ondersteun;

7. Voltooi die vorm soos voorgeskryf deur Artikei 24 van die RAF Wet.

8. In die geval waar verlies aan onderhoud of begrafniskoste geeis word verskaf dokumentere bewys van die dood van die oorledene; en

9. Sou die spasie wat in die eisvorm voorsien word onvoldende wees on enige vraag te beantwoord is u welkom om 'n verdere bladsy(e) by die eisvorm aan te heg waarin die inligting aan die RAF verskaf word.

10. Sou u enige bystand benodig met die voltooiing van die eisvorm is u welkom om die RAF te kontak by ShareCall nommer 0860 235 5523.

BL7


DERDEPARTY EISVORM

2 1 DEKLARASIE EN TOESTEMMING

Die Toesteming aan die Padongelukfonds (fViF) verleen in hierdie paragraaf magtig die RAF om afskrifte te bekom van enige dokument en om toegang te verkry tot enige inligting wat verband hou met hierdie eis om vergoeding, en om enige persoon of entiteit te kontak ten einde sodanige inligting te bekom of te verifieer.

. (naam en van van eiser). Ek, verklaar dat, na die beste van my wete, die inligting verskaf in hierdie Derdeparty Eisvorm w/aar en korrek is in alle opsigte; en

Ek bevestig dat ek vergoeding els;

in my persoonlike hoedanigheid as gevolg van beserings v fat ek opgedoen het in die botsing; altematiewelik in my persoonlike en / of verteenwoordigende hoedanigheid as (meld hoedanigheid) namens (naam en van van beseerde) wie beserings in die botsing opgedoen het; altematiewelik

in my persoonlike en / of verteenwoordigende hoedanigheid as. (meld hoedanigheid) van. . (meld naam en van van die oorledene) wie oorlede is as gevolg van die beserings opgedoen in die botsing.

(Dui aan, en indien toepaslik voltooi, die toepaslike stelling hierbo)

Ek stem hiermee toe tot die beskikbaarstelling, aan die Padongelukfonds, van afskrifte van alle dokumentasie en / of inligting, insluitend maar nie beperk tot dokumentasie en / of inligting van 'n mediese of finansiele aard nie, in die besit van enige persoon of entiteit, weike dokumentasie of inligting op enige wyse verband hou met hierdie eis vir vergoeding voortspruitend uit die motorvoertuigongeluk gespesifiseer in hierdie eisvorm.

Ek stem verder toe, en magtig, die Padongelukfonds om enige persoon of entiteit te kontak ten elnde sodanige inligting en / of dokumentasie te bekom of te verifieer.

Handtekening van Eiser Handtekening van getuie

BL9


DERDEPARTY EISVORM

2 2 MEDIESE VERSLAG

Artikel 24{2)(a) bepaal dat die verslag deur die mediese praktisyn voltooi moet word wat die beseerde- of oorledene behandel het vlr die beserings wat hy/sy opgedoen het in die botsing waaruit die els voortsprult.

1. BESONDERHEDE VAN PASIENT

Naam(e) Van

ID nommer Geboortedatum

2. GELEDE NOOD MEDIESE BEHANDELING

Neem kennis dat, In terme van die regulasles, nood mediese behandeling gedefinleer word as "...die onmiddelike, gepaste en regverdigbare mediese evaluasie, behandeling en sorg vereis In 'n nood sltuasie ten einde die persoon se lewe of liggaamsfunksies, of albel, te beskerm"

Het die pasient nood mediese behandeling ontvang.soos gedefinleer,

I I Ja I I Nee Indien u JA geantwoord het verskaf asseblief die volgende inllgting in verband met sodanige behandeling-

Wat was die aard van die behandeling?

Nood vervoer

I I Hospitaalsorg

I I Intensiewesorg

Ander, indien 'ander" dui asseblief die aard van die behandeling aan

ICD 10 Kode Behandelingsplan

Geliewe die ICD 10 Kodes van toespassing op die nood mediese behandeling aan die patient verskaf te meld en motiveer hoekom die behandeling geag word nood mediese behandeling te wees. Sou die spasie wat in die eisvorm voorsien word onvoldende wees on enige vraag te beantwoord heg 'n verdere bladsy{e) by die eisvorm aan waarin die inllgting aan die RAF verskaf word.

BL10

STAATSKOERANT, 21 JULIE 2008 No. 31249 9 3

DERDEPARTY EISVORM

''S?

MEDIESE VERSLAG

3. GELEDE NIE-NOOD MEDIESE BEHANDELING

Neem kennis dat alle evaluasies en behandeling virat buite die voorgeskrewe definisie val van nood mediese beliandeling nie-nood mediese behandeling Is.

Het die pasient nIe-nood mediese behandeling ontvang?

' 1 Ja [ ^ Nee

Indien u JA geantwoord het verskaf asseblief die volgende Inllgting in verband met sodanige behandeling. In die skedule hieronder, identifiseer asseblief die spesifleke ICD 10 kode{s) van toepassing en beskryf die behandeling toegedlen.-

ICO 10 Kode Behandelingsplan

4. VOORAFBESTAANDE MEDIESE TOESTANOE

Het die pasient gely aan enige voorafbestaande toestand(e) (besering, siekte, kwaal, of ander fisiese, mediese, geestes-of senuweetoestand, aandoening of ongesteldheid)

1 Ja [ ^ Nee

Indien u JA geantwoord het identifiseer asseblief die voorafbestaande toestand(e), verskaf die toepaslike ICD 10 kode(s) (as daar so 'n kode bestaan) en beskryf die impak van die besering(s) in die botsing opgedoen op sodanige voorafbestaande toestand(e)-

Voorafbestaande toestand ICD 10 Kode Impak van botsing

BL11


DERDEPARTY EISVORM

MEDIESE VERSLAG

5. TOEKOMSTIGE MEDIESE BEHANDELING

Ontvang die pasient tans voortgesette mediese behandeling vir die besering(s) opgedoen in die botsing, of word dit voorsien dat die pasient toekomstige mediese behandeling sal benodig vir sodanige besering(s),

D - D Nee

Indien u JA geantwoord het verskaf asseblief die naam(e) en kontaknommer(s) van die diensverskaffer(s) wie die behandeling, toekomstige behandeling sal verskaf.

6. MEDIESE BEHANDELING IN MEDIESE FASILITEIT / HOSPITAAL

Was die pasient opgeneem in 'n mediese fasiliteit / hospitaal as gevolg van die besering(s) opgedoen in die botsing, of is die pasient behandel by 'n mediese fasiliteit / hospitaal vir sodanige besering(s),

Nee

Indien u JA geantwoord het verskaf asseblief die naam(e) en kontaknommer(s) van die hospitaal / fasiliteit, en indien opgeneem, die datum opgeneem en die datum ontslaan -

Naam van Hospitaal / Fasiliteit Kontaknommer Datum opgeneem Datum ontslaan

7. MEDIESE PRAKTISYN SE BESONDERHEDE

Naam Selfoonnommer

Van Fisiese adres

Kwalifikasies

Praktyknommer (HPCSA en / of BHF) Posadres

Telefoonnommer Faksnommer

BL12


DERDEPARTY EISVORM

DEKLARASIE

Ek verklaar hiermee dat die inligting in hierdie verslag vervat na die beste van my wete waar en korrek is In alle opsigte.

Handtekening van mediese praktisyn

Geteken te

Datum

BL13


VERSKAFFER EISVORM

1 VERSKAFFER BESONDERHEDE

Verskaffer naam Posadres:

Praktyknommer (BHF / HPCSA):

Telefoonnommer:

Belastingverwysingsnommer:

Faksnommer:

=islese adres:

Selfoonnommer:

Hoe verkies u dat ons met u in verbinding tree?

E - p o s Q Sm[J P o s Q

Tel • SelQ

Hoe verkies u dat ons met u in verbinding tree?

E - p o s Q Sm[J P o s Q

Tel • SelQ

2 VERSKAFFER SE BANKBESONDERHEDE

Indian u els suksesvol Is sal die RAF u direk betaal. Verskaf assebllef bankbesonderhede vir die betaling van vergoeding verskuldig aan u.

Bank (Naam): Rekeningnommer:


BANKBESONDERHEDE VAN VERSKAFFER SE VERTEENWOORDIGER

Indien die verskaffer se eis suksesvol Is sal die RAF die vergoeding direk aan die verskaffer betaal en koste (Indien verskuldig) aan die verskaffer se verteenwoordlger verskaf assebllef die rekening besonderhede waarln u wil he die koste betaal meet word. Rekeningnommer: Bank Naam:


Gelievife een van die volgende dokumente by die eisvorm aan te heg ten eInde die RAF in staat te stel om die bankbesonderhede te verifieer: 'n gekanselleerde tjek of "n leesbare gesertifiseerde afskrif / oorspronklike bankstaat wat die rekeninghouer se naam en die rekening- en taknommer duidelik aandui of'n oorspronklike brief van die bank (op 'n amptelike briefhoof) wat die rekeninghouer se naam en die rekening- en taknommer bevestig.

BL1


VERSKAFFER EISVORM

4 MOTORVOERTUIGBOTSING BESONDERHEDE

Verskaf asseblief die volgende inligting ten einde die RAF in staat te stel om die eis te ondersoek.

Datum van ongeluk:

Tyd van ongeluk:

PIek van ongeluk (straat nommer en naam, buurt, dorp, provinsie):

SAPD stasia waar die botsing aangemeld is:

Botsingsverslag nommer:

Geliew 'n afskrif van die botsingsverslag by hierdie eisvorm aan te heg of 'n verklaring deur die beseerde waarin die gebeure wat tot die botsing gely het beskryf word.

5 BESEERDE / OORLEDENE SE BESONDERHEDE

Titel Van Posadres

Naam

Geboortedatum Huis telefoonnommer

• , • : " ; : . - - • : ; • : • ;

ID Nommer: Werk telefoonnommer

Belastingverwysingsnommer Selfoonnommer

Huisadres E-pos

(Heg asseblief hierby aan 'n afskrif van die beseerde se 1

lueniiimisuuKuineMi ui, niujen luepasiiK, n aisKni van uie oorledene se doodsertifikaat en die toepaslike geregtelike doodsondersoek / klagstaat)

6 VERGOEDING GEEIS

Waarvoor eis u?

Kategorie van eis Bed rag Geeis

u Nood mediese behandeling (heg oorspronklike rekening aan) R Nie-nood mediese behandeling (heg oorspronklike rekening aan) R

Totale Bedrag Geeis R





BL2


VERSKAFFER EISVORM

GELEDE NOOD MEDIESE BEHANDELING

Neem kennis dat, In terme van die regulasies, nood mediese behandeling gedeflnieer word as "...die onmlddelike, gepaste en regverdigbare mediese evaluasie, behandeling en sorg vereis in 'n nood situasie ten einde die persoon se lewe of liggaamsfunksies, of albei, te beskerm"

Het die pasient nood mediese behandeling ontvang,soos gedeflnieer,

I I Ja [ ^ Nee

Indien u JA geantwoord het verskaf asseblief die volgende inligfing in verband met sodanige behandeling-


I I Nbod yervoer

I I Hospitaalsorg

Intensiewesorg

D Ander, indien 'ander' dui asseblief die aard van die behandeling aan

ICD 10 Kode Behandelingsplan

Geliewe die ICD 10 Kodes van toespassing op die nood mediese behandeling aan die patient verskaf te meld en motiveer hoekom die behandeling geag word nood mediese behandeling te wees. Sou die spasle wat in die eisvorm voorsien word onvoldende wees on enige vraag te beantwoord is u welkom om 'n verdere bladsy(e) by die eisvorm aan te hag waarin die inligting aan die RAF verskaf word.

BU3


V E R S K A F F E R E ISVORM

8 GELEDE NIE-NOOD MEDIESE BEHANDELING

Neem kennis dat alle evaluasies en behandeling wat buite die voorgeskrewe definisie val van nood mediese behandeling nie-nood mediese behandeling is.

Het die pasient nie-nood mediese behandeling ontvang,

• Ja • Nee Indien u JAgeantwoord het verskaf asseblief die volgende inligting in verband met sodanige behandeling.


I I Vervoer

I I Hospitaalsorg

I I Ander, indien'ander'dui asseblief die aard van die behandeling aan

In die skedule hieronder, identifiseer asseblief die spesifieke ICD 10 kode(s) van toepassing op die evaluasie(s) / behandeling aan die pasient verskaf en beskryf die behandeling toegedien (heg hierby aan gedetaileerde rekening en mediese ondersoek verslae)

ICD 10 Kode Behandeling

9 VOORAFBESTAANDE MEDIESE TOESTANDE

Het die pasient gely aan enige voorafbestaande toestand(e) (besering, siekte, kw^aal, of ander fisiese, mediese, geestes- of senuweetoestand, aandoening of ongesteldheid) wat bestaan het ten tye van die botsing,,

Ja L _ J Nee n Indien wel, verskaf asseblief besonderhede.

BL4


VERSKAFFER EISVORM

1 0 MEDIESE BEHANDELING IN MEDIESE FASILITEIT / HOSPITAAL

Naam van Hospitaal / Fasiliteit Kontaknommer Datum opgeneem Datum ontslaan

11 DEKLARASIE

Ek verklaar hiermee dat:

1) Na die beste van my wete die inligting in hierdie eisvoirn vervat waar en korrek is in alle opsigte; 2) Die akkomodasie in 'n hospitaal of verpleeginrigting en die behandeling, of goedere verskaf, soos na verwys

hierin, aan die beseerde persoon verskaf is; en 3) Ek nie / die verskaffer nie betaling ontvang het vanaf enige bron, insake die akkomodasie in 'n hospitaal of

verpleeginrigting en die behandeling, of goedere verskaf, soos na verwys in hierdie eisvorm nie, en sou ek / die verskaffer van enige bron betaling ontvang insake daarmee dan sale ek /die verskaffer volledige besonderhede daan/an aan die Padongelukfonds openbaar.

Handtekening van verskaffer, of verskaffer se behoorlik gemagtigde verteenwoordiger of agent. Waar die verskaffer 'n regspersoon is heg hierby aan skriftelike bewrys van die verteenwoordiger se magtiging om hierdie eisvorm te onderteken. Waar die verskaffer deur 'n agent verteenwoordig word heg skriftelike bewys aan van die agent se mandaat.

Geteken te

Datum

1 2 SUBSTANTIEWE NAKOMING

Voltooi asseblief die volgende inligting ten einde aan die geldigheidsvereistes van Artikel 24 van die RAF Wet te voldoen.

1. Die identiteit van die beseerde / oorledene - (paragraaf 5). 2. Die datum en piek van die botsing (paragraaf 4) 3. Presiese indikasie van die bedrae geeis as vergoeding (paragraaf 6); 4. Heg hierby aan gespesifiseerde rekeninge, kwitansies, facture ens. om u eis vir mediese uitgawes te

ondersteun. 5. Voltooi die vorm soos voorgeskryf ingevolge Artikel 24 van die RAF Wet. 6. Sou die spasie wat in die eisvorm voorsien word onvoldende wees on enige vraag te beantwoord is u

welkom om 'n verdere bladsy(e) by die eisvorm aan te heg waarin die inligting aan die RAF verskaf word. 7. Sou u enige bystand benodig met die voltooiing van die eisvorm is u welkom om die RAF te kontak by

ShareCall nommer 0860 235 5523 __


A A N M E L D I N G VAN BOTSING VORM (ARTIKEL 22(1 )(a) VAN WET NO. 56 VAN 1996

1) Wanneerenige persoon beseerof gedood word as gevolg van die bestuur van "n motorvoertuig, moet die eienaar en die bestuurder van die motorvoertuig die botsing binne 14 dae by die Fonds aanmeld op hierdie vorm, en sou hulle in gebreke bIy om dit te doen kan die Fonds die skadevergoeding wat aan die derdeparty betaal is vertiaal vandie eienaarof die bestuurder.

2) Sou die spasie wat in die eisvorm voorsien word onvoldende wees on enige vraag te beantwoord is u welkom om 'n verdere bladsy(e) by die eisvorm aan te heg waarin die inligting aan die RAF verskaf word.

3) Sou u enige bystand benodig met die voltooiing van die eisvonm is u welkom om die RAF te kontak by ShareCall nommer 0860 235 5523

Posgeld sal deur die geadresseerde betaal word

Geen posgeld nodig Indien gepos word

binne die Republiek van Suid Afrika

HOOF UITVOERENDE BEAMPTE Posbus 2743 PRETORIA 0001

1 BESONDERHEDE VAN DIE BESTUURDER VAN DIE VOERTUIG

Naam(e) . Fisiese adres

Van

D Nommer / Paspoortnommer Posadres

Burgerskap

Telefoonnommer Besfuurderslisensienommer

Faksnommer Datum van uitreiking

- • • " : :

Selfoonnommer Endossemente, in dien enige

E-pos adres Fisiese / geestelike gebreke, indien enige

Meld of u die eienaar is van die voertuig -

BL1


AANMELDING VAN BOTSING VORM (ARTIKEL 22(1 )(a) VAN WET NO. 56 VAN 1996

•'o»

« BESONDERHEDE VAN DIE EIENAAR VAN DIE VOERTUIG - MOET ^ VOLTOOI WORD WAAR DIE BESTUURDER NIE DIE EIENAAR WAS NIE Naam(e) Selfoonnommer

Van E-pos adres

D Nommer/Paspoortnommer Fisiese adres

Burgerskap

Telefoonnommer Posadres

-aksnommer

3 BESONDERHEDE VAN DIE MOTORVOERTUIG

Registrasienommer Maak

Tipe voertuig (bv. sedan, trok, bus, ens.) Model

Kleur Jaar

4 BESONDERHEDE VAN ANDER MOTORVOERTUIE BETROKKE IN DIE BOTSING

Voertuig 1

Registrasienommer

Voertuig 2

Registrasienommer

Naam(e) en van van bestuurder Naam(e) en van van bestuurder

Telefoonnommer / Selnommer Telefoonnommer / Selnommer

Naam(e) en van van eienaar Naam(e) en van van eienaar

Fisiese adres Fisiese adres

Posadres Posadres

BL2


A A N M E L D I N G VAN BOTSING VORM (ARTIKEL 22(1 )(a) VAN WET NO. 56 VAN 1996

4 BESONDERHEDE VAN ANDER MOTORVOERTUIE BETROKKE IN DIE BOTSING

Voertuig 3

Registrasienommer

Voertuig 4

Registrasienommer

Naam(e) en van van bestuurder Naam(e) en van van bestuurder

Telefoonnommer / Selnommer Telefoonnommer / Selnommer

Naam(e) en van van eienaar Naam(e) en van van eienaar

-isiese adres Fisiese adres

Posadres ^osadres

5 BESONDERHEDE VAN DIE BOTSING

Wat is die datum van die boting? By watter polisiekantoor is die botsing aangemeld?

Hoe laat hef die botsing plaasgevind? Wat isdiepolisiese venwysingsnommer?

Waarhetdie botsing plaasgevind?

6 BESONDERHEDE VAN GETUIE(S) TOT DIE BOTSING

' Getuie 1 Selfoonnommer

\iaam{e)

E-pos adres Van

-isiese adres D Nommer/

^aspoortnommerTelefoonnommer

Posadres -al^snommer

Posadres -al^snommer

BL3


A A N M E L D I N G V A N BOTSING VORM (ARTIKEL 22(1 )(a) VAN WET NO. 56 VAN 1996



Getuie 2

Naam(e)

Selfoonnommer Getuie 2

Naam(e)

E-posadres

Van

Fisiese adres ID Nommer /

PaspoortnommerTelefoonnommer

Posadres âksnommer

Posadres âksnommer

Getuie 3

Naam(e)

Selfoonnommer Getuie 3

Naam(e)

E-pos adres

Van

Fisiese adres

D Nommer/

PaspoortnommerTelefoonnommer

ôsadres

Faksnommer

ôsadres

Faksnommer

BL4


AANMELDING VAN BOTSING VORWl (ARTIKEL 22(1)(a) VAN WET NO. 56 VAN 1996

7 BESONDERHEDE VAN PERSOON(E) BESEER / GEDOOD

^Persoon 1 E-pos adres Naam(e)

Fisieseadres Van

ID Nommer/ Paspoortnommer

Posadres Telefoonnommer Telefoonnommer

-aksnommer -aksnommer

Meld of die beseerde / oorledene 'n bestuurder, passasier, fietsryer of voetgangerwas -Selfoonnommer Meld of die beseerde / oorledene 'n bestuurder, passasier, fietsryer of voetgangerwas -

7 BESONDERHEDE VAN PERSOON(E) BESEER / GEDOOD

r Persoon 2 E-pos adres Naam(e)

Fisieseadres Van

ID Nommer/ Paspoortnommer

Posadres Telefoonnommer Telefoonnommer

Faksnommer Faksnommer

Meld of die beseerde / oorledene 'n bestuurder, passasier, fietsryer of voetgangerwas-Selfoonnommer Meld of die beseerde / oorledene 'n bestuurder, passasier, fietsryer of voetgangerwas-

8 TOESTANDE TEN TYE VAN DIE BOTSING

Tyd van die dag (bv. oggend, middag, sononder, nag) Straatligte-aanofaf

Weerstoestande (bv. sonskyn, mistig, bewolk, reenerig,) Eie voertuig se ligte- af, gedemp, skerp

Uitsig (bv. goed, redelik, sleg, ens.) Andervoertuig se ligte-af, gedemp, skerp

Padoppervlak (bv. grond, sand.teer, ens.) Spoed van eie voertuig ten tye van die botsing

BL5


AANMELDING VAN BOTSING VORM (ARTIKEL 22(1)(a) VAN WET NO, 56 VAN 1996

9 SKETSPLAN VAN DIE TONEEL VAN DIE BOTSING

W

1 0 GEDETAILLEERDE BESKRYWING VAN DIE BOTSING

BL6


AANMELDING VAN BOTSING VORM (ARTIKEL 22(1 )(a) VAN WET NO. 56 VAN 1996

11 DEKLARASIE

Ek / ons verklaar hiermee dat die inligting in liierdie vorm Handtekening van eienaar vervat na die beste van my / ons kennis vi aar en korrek is.

Handtekeninq van bestuurder Geteken te Geteken te

Datum V , . ..->::.. --r, Datum V , . ..->::.. --r,

BL7


ERNSTIGE BESERING ASSESSERINGSVERSLAG

(a) n Eis vir nie-vermoenskade ("algemene skade" of "pyn en lyding") sal nie oonweeg word tensy hierdie verslag behoorlik voltooi word en ingedien word nie.

(b) Die Padongelukfondswet (Wet No. 56 van 1996) vereis dat hierdie verslag voltooi moet word deur 'n geneestieer, geregistreer ingevolge die Wet op Gesondheidsberoepe (Wet No. 56 van 1974).

(c) Die assessering van die ernstige besering moet gedoen ingevolge die metode pepaal in die Regulasies wat gepromulgeer is kragtens die Padongelukfondswet.

(d) Voorleggings, mediese verslae en opinies mag as aantiangsels to hierdie verslag ingedien word. (e) As enige afdeling van hierdie verslag nie van toepassing is nie, merk die afdeling "NVT*. (f) Die "impairment evaluation reports" vir Boonste Ekstremiteite, Onderste Ekstremiteite en Rug en Bekken is

aangeheg. Indien die besering 'n aantasting veroorsaak het aan 'n ander liggaamsdeel of sisteem , heg ook hierby aan die verslag gespesifiseer in die AMA Guides (6de Uitgawe).

(g) Wanneer die verslag voltooi word, verwys na syfers, tafels en bladsynommers van die AMA Guides (6de Uitgawe).

1 BESONDERHEDE VAN PASIENT

Naam en Van Datum van assessering

•• • V M : . . . • • • • • ! • •

ID Nommer Datum van ongelu k

•• .", ...1 7 3

Eisnommer (indien beskikbaar)

Kontaknommer

2 GENEESHEER SE BESONDERHEDE

Jaam en Van Telefoonnommer

Praktyknommer (HPCSA en / of BHF) E-pos

3 LYS VAN NIE-ERNSTIGE BESERINGS

'ingevolge die Padongelukfondswet (Wet No. 56 van 1996) en Regulasie 3(1 )(b)(i) wat daaronder gepromulgeer is mag die Minister, na oorleg met die Minister van Gesondheid, 'n lys van beserings in die Staatskoerant publiseer weike beserings vir doeleindes van artikel 17 van die Wet nie beskou word as emstige beserings nie en geen besering moet assesseer word as ernstig indien daardie besering voldoen aan die beskrywing van 'n besering wat op die lys verskyn nie. Wanneer dit gepubliseer is, moet die deel voltooi word met verwysing na die lys. 'n Kopie van die nuutste weergawe van die lys is beskikbaar bv www.raf .co.za. Vir meer inliotino kontak die Padonaelukfonds bv ShareCallnommer: 0860 235 5523.

Nommer Beskrywing van besering

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^AWIA'MMPAiRMENTVRATIr<G''SMbET^iVO^ DIELYS VAN;NIE-ERNSilGEa6SERIN^

r 4.1 Beskryf die aard van die motorvoertuigongeluk

4.2 Mediese behandeling verskaf vanaf datum van ongeluk tot hede

4.3 Huldige simptome en klagtes

4.4 Diagnose

4.5 Bevinding rakende Fisiese Ondersoek

4.6 Bevinding rakende Kliniese Studies. (IHersien en dokumenteer vi/erklike studies en bevindinge van relevante

diagnostiese studies en skanderings, insluitende X-strale, CT, MRI ens.)

4.7 Mediese Geskiedenis

4.8 Sosiale en Persoonlike Geskiedenis

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AMA "IMPAIRMENT RATING": MOET VOLTOOI WORD WAAR DIE BESERING NIE OP DIE LYS VAN NIE-ERNSTIGE BESERINGS IS NIE

4.9 Opvoedkundige en Beroepsgeskiedenis

4.10 Het die pasient "MIVll" bereik?

4.11 Spesifiseer besonderhede van verdeling, indien enige -

4.12 'n Duidelike, akkurate en volledlge verslag moet verskaf word om 'n bevinding van aantsating te staaf met

werwysing na kliniese evaluasie analise van bevindinge en 'n bespreking van hoe die gradering van die aantasting

bereken is.

Die volgende "impairment evaluation reports" is aangeheg:

•Aanhangsel A: Boonste Ekstremiteite (Hoofstuk 15)

•Aanhangsel B: Onderste Ekstremiteite (Hoofstuk 16)

•Aanhangsel C: Rug en Bekken (Hoofstuk 17)

4.13 Uitsonderings

ERNSTIGE BESERING: DIE NARRATIEF TOETS

Indien die besering nie op die nie-ernstige beseringslys verskyn nie en ook nie 'n 30 persent "Whole Person Impairment" tot gevolg het nie, soos voorsien in die AMA Guides, oorweeg of die besering aanleiding gegee het tot enige van die gevolge hieronder uiteengesit. Verskaf voile besonderhede en indien nodig staaf die opinie met verslae wat hierby aangeheg is as aanhangsels.

5.1 Ernstige, lang-termyn aantasting of verlies van 'n liggaamlike funksie.

5.2 Permanente ernstige ontsiering.

5.3 Hewige, lang-tennyn verstandelike of hewige lang-termyn gedragssteurnis of gedragsaandoenlng.

5.4 Verlies van 'n fetus.

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6 DEKLARASIE

r Ek verklaar hiermee dat die inligting in hierdie verslag vervat na die beste van my wete waar en korrek is in alle opsigte

Handtekening van mediese praktisyn Handtekening van mediese praktisyn

'"'' ' • ' * ' . ' i ... -.- • • ' " , ' ' . ' ' {

Geteken te

Datum

BL4


AANHANGSEL A - UPPER EXTREMITY IMPAIRMENT EVALUATION

Naine: EiiMn Datcr IONumb«r Sex: F M Sid«: R L BrrthDate: Diagowis; Injury Date:

Dlagiuitis^Bascil Impairincnts -Grida Dl^hMtt/Crittila Anlgnsd C U M Or*iii Modif IM AdjustncnB A»»ign«d Dx S»d> nraiue Digit m Wri«(W) Elbow (E) Shoulder(SJ

| 0 | 1 | 2 U | 4 | ~~ " • " Net s-2 -1 e +1 i+2

A a C D f

Digit m Wri«(W) Elbow (E) Shoulder(SJ

GMFH 0 1 2 3 -4 s-2 -1 e +1 i+2 A a C D f


GMPE 0 1 2 3 4 s-2 -1 e +1 i+2

A a C D f


GMCS « 1 2 3 4

s-2 -1 e +1 i+2 A a C D f


liftMluttMCfK - tSMfh rOna*

s-2 -1 e +1 i+2 A a C D f

0 w E s

lohblsUI " • mm, • "

N«t s - l - t 0 *i i*3

A B'C tt E

0 w E s

SMFH 0 1 2 3 ^ s - l - t 0 *i i*3 A B'C tt E

0 w E s GMPE 0 1 2 3 «

s - l - t 0 *i i*3 A B'C tt E

0 w E s OMCS a 1 3 1 4

s - l - t 0 *i i*3 A B'C tt E

0 w E s

«j>IVE - O X ) T ISMCl -COlO

s - l - t 0 *i i*3 A B'C tt E

D •w e s A, S C 0 C

D •w e s

| 0 | T | 2 [ 3 U | Net

A, S C 0 C

D •w e s

fium 0 1 i 3 4 A, S C 0 C

D •w e s

GMPE 0 1 2 3 4 A, S C 0 C

D •w e s

6MCS 0 1 2 3 4 A, S C 0 C

D •w e s

Net Mjjuiunein - (SMFH - CDXI v IGMPt - CD» + (SMQ - OW)

A, S C 0 C

Combinad UEI

Pexiphtial Narve/ Entrapment?

5<nsory«nd Motor Grading AsslgiwdOtM S«ad* Medifiar Adjustments Axiignad 0* Gradm Combined UEI

Seniory D«f kit

I0lll2l3|4in/al Moftor Oaficit | 0h |? |3 |4 | t t ;»1

Sensor/Oef kit

lohUl3l«l MotOf Deficit |0|l|Zt3|4|nfa1

C M m u 'h 3J4 nia GMCS la '1' 3 |4 Ma

SMfHtO 1|J M* nf* GMCS b ik 3|4 n/a

Sensory; A 8 CO I

MM»r-A B C b E

Entrapment EJcctrodlagtioitio: T«»t 0 1 2 3 * n/a

HiRory 6 1 2 3 4 fva PhyiJcal 6 t 2 3 .f n/»

AMsrage: functional Srade: Normal Mild M«d«rate Sev«r«

CRPSI linp^rm«nt

Peinti AirignedOass Adjuitments AHigned Grade final UEI

J 0 | l | 2 j 3 | 4 | m 0 1 2 3 4 n/a A S C D I

K 0 1 2 3 4 n't

A S C D I

cs 0 1 a 3 4 n/a

A S C D I

Amputation Level A(si n«d Clai» Adjuitinentl Assigned 6nd« Final UEI

I0H12I3I4I FH 0 1 2 3 4 n/a A B C D E

PE 0 1 2 3 4 nra

A B C D E

CS 0 1 2 3 4 n/a

A B C D E

AdittRIMflt AbbrevartkHts S-Shouldar E:r Elbow W»Wfl5f Jt=Hand I> = bigit GMFK - Gradt ModIfJer Functional History GMPE « Grade Modifier Pihyjieal fitamipatlon 6 M C S : - Grade Modifier Clinical Stud<»

Motion Joint Total UB Assigned Claas

I 0 } t l 2 l 3 l 4 l

| ( , | , |2 |3 |4 |

|0 ( l |2 t3 |4 |

Combined OEI

Signed:. . Name<Prbt): Date;.

Surnmaiy i={natUE)

Diajnosis-Basad Impairment

Peripliehir Nerve

Entrapment

CRPS^and-aione)

Amputation

Kingi of Motion (Stand-riond

Final Combinad Impairment

Wiote Person Impairment

Regional Impaiiinants

BLS


AANHANGSEL B - LOWER EXTREMITY IMPAIRMENT EVALUATION

Nam: fixwnOvte:

10 NumlMn S«it: F M SMr. R L WrthOate:

OtagmMita: ia^mfOMK

Di*gno<l«-Sas«d Imp^ntMr i t t

Gtide DiiQinxIs > Criteria AjslgrutdOan' Gnr i * Madfftw A4futtni«itt|i Anigncd Ox Sraiie Nna(UCl

Wr(«t (Wi

EbamXB

I0hl2hl4| • - — Met

st-2 - I 0 • ! * • « .

A S C O E

Wr(«t (Wi

EbamXB 6 M m 8 1 2 T 4 st-2 - I 0 • ! * • « .

A S C O E

Wr(«t (Wi

EbamXB « M H e 1 a 3 * •

st-2 - I 0 • ! * • « .

A S C O E

Wr(«t (Wi

EbamXB

SMCS 0 1 2 3 4

st-2 - I 0 • ! * • « .

A S C O E

Wr(«t (Wi

EbamXB

HHAditBtmKK •«»)»< ^ CEK) .

st-2 - I 0 • ! * • « .

A S C O E

0 vv t i

i o l l i i h U I Net.

A B C D E

0 vv t i

GMR< n » • i 3 4

A B C D E

0 vv t i

Stan 0 1 2 « 4 A B C D E

0 vv t i

6MCS 0 ) 2 3 4 A B C D E

0 vv t i

M«t AdjuittMm »(SM»t - Cmi) •

A B C D E

D W E S

mi\2l3\*i • " • " I«««

=1-2 -1 - 0 . r l i^J

A 11 C D e.

D W E S

GMm e 1 2 J • =1-2 -1 - 0 . r l i^J

A 11 C D e.

D W E S

G M M 0 1 J » 4

=1-2 -1 - 0 . r l i^J

A 11 C D e.

D W E S

GMCS s 1 2 3 *

=1-2 -1 - 0 . r l i^J

A 11 C D e.

D W E S

=1-2 -1 - 0 . r l i^J

A 11 C D e.

Comblneil UEt

Mwva/

NtrM Sensory and Koior fimNng Asslgmd diss Brnde MorfiRcr Ai^s^tRwnti. AMigmd Ox Grade COXUMMIIUU

StmarfOtUcH MitferyDKfKft

| e i l U l 3 | 4 | Motot Dcft'dt

| 0 ( t | 2 | 3 f 4 | n * , |

6MFH 7 i j z T 4 } n 6 i

CMCS 0 1 i 3 41 n/»

QMfH 0 ' ! • * 3 * 1 nte

CMCS £ T | 2 1 41n /«

Sensor/: AB CO £

Motor A f l C D E

EminitBMiit

E1««tro<i[*0rwstics: T«t 9 1 2 3 7 nla Mitory 0 1 2 3 * na Phy^ol 0 t 2 3 1 («4

Average

Functional QMde: (HornmSMati Moderate Severe

CRPSI impafmant

Points AHigntiiClai» A(i,^nmMHtti AJtJgnti(Gf«dt nn«IUEI

lo l iUUMI HH 0 1 2 3 4 n ^ A B c D e

PE 0 1 2 3 4 aft

A B c D e

CS 0 1 2 3 4 n/s

A B c D e

Amputation V ,

u m AMijfiMdOasx Miustmenis Aaifpti Grade Fbwiuei

iOhl2 l3 l4 | FH 0 1 2 3 4 n/* A B C D £

PE 0 t 2 3 4 n a

A B C D £

a a 1 2 3 4 rtf4

A B C D £

AcKuttlMM Abttrcviitioiu S'Shoulder EsEfllow WoWrtK H«H*n<t D* Digit GMFN« iSnde Modlflar Fiinc<k»>«a) History GMPE « &«i« ModWlef ltvsk»i Ixaminstioft 6MCS • Srwte ModHier CMnical Studies

Motion

ioint Total UQ AsstgmKlCtaH

|0it|2|3l4| |9hl i |k l4l

0|l[2tJ|4| Combined US

Siyrwd:, Nj fn* CWflt]:,

SiHnmary Ftnaluei

Diagmostt-Sased trnpatrmcnt

P«fj|)her«I Jt«n«e

Entrapmint

CRKStand^one)

Amputalfortt^

Rcnge of Motion (Stand-aloae)

Final Cood>inetl Impatrmant

Whole Perion ImpMrmcnt

RcQtonal Impairmeats

BL6


AANHANGSEL C - SPINE AND PELVIS IMPAIRMENT EVALUATION

Nam*: ExamDatt: ID Numbcn S B X : F M SidK R L KrthOatet

DlagnoiiB H^ury P»tt: Diagnoils-Based ImpiJrinerrtt

Grid Dfagnos((/Criteria Class Di«gnoils (COX) Grade WocHfier Adjusnmints Net AdjuttuMtit Value antt Assigned GradiUodifiii

Whole person Impairment

Cenriul {C} l 0 ' « i ^ ' 3 U I GMFH 0 1 2 3 * n/« GMPE 0 1 2 3 4 (V« GK4CS ± 1 2 3 4 n/a

Adjusted Grade • Net

Adjustinent applied to

Default Value C

Net Anguitment =r{GMFH - O K ) + <GMPC -cm + (GMCS-CDX)

isz- -1 0 * t aa A 1 C D E

Thoracic (T) lo l l h I a U l GNim 0 J 2 3 4 n/« GMt>E 0 1 2 3 4 n/a GMCS 0 t C 3 4 n^i

Adjusted Grade

!S2 -1 T" •*T ^ A • c D xJ Lumbar (U l ° M t ^ ' 3 U t GMfH

GMPE

GMCS i J -,J-

n<i»

n/>

Adjutted Grade

^ * l &2 T"

Pelvis (P) 0 I } 2 | 3 | 4 GMFH GMPE GMCS

n/a nte

Adjusned Grade

£2 aa

Signed: Date: Whole Penon lirpalrntent

BL7


KENNISGEWING VAN DISPUUT

1 MOET VOLTOOI WORD WAAR DERDEPARTY DISPUUTRESOLUSIE VERSOEK:

Titel Van

Naam

Geboortedatum Geslag Manlik Vroulik

D D ID Nommer / Paspoortnommer

Woonadres

Posadres

Huls telefoonnommer

Werk telefoonnommer

Faksnommer

Selfoonnommer

E-pos

2 MOET VOLTOOI WORD WAAR DIE FONDS DISPUUTRESOLUSIE VERSOEK:

Voltooi beskikbare besonderhede van derdeparty: Posadres

Titel Van

1 1 1 1 Naam Naam

Huis telefoonnommer Huis telefoonnommer

Geboortedatum Geslag Manlik Vroulik

•• • : : ' '•.•\^ D • Faksnommer •• • : : ' '•.•\^ D •

ID Nommer / Pasp oortnommer

Werk telefoonnommer

Woonadres

Selfoonnommer

E-pos

BL1



2 MOET VOLTOOI WORD WAAR DIE FONDS DISPUUTRESOLUSIE VERSOEK:

Besonderede van Fonds kontakpersoon: Telefoonnomnier

Titol \ / an

Faksnommer Faksnommer

E-pos E-pos

Posadres

Ven/vysing

3 DUI AAN DIE AARD VAN DIE DISPUUT

I Dispuut oor assessering - voltooi paragrawe 4 en 6.

I I Dispuut oor verwerping van ernstige besering assesseringsverslag - voltooi paragravtre 5 and 6.

4 BESONDERHEDE VAN ASSESSERING

Wie hat die assessering gedoen?

Wanneer was die assessering gedoen?

Wanneer is u ingelig oor die uitslag van die assessering?

(Heg asseblief die emstige besering assesseringverslag aan - RAF4)

5 BESONDERHEDE VAN VERWERPING

Wanneer is die ernstige besering assesseringsverslag verwerp?

Wanneer is u ingelig dat die verslag venwerp is?

(Heg asseblief hierby aan die redes deur die Fonds verskaf)

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6 BESONDERHEDE VAN DISPUUT

Verskaf die gronde waarop u die assessering / verwerping van die ernstige besering assesseringsverslag in dispuut plaas. Heg alle voorieggings, mediese verslae en opinies waarop u steun hierby aan.

Handtekening van person wat dispuutresolusie versoek

Datum

STUUR ASSEBLIEF HIERDIE KENNISGEWING NA DIE REGISTRATEUR VAN DIE RGSA, Posbus 205 Pretoria 0001 OF faksimilee 012 328 5120 OF [email protected]

(BELANGRIK: Geliewe BEWYSE TE BEHOU VAN WANNEER die kennisgewing gepos is per geregistreerde pos, of gefaks is of per e-pos gestuur is)

BL3



KENNISGEWING VAN DISPUUT INSAKE DIE ASSESSERING VAN 'N ERNSTIGE BESERING

HOE DISPUUTRESOLUSIE U SAL HELP?

In terme van die Wet en Regulasles moet u els vir nie-vermoenskade ondersteun word deur "n emstige besering assesseringsverslag wat aandui dat die besering deur 'n geneesheer geassesseer Is as emstig en die Fonds moet tevrede wees dat die besering korrekgeassesser Is as emstig.

Watterdipute word gedek deur die dispuutresolusie diens?

Dispuutresolusie help u as:

die geneesheer u besering geassesseer het as "nie -emstig'; die Fonds 'n emsfge besering assesseringsverslag deur'n geneesheer verwerp het Ingevolge waarvan u besering as "emstig" geassesseer Is.

U moet op die vorm aandui of u die assessering deur<!lje geneesheer of die verwerping van die verslag deur die Fonds in dispuut plaas. Indien u verskil varrenige van die twee "moet u 'n dispuut Indien by die Registrateur van die Raad vir Gesondheldsberoeps van Suid Afrika ("die ROSA").

Wanner moet 'n dispuut ingedien word?

Binne 90 dae vanaf u in kennis gestel is van die uitslag van die assessering of In kennis gestel is van die venwerping van die emstige besering assesseringsverslag en die redes daarvoor, by gebreke waaraan u mag aansoek doen by die Registrateur van die RGSAvlrgoedkeuring (kondonasle) virdie laat kennisgewlng.

Hoe werk die dispuutresolusie proses?

a) U kennisgewlng moet by die Registrateur van die RGSA Ingedien word tesame met alle voorieggings (argumente), mediese verslae en opinles (ekspert advies) waarop u wil steun.

b) Nadat u die dispuut Ingedien het moet die Registrateur die Fonds van die dispuut in kennis stel en voorsien van afskrifte van alle dokumentasle deuru ingedien.

c) Die Fonds het 90 dae om op u saak te antwoord deurdie Registrateurte voorsien van hulle voorieggings, mediese verslae en opinles.

d) Hierna sal die Registrateur u In kennis stei van die name van die geneeshere wat aangestel Is om die dispuut te besleg. U mag beswaar maak teen die aanstellings indien u dit sou verkies.

e) Indien versoek, mag die appSltribunaal bepaal dat regsargumente aangevoer moet word rakende sekere aangeleenthede en 'n prokureur of advokaat sal dan aangestel word om sodanige argumente aan te hoor.

f) Uitgebreide magte word aan die appeltribunaal verieen ingevolge die regulasles om hulle In staat te stel om die dispuut tehanteer

Die tribunaal mag u vra om u aan 'n verdere assessering deur 'n geneesheer te onderwerp, wat deur die Fonds betaal sal word. Die tribunaal mag vra dat u voor hulle verskyn sodat hulle self u besering kan ondersoek. Die tribunaal mag u vra vir verdere voorieggings of mediese rekords.

g) Indien versoek om enige van bovermelde te doen moet u voldoen aan die versoek anders mag die appeltribunaal weierom u dispuut teoorweeg.

h) Ten laaste sal die appeltribunaal u dispuut beslis en sal u deurdie Registrateur van die uitslag in kennis gestsel word. Die Fonds sal verplig wees om die bevindlnge van die appSltribunaal te aanvaar.

Hoe lank sal dit neem?

Die appeltribunaal, aangestel deur die Registrateur van die RGSA om die dipuut te besleg, moet sy bevindlnge publiseer binne 90 dae vanaf die datum waarop die dispuut na dit venwys Is, wat normaalweg gedoen sal word nadat die Fonds op u saakgeantwoord het.

Vir meer inligiting kontak die RAF by ShareCallnommer: 0860 235 5523

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No. R. 771 21 July 2008

ROAD ACCIDENT FUND ACT, 1996 (ACT NO. 56 OF 1996), AS AMENDED

ROAD ACCIDENT FUND REGULATIONS, 2008

The Road Accident Fund hereby, under regulation 5(2) of the Road Accident Fund

Regulations, 2008, nnade under the Road Accident Fund Act, 1996 (Act No. 56 of 1996),

as amended, gives notice of the tariff set out in the Schedule hereto.

This notice shall come into operation on 1 August 2008.

SCHEDULE

Ambulance Services 2008 ro o

AlWBULANCE SERVICES Z o

u

ro

This schedule is only applicable to road accident trauma emergency care where the RAF is liable for compensation In terms of the Road Accident Fund Act (Act Nr 56 of 1996) as amended.

Emergency care means the immediate, appropriate and Justifiable medical assessment, treatment and care required to prevent or limit future Impairment to bodily functions and/or to preserve the person's life.

In calculating the prices in this schedule, the following rounding method Is used: Values RIO and below rounded to the nearest cent, R10+ rounded to the nearest 10 cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed. ALL PRICES ARE VAT EXCLUSIVE. Preanible REGULATIONS DEFINING THE SCOPE OF THE PROFESSION OF EMERGENCY CARE - GENERAL RULES GENERAL RULES

001

002

Long distance claims (items 111,129 and 141) to be rejected unless distance travelled by patient is reflected. Longdistancechargesmay not include item codes 100,103,125,127,131 or 133.

Long distance claims (Items 112,130 and 142) to be rejected unless the distance is reflected. Long distance charges may not Include Hem codes 100,103,125,127,131 or 133. No after hours fees may be charged

06.52

06,52 O O < m 33 z <: m z H O > N m

ro

c_ C

O O CD

003 item code 151 may only be charged for services provided by a second vehicle (either ambulance or response vehicle) and shall be accompanied by a motivation.

004 Guidelines for information required on each account: ' Name of service • BHF practice number ' Address ' Telephone number ' The name of the patient ' Diagnosis of patient's condition ' Summary of medical procedures undertal en on patient and vital signs of patient ' Summary of all equipment used ' The date on vriiich the service vras rendered, ' Name and HPCSA registration number of care providers ' Name, practice number and HPCSA registration number of medical doctor • Response vehicle: Details of vehicle driver and Intervention undertaken on patient • The code number of the procedure used in this tariff.

005 When drugs, consumables and disposable items are used during a procedure, or issued to a patient on discharge, the Fund shall only reimburse the cost of such items, in line with this tariff, if the appropriate code Is supplied on the account. _^____ _ _ _ _ _ _ _ _ _ _ _ „ _ ^ _ _ _

06.52 06.52

06.52

006 IA BLS service (Practice type "51200") may not charge for ILS or ALS, an ILS service (Practice type "51100") may not charge for ALS. An ALS service (Practice type "51000") may charge all codes. 106.52 DEFINfTION OF AMBULANCE PATIENT TRANSFER

Basic Life Support - A callout where patient assessment, treatment administration, interventions undertal<en and subsequent monitoring fall within the scope of practice of a registered Basic Ambulance Assistant whilst patient in transit.

intermediate Life Support - A callout vriiere the patient assessment, treatment administration. Interventions undertalcen and subsequent monitoring fall within the scope of practice of a registered Ambulance Emergency Assistant (AEA). (e.g. Initiating and/or maintaining iV therapy, nebuiisatlon etc.) whilst patient in transit.

Advanced Life Support - A callout where patient assessment, treatment administration, interventions undertal(en and subsequent monitoring fall within the scope of practice of a registered Paramedic (CCA and NDIP) whilst patient in transport. This Includes all incubated neonatal transfers.

NOTES:

Incubator transfers require ALS trained personnel in accordance with the HPCSA ruling.

' If a hospital or the attending physician requires a Parame(£c to accompany the patient on a transfer in the event of the patient needing ALS Intervention the doctor requesting the Paramedic must vwite a detailed motivational letter in order for ALS to be charged.

06.52

01 Jul 2008 Page 1 of 6 Version 2008.51

Code Description Ver Add Ambulance Services : Advanced Life

Support

Ambulance Services : Intermediate Life

Support

Ambulance Services : Basic Life Support

Ambulance Services -Other

RVU Fee RVU Fee RVU Fee RVU Fee

• If a hospital or the attending physician requires a Paramedic to accompany the patient on a transfer in the event of the patient needing ILS intervention the doctor requesting the Paramedic must viff-ite a detailed motivational letter in order for ILS to be charged.

' In order to bill as an advanced life support call, a registered advanced life support provider must have examined, treated and monitored the patient while in transit to hospital.

' In order to bill as an intermediate life support call, a registered intermediate life support provider must have examined, treated and monitored the patient while in transit to hospital.

' Where an ALS provider is in attendance at a callout but does not do any interventions at an ALS level on the patient or ALS monitoring and presence is not required, the billing will be based on a lower level dependent on the care given to the patient, (e.g. Paramedic sites IV line or nebulises patient with a B agonist - this falls within the practice of an AEA and thus is to be billed as an ILS call not an ALS call).

Where an ILS provider Is in attendance at a callout l3ut does not do any Interventions at an ILS level on the patient or ILS monitoring and presence is not required, the billing will be BLS.

- Where the management undertaken by a paramedic or AEA fall within the scope of practice of a BAA the call must be at a BLS level.

Please Note:

' The amounts reflected in the NRPL for each level of care is inclusive of any disposables (except for pacing pads, heimllch valves, high capacity giving sets, dial a flow, intra-osseous needles) and drugs used in the management of the patient, as per attached nationally approved medication protocols.

' IHaemaccel and colloid solution may be charged separately.

' Claims for patient discharges home will only be entertained If accompanied by a written motivation from the attending physician who requested such transport - clearly stating vi/hy an ambulance is required for such a transport and what n)edlcal assistance the patient requires on route.

DEFINITION OF RESPONSE VEHICLES Response vehicles only • Advance Life Support (ALS)

A clear definition must be drawn between the acute primary response and a bool<ed call.

1. The Acute Primary Response Is defined as follows: A call that is received for medical assistance to a member of the public who is ill or injured at work, home or in a public area e.g. motor vehicle accident. Should a response vehicle be dispatched to the scene of the emergency and the patient is in need of Advanced Life Support and which is rendered by ALS Personnel e.g. CCA or National Diploma, the respective service shall be entitled to bill on Item 131, for such service. However, the service vifhich is transporting the patient shall not be able to levy a bill, as the cost of transportation is included in the ALS rate under items 131 and 133. Furthermore the ALS response vehicle personnel must accompany the patient to hospital to entitle the service to bill for said ALS services rendered.

2. in the event of a sen/Ice rendering ALS and not having its own ambulance in which to transport the patient to a medical facility, and mal<e8 use of another service, only the bill for the response vehicle may be levied as the ALS bill under items 131 and 133. Since the ALS tariff already includes transportation, the response vehicle service is responsible for the bill for the other service provider, which will be levied at a BLS rate. This ensures that there is only one bin levied per patient. Furthermore the response vehicle ALS personnel must accompany the patient to hospital in the ambulance to entitle the service to bill for said ALS services rendered.

3. Should a response vehicle go to a scene and not render any ALS treatment then the said response vehicle may not levy a bill.

4. Notwithstanding that, item 151 applies to aK ALS resuscitation per the notes in this schedule.

Response vehicle only - Intermediate Life Support (ILS)

A clear definition must be drawn between the acute primary response and a booKed call.

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Ambulance Services • Ott»r


1. The Acute Primary Response is defined as follows; A call that is received for medical assistance to a member of the public who is ill or injured at work, home or in a public area e.g. motor vehicle accident. Should an ILS response vehicle be dispatched to the scene of the emergency and the patient is in need of Intermediate Life Support and which is rendered by ILS Personnel e.g. AEA, the respective service shall be entitled to bill on item 125, for such service. However, the service which is transporting the patient shall not be able to levy a bill, as the cost of transportation is included in the ILS rate under items 125 and 127. Furthermore the ILS response vehicle personnel must accompany the patient to hospital to entitle the service to bill for said ILS services rendered.

2. In the event of a service rendering ILS and not having its own ambulance in which to transport the patient to a medical facility, and makes use of another service, only the bill for the response vehicle may be levied as the ILS bill under items 125 and 127. Since the ILS tariff already includes transportation, the response vehicle service is responsible for the bill for the other service provider. This ensures that there is only one bill levied per patient. Furthermore the response vehicle ILS personnel must accompany the patient to hospital in the ambulance to entitle the service to bill for said ILS services rendered.

3. Should a response vehicle go to a scene and not render any ILS treatment then the said response vehicle may not levy a bill. 1 BASIC UPE SUPPORT Metropolitan ares C0<i9 Deeciripeiafl Ver Add AmtHilance Servieee

: Advanced Life Suoport

Ambulance Servieee : Intermediate Life

Support

Ambulance Services : Basic Ufe Support

Ambulance Services - ^ h e r

RVU PeB RVU Fee RVU Fee RVU Fee

100 ! Up to 45 minutes 06.52 171.276 766.10 171.276 766.10 171.276 766.10 102 Up to 60 minutes 06.52 228.156 1020.50 228.156 1020.50 228.156 1020.50 103 Every 15 minutes thereafter or part thereof, where specially motivated 06.52 57.084 255.40 57.084 255.40 57.084 255.40 Longdistanee 111 Per km (> 100 km) DISTANCE TRAVELLED BY PATIENT 06.52 2.843| 12.70 2.843 12.70 2.843 12.70 1

112 Per km (> 100 km) (BLS return - non patient carrying kilometres) to a maximum of R1986.40 06.52 1.0001 4.47 1.000 4.47 1.000 4.47 i i INTERMEDIAHE UFE SUPPORT MetroimlKan area 125 Up to 45 minutes 06.52 231.226 1034.20 231.226 1034.20 - -127 Every 15 minutes thereafter or part thereof, where specially motivated 06.52 77.075 344,70 77.075 344.70 . -Long distance 129 Per km (> 100 km) DISTANCE TRAVELLED BY PATIENT 06.52 3.850 17.20 3.850 17.20 - -130 Per km (> 100 km) (ILS return - non patient carrying kilometres) to a maximum of R1986.40 06.52 1.000 4.47 1.000 4.47 - -3 ADVANCED UFe SUPPORT / INTENSIVE CARE UNIT W^aecxsmoKA. • 131 Up to 60 minutes 06.52 406.641 1818.90 . - . - 1

1 133 Every 15 minutes thereafter or part thereof, where specially motivated. 06.52 101.660 454.70 - - - - : UMKJ dis^nce 141 Per km (> 100 km) DISTANCE TRAVELLED BY PATIENT 06.52 5.072 22.70 - -1 -142 Per km (> 100 km) (ALS return - non patient carrying kilometres) to a maximum of R1986.40 06.52 1.000 4.47 - i . 4 ADOmONAL VEHICLE OR STAFF FOR INTEBMEOIATE UFE SUPPORT, ADVANCED UFE SUPPORT AND INTENSIVE CABEUNIT 151 Resuscitation fee, per incident 06.52 454.000 2030.60 454.000 2030.60 - -153 Doctor per hour 06.52 130.000 581.50 130.000 581.50 - -

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Note: A resuscitation fee may only be billed when a second vehicle (response car or ambulance) with staff (inclusive of a paramedic) attempt to resuscitate the patient using full ALS interventions. These interventions must include one or more of the following: • Administration of advanced cardiac life support drugs. • Cardioversion-synchronised or unsynchronised (defibrillation) ' External cardiac pacing • Endotracheal intubation (Oral or nasal) with assisted ventilation

06.52

Note: Where a doctor callout fee is charged the name and HPCSA registration number and BHF practise number of the doctor must appear on the bill. 06.52

5. AEROSilEDICAL TRANSFERS BY ARRANGEMENT WITH THE ROAD ACCIDENT FUND 08.51

Rototwing Rates Definitions:

1. Helicopter rates are determined according to aircraft type 2. Day light operations are defined from Sunrise to Sunset (and night operations from Sunset to Sunrise) 3. If flying time is mostly in night time (as per definition above), then night time operation rates apply (type C). 4. Call out charge includes Basic Call Cost plus other flying time incun-ed, Staff and consumables cost can only be charged if a patient has been treated. 5. Should a response aircraft go to a scene and not render any treatment then the Road Accident Fund shall not be liable. 6. Flying time shall tie calculated per minute but a minimum of 30 minutes apply to the payment. 7. If two patients are transferred simultaneously 75% of the Basic costs and flight costs shall apply but Staff and Consumables costs remain per patient. (Only if aircraft capability allows for multiple patients). 8. Rates are calculated according to time; from throttle open, to throttle closed. 9. Group A - C must fall within the Cat 138 Ops as determined by Civil Aviation. 10. Hot loads restricted to 8 minutes ground time and must be indicated separately with the indicated code (time NOT to be included in actual flying time).

08.51

AIRCRAFT TYPE A: (typically a single engine aircraft) HB206L, HB204 / 205, HB407, AS360, EC120, MD600, AS350, At 19

AIRCRAFT TYPE B & Ca (DAY OPERATIONS): (typically a twin engine aircraft) 80105, 206CT, AS355, A109

AIRCRAFT TYPE Cb (NIGHT OPERATIONS): (typically specially equipped craft for night flying) HB222, HB212 / 412, AS365, S76, HB427, MD900, BK117, EC135, BO105

AIRCRAFT TYPE D (RESCUE) H500, HB206B, AS350, AS315, FH1100, EC130, S316

08.51

Ratorwlrqi type A 700 Basic call cost 08.51 163.778 7326.90 701 Flying time: Cost per minute up to 120 minutes 08.51 2.605 116.60 701

Minimum cost for 30 minutes applicable. Supply motivation for not using a fixed wing ambulance if the time exceeds 120 minutes.

08.51

702 Hot load (per minute) - maximum 8 minutes 08.51 1.737 77.70 Rotorwlng Type B & Co 09ay Operations): Transport 710 Basic call cost 08.51 287.850 12877.50 711 Flying time : Cost per minute up to 120 minutes 08.51 4.496 201.10

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Minimum cost for 30 minutes applicable. Supply motivation for not using a fixed wing ambulance If the time exceeds 120 minutes.

08.51

712 Hot load (per minute) - maximum 8 minutes 08.51 4.496 201.10 notortiittB type Cb (Night OperMons): Transport 720 Basic call cost 08.51 409.428 18316.50 721 Flying time: Cost per minute up to 120 minutes 08.51 4.496 201.10


08.51

722 Hot load (per minute) - maximum 8 minutes 08.51 4.496 201.10 Rotorvflng type A, B and C : Staff and con^intaWes 730 Staff and consumables : 1 - 30 minutes 08.51 25.777 1153.20 731 Staff and consumables - .31-60 minutes 08.51 51.555 2306.40 732 Staff and consumables : 61 - 90 minutes 08.51 77.332 3459.60 733 Staff and consumables: more than 90 minutes 08.51 103.106 4612.60 RotonwItQ type D: Transport 740 Basic call cost 08.51 345.417| 15452.90 741 Rying time: Cost per minute up to 120 minutes 08.51 5.3611 239.80


08.51

742 Hot load (per minute) - maximum 8 minutes 08.51 1 5.361 239.80 OtherCosts 595 IWinching, per lift 106.521 | I I I I I I 44.9531 2011.10 Air AmtMilancs: Rseed Wing Rates

DEFINITIONS:

1. Group A must fall within the Cat 138 Ops as determined by Civil Aviation. 2. Please note that no fee structure has been provided for Group B, as emergency charters could Include any fonm of aircraft. It would be Impossible to specify costs over such a t>road range. As these would only be used during emergencies when no Group A aircraft are available, no staff or equipment fee would be advised. 3. Staff and consumables cost can only be used if the patient has been treated. 4. If two patients are transferred simultaneously 75% of the Basic costs and flight costs shall apply but Staff and Consumables costs remain per patient. (Only if aircraft capability allows for multiple patients)

08.51

ftxattminaiitoapA (Tariff is composed of flying cost per kilometer and staff and equipment cost per minute) 08.51

l^xe#wlRB<^«up4: Aircraft costt (per fcflome^ 651 Beechcraft Duke 06.52 0.657 29.40 653 Lear 24F 06.52 1.033 46.20 655 Lear 35 06.52 1.033 46.20 657 Falcon 10 06.52 1.194 53.40 659 King Air 200 06.52 0.946 42.30 661 Mitsubishi MU2 06.52 1.033 46.20 663 Cessna 402 06.52 0.573 25.60 665 Beechcraft Baron 06.52 0.496 22.20

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Ambulance Services : Intermediate Life

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Ambulance Services : Basic Life Support



667 Citation 11 06.52 0.785 35.1 C 669 PllatusPC12 06.52 0.785 35.1C Fixed winq Group A : Staff cost 750 Doctor - cost per minute 08.51 0.827 37.0C

Minimum cost for 30 minutes applicable. 08.51

751 ICU Sister - cost per minute 08.51 0.302 13.5C Minimum cost for 30 minutes applicable. 08.51

752 Paramedic - cost per minute 08.51 0.302 13.5C Minimum cost for 30 minutes applicable. 08.51

Fixed wing Oroup A : Equipment cost 760 1 Per patient-cost per minute 108.51 I I I 1 1 | | | 0.369| 16.5C Fixed Wing Oroup B - Emergency Charters

1. No staff and equipment fee allowed. 2. Cost to be reviewed per case. 3. Only allowed if a Group A aircraft Is not available wittiin an optimal time period for transportation and stabilisation of tlie patient.

08.51

770 Service rendered to be clearly specified witii cost Included. Each case will be reviewed and assessed on merit.

08.51 -

6 NATIONALLY APPROVED MEDICATIONS WHICH MAY BE ADMINISTERED BY HPCSA-REGISTERED AMBULANCE PERSONNEL ACCORDING TO HPCSA-APPROVED PROTOCOLS Registered Basic Ambulance Assistant Qualification • Oxygen ' Entonox ' Oral Glucose

Registered Ambulance Emergency Assistant Qualification As above, plus ' Intravenous fluid therapy ' intravenous dextrose 50% ' 82 stimulant nebuKser Inhalant solutions (Hexoprenallne, Fenoterol, Sulbutamol) ' Soluble Aspirin

Registered Paramedic Qualification As above, plus • Oral glyceryl trinitrate, activated charcoal ' Ipratropium bromide Inhalant solution ' Endotracheal Adrenaline and Atropine ' Intravenous Adrenaline, Atropine, Calcium, Hydrocortisone, Lignocaine, Naloxone, Sodium bicarbonate, Hetaclopramlde ' Intravenous Diazepam, Flumazenil, Furosemlde, Hexoprenallne, Midazolam, Nalbuphine and Tramadol may only be administered after permission has been obtained from the relevant supervising medical officer. ' Pacing and synchronised cardioversion require the permission of the relevant supervising medical officer.

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Clinical Technologists 2008

SERVICES BY CLINICAL TECHNOLOGISTS This schedule is only applicable to road accident trauma emergency care where the RAF Is liable for compensation In terms of the Road Accident Fund Act (Act Nr 56 of 1998) as amended.

Emergency care means the immediate, appropriate and justifiable medical assessment, treatment and care required to prevent or limit future impairment to bodily functions and/or to preserve the person's life.

In calculating the prices in this schedule, the following rounding method is used; Values RIO and below rounded to the nearest cent, R10+ rounded to the nearest 10 cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed. VAT EXCLUSIVE PRICES APPEAR IN BRACKETS. GENERAL RULES cni When drugs, cor»umables and disposable items are used during a procedure, or issued to a patient on discharge, the Fund shall

only reimburse the cost of such Items, in line with this tariff, if the appropriate code is supplied on the account. 06.52

MODIFIERS 0001 I Fee prorated according to number of treatment days;, fee = flnumber of treatment days] / 30) X (item fee) 106.52

ITEMS Surgical Support Code 1 Description 1 Ver JAdd Clinical Technology

RVU Fee

010 At>lations 06.52 219.700 1667.30 (1462.50)

011 Preparation of extra-corporeal equipment for surgical procedures. 06.52 196.700 1492.80 (1309.50)

012 Operation of heart laser during myocardial revascularisation 06.52 219.700 1667.30 (1462.50)

013 Continued operation of extra-corporeal equipment during surgery for a time in excess of one hour in 30 minute increments or part thereof provided that such part comprises 50% or more of the time

06.52 20.300 154.10 (135.20)

014 Radiofrequency Catheter Ablations 06.52 219.700 1667.30 (1462.50)

Not to be charged with item 012 06.52

015 Preparation and operation of pre-operative, intra-operative or post operative physiological monitoring per patient, per admission

06,52 19,400 147.20 (129.10)

May only submit once in theatre and once in catheterisation laboratory 06.52

017 Standby with extra-corporeal equipment for surgery within hospital 06.52 58.800 446.20 (391.40)

Cannot be used with 011 06.52

019 Standby within the hospital for coronary angioplasty. 06.52 19.400 147.20 (129.10)

021 Preparation and operation of intra-aort'ic balloon pump in theatre, intensive care unit and catheterisation laboratory.

06.52 58,800 446.20 (391.40)

085 Each additional 30 minutes or part thereof, provided that such part comprises 50% or more of the time.

06.52 10.000 75.90 (66.60)

023 Global fee for preparation and operation and removal of cardio assist device (LVAD, RVAO, BVAD) in theatre and intensive care unit.

06.52 196.700 1492.80 (1309.50)

027 Preparation and operation of a pre- and post-operative Mood salvage device. 06.52 19,400 147.20 (129.10)

029 Preparation and operation of an autotransfusion cell washing system. 06.52 77.100 585.10 (513.20)

031 Determination and monitoring of haemodynamic/pulmonary parameters, metabolism, arterial/venous pressure flow studies in high oare/ICU (per patient per multiple procedures per day)

06.52 61.700 468.20 (410.70)

033 Assistance with bronchoscopy procedures, placement of arterial/venous catheters, ultrasound examinations or photography.

06.52 14.600 110.80 (97.20)

034 Lymph compression treatment. 06.52 22.500 170.80 (149.80)

116 Preparation and operation of an artificial heart (Berlin-Heart) 06.52 219.700 1667.30 (1462.50)

118 Daily monitoring of artificial heart, per hour 06.52 33.400 253.50 (222.40)

157 Standby with extra corporeal equipment (maximum 4 hours) (per event). 06.52 26,300 199.60 (175.10)

Pubnonology

Items 035 to 061 apply only to outpatient department and normal wards - Not high care or intensive care, except item 050 which applies to Intensive care only.

06.52

035 Nebullzation (per one procedure). 06.52 12,300 93.30 (81.80)

037 Measurement of Lung volumes and capacities by means of closed circuit (He) or (N2) washout or body plethysmography.

06.52 24.200 183,70 (161,10)

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Code 1 Description 1 Ver |Add Clinical Technology RVU Fee

039 Flow-volume determinations. 06.52 30.600 232.20 (203.70)

041 Flow-volume (Pre-post B-D). 06.52 50.800 385.50 (338.20)

043 Airways resistance and conductance measurements using plethysmograph or similar apparatus. 06.52 24.200 183.70 (161.10)

045 Gas distribution measurements. 06.52 24.200 183.70 (161.10)

047 Diffusion determinations. 06.52 24.200 183.70 (161.10)

050 ECMO change-out and re-establishment. 06.52 46.300 351.40 (308.20)

Cardiology 062 Assist in preparations and operations of Rotablator Procedures 06.52 29.900 226.90

(199.00) 063 Cardiac catheterisatlon for the first hour. 06.52 40.300 305.80

(268.20) 065 Each additional 30 minutes or part thereof provided that such part comprises 50% or more of the

time 06.52 10.000 75.90

(66,60) 064 intravascular Ultrasound (IVUS) 06.52 25.700 195.00

(171.10) This fee can only be charged once, irrespective of how many times this procedure is repeated. The technologist cannot charge for this procedure if a representative of a company or any other person is operatinq the IVUS machine

06.52

068 Each additional 30 minutes or part thereof provided that such part comprises 50% or more of the time.

06.52 10.000 75.90 (66.60)

066 Cardiac Cath Right Heart Studies 06.52 56.000 425.00 (372.80)

067 Cardiac Electro physiology and related procedures for first FOUR hours. 06.52 67.900 515.30 (452.00)

Dialysis 145 Preparation of extra-corporeal equipment: Haemoperfusion (HP), Haemofittration (HF),

Haemoconcentration (HC), Continuous renal replacement therapy (CRRT), Aphaeresis, Auto transfusion and cell recovery (AT).

06.52 46.300 351.40 (308.20)

150 Acute haemodialysis 06.52 317.200 2407.20 (2111.60)

Emergency dialysis treatment in hospital; includes dialyser, bloodlines, acetate/bicarbonate dialysate, priming set, equipment set-up, up to 5 houis treatment time, equipment rental

06.52

151 Treatment procedures for CRRT up to 6 hours or part thereof provided that such part comprises 50% or more of the time

06.52 24.800 188.20 (16510)

152 Treatment procedure for CRRT up to 12 hours or part thereof provided that such part comprises more than 6 hours of the time

06.52 49.700 377.20 (330.90)


06.52 74.500 565.40 (496.00)


06.52 99.300 753.60 (661.10)

153 Patient training in centre for dialysis, CPAP training and problem-solving, home ventilators and nebullsers, per 30 minutes (to maximum of 24 hours)

06.52 16.600 126.00 (110.50)

155 Patient training or follow-up at patient's home, for dialysis, home ventilators and nebullsers, per 30 minutes (to maximum of 24 hours).

06.52 29.100 220.80 (193.70)

Miscellaneous 171 Travelling per km in excess of 16l<m (in own car). 06.52 0.675 5.12(4,49) 173 Equipment hire (By arrangement with the Fund). 06.52 - . 175 Medication / Material 06.52 - -

The amount charged in respect of medicines and scheduled substances shall not exceed the limits prescribed in the Regulations Relating to a Transparent Pricing System for Medicines and Scheduled Substances, dated 30 April 2004, made in terms of the Medicines and Related Substances Act, 1965 (Act No 101 of 1965).

In relation to all other materials, items are to be charged (exclusive of VAT) at net acquisition price plus-

* 26% of the net acquisition price where the net acquisition price of that material is (ess than one hundred rands; and

* a maximum of twenty six rands where the net acquisition price of that material is greater than or equal to one hundred rands.

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Medical Practitioners 2008

SERVICES BY MEDICAL PRACTITIONERS

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This schedule is only applicable to road accident trauma emergency care where the RAF is liable for compensation in terms of the Road Accident Fund Act (Act Nr 56 of 1996) as amended.

Emergency care means the immediate, appropriate and Justifiable medical assessment, treatment and care required to prevent or limit future impairment to bodHy functions and/or to preserve the person's life.

In calculating the prices in this schedule, the following rounding method is used; Values RIO and below rounded to the nearest cent, R10+ rounded to the nearest 10 cent. Modifier values are rounded to the nearest cent. When new item prices are calculated, e.g. when applying a modifier, the same rounding scheme should be followed. VAT EXCLUSIVE PRICES APPEAR IN BRACKETS. RULES qOVERNING THE TARIFF

Consuttations: Definitions: (a) New and estatMished patients: A consultation/visit refers to a clinical situation v^ere a medical practitioner personally obtains a patient's medical history, performs an appropriate cNnical examination and, if indicated, administers treatment, prescribes or assists with advice. These services must t>e face-to-face with the patient and excludes the time spent doing special investigations which receive additional remuneration, (b) Subsequent visits: Refers to a voluntarily scheduled visit performed within four (4) months after the first visit. It may imply talcing dovm a medical history and/or a clinical examination and/or prescribing or administering of treatment and/or counselling, (c) Hospital visits: Where a procedure or operation was done, hospital visits are regarded as part of the normal after-care and no fees may be levied (unless othenwise indicated). Where no procedure or operation vi^s carried out, fees may be charged for hospital visits according to the appropriate hospital or inpatient follow-up visit code. •

06.52

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Normal hours and after hours: After-hours services are paid at the same rate as benefits for normal hours services. Bona fide emergency medical services rendered to a patient, at any time, may attract a fee as specified in modifier 0011 and items0146or 0147 (which should be added to the appropriate consultative services code selected from Kerns 0190-0192, 0173-0175, 0161-0164, 0166-0169)

06.52

Comparable services: A service may be rendered that is not listed in this edition of the coding structure. The fee that may be charged in respect of the rendering of a service not listed in this coding structure shall tie based on the fee in respect of a comparable service. For these procedure(s)/service(s), item 6999: Unlisted procedure or service code, should be used. Please contact the SA Medical Association (SAMA) Private Practice Unit via e-mail on [email protected] to obtain a comparable code for the unlisted procedure/service M4iich will be based on the fee for a comparable service in the coding structure. When item 6999 is used to indicate that an unlisted service was rendered, tlie use of the item must be supported by a special report. This report must include: (1) An adequate definition or description of the nature, extent and need for the procedure/service or "medical necessity"; (2) In which respect is this service unusual or different in technique, compared to available procedures/services listed in the coding structure? Information regarding the nature and extent of the procedure/service, time and effort, special/dedicated equipment needed to provide this service, must t>e included in the report; (3) Is this procedure/service medically appropriate under the circumstances? Explain w/hy another procedure/service listed in the coding structure will not be appropriate in this case; (4) A description of the complexity of the symptoms and concurrent problems must be supplied; (5) Final diagnosis supported by the appropriate ICD-10 code(s); (6) Pertinent physical findings (size, location and number of lesions if applicable); (7) Mention any other diagnostic or therapeutic procedure(s)/sen/ice(s) provided at the same session; (8) Any further diagnostic or therapeutic procedure(s)/service(s) to be provided in the follow-up period; and (9) Description of the follow-up care needed. Please note: This comparable service code may not be used for a period longer than six months for a particular procedure /service after which time an application has to be made to the Fund for the addition of a specific code or for an extension of time.

06.52

Cancellation of appointments: Unless timely steps are taken to cancel an appointment for a consultation, the relevant consultation fee may be charged. In the case of a general practitioner "timely" shall mean two hours and in the case of a specialist 24 hours prior to the appointment. Each case shall, however, be considered on merit and, if circumstances warrant, no fee shall be charged. If a patient has not turned up for a procedure, each memlier of the surgical team is entitled to charge for a visit at or away from doctor's rooms as the case may be Pre-operative visits: The appropriate fee may be charged for all pre-operative visits with the exception of a routine pre-operative visit at the hospital

06.52

06.52 Administering of injections and/or infusions: Where applicable, fees for administering injections and/or infusions may only be charged when done by the practitioner himself 06.52 Post-operative care: (a) Unless otherwise stated, the fee in respect of an operation or procedure shall include normal after-care for a period not exceeding ONE month (after-care is excluded from pure diagnostic procedures during which no therapeutic procedures were performed), (b) If the normal after-care is delegated to any other registered health professional and not completed by the surgeon, it shall be his/her ovm responsibility to an-ange for this to be done without extra charge, (c) When post-operative care/treatment of a prolonged or specialised nature is required, such fee as may be agreed upon between the surgeon and the Fund or the patient (in case of a private account) may be charged, (d) Normal after-care refers to an uncomplicated post-operative period not requiring any further incisions

06.52

Removal of lesions: Items involving removal of lesions include follo»iA-up treatment for 10 days 06.52 Practice of specialists: In terms of the conditions in respect of the practice of specialists as published in Government Gazette No. 12958 of 11 January 1991, a specialist may treat any person who comes to him direct for consultation. A specialist who is consulted by a patient or who treats a patient, shall take all reasonable steps to ensure the collaboration of the patient's general practitioner.

06.52

Procedures performed at time of visits: If a procedure is performed at the time of a consultation/visit, the fee for the visit PLUS the fee for the procedure is charged 06.52 Procedure planned to be performed later: In cases where, during a consultation/visit, a procedure is planned to be performed at a later occasion, a visit may not be charged for again, at such a later occasion

06.52

"Per consultation": No additional fee may be charged for a service for which the fee is indicated as "per consuftation". Such services are regarded as part of the consultation/visit performed at the time the condition is brought to the doctor's attention

06.52

Costly or prolonged medical services or procedures: In the case of costly or prolonged medical services or procedures, the medical practitioner shall first ascertain from the Fund for what amount the will accept responsibility in respect of such treatment, should the practitkmer wish any direct payment from the Fund

06.52


Code Description Ver Add Specialists General Practitioners / non-designated

Specialists

Anaesthesiology

RVU Pee RVU Pee RVU Fee

Travelling fees: (a) Where, in cases of emergency, a practitioner was called out from his residence or rooms to a patient's home or the hospital, travelling fees can be charged according to the section on travelling expenses (sectk>n IV) if he had to travel more than 16 kilometres in total, (b) If more than one patient would be attended to during the course of a trip, the full travelling expenses must be divided between the relevant patients, (c) A practitioner is not entitled to charge for any travelling expenses or travelling time to his rooms, (d) Where a practitioner's residence would be more than 8 kilometres away from a hospital, no travelling fees may be charged for services rendered at such hospitals, except in cases of emergency (services not voluntarily scheduled), (e) Where a practitioner conducts an itinerant practice, he b not entitled to charge fees for travelling expenses except In cases of emergency (services not voluntarily scheduled), (f) For voluntarily scheduled services, fees for travelling expenses may only be charged where the patient and the practitioner have entered Into an agreement to this effect. The Fund benefits will not be applfcable in such instances.

intensive care/IHigh Care: Units in respect of items 1204 to 1210 (Categories 1 to 3) EXCLUDE the following: (a) Anaesthetic and/or surgical fees for any condition or procedure, as vi/ell as a first consultationArisit, which is, regarded as the assessment of the patient, while the daily intensive care/high care fee covers the daily care in the intensive/high care unit, (b) Cost of any drugs and/or materials, (c) Any other cost which may be incurred before, during or after the consultation/visit and/or the therapy, (d) Blood gases and chemistry tests, including the arterial puncture to obtain the specimen, (e) Procedural items 1202 and 1212 to 1221. but INCLUDE the follovi/ing: (0 Performing and interpretatton of a resting ECG. (g) Interpretation of chemistry tests and x-rays, (h) Intravenous treatment (items 0206 and 0207), except intravenous infusion in patients under the age of three years (item 0205) that does not form a part of the daily ICU/HIgh Care fee and may be charged for separately on a daily basis (fee includes the introduction of the cannula as well as the daily management)

06.52

06.52

Multiple organ failure: Units for items 1208, 1209 and 1210 (Category 3: Cases with multiple organ failure) include resuscitation (i.e. item 1211: Cardio-respiratory resuscitation) Ventilation: Units for items 1212, 1213 and 1214 (ventilation) include the following: (a) Measurement of minute volume, vital capacity, time- and vital capacity studies, (b) Testing and connecting the machine, (c) Putting patient on machine: setting machine, synchronising patient with machine, (d) Instruction to nursing staff, (e) All subsequent visits for 24 hours.

06.52 06.52

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Ventilation fitems 1212 to 1214) does not form a part of normal post-operative care, but may not be added to Hern 1204: Category 1: Cases requiring intensive monitoring Obstetric procedures: (a) When a general practitioner treats a patient in the ante-natal period and, after starting the confinement, requests an obstetrician to take over the case, the general practitioner shall be entitled to charge for all the ante-natal consultations he/she has performed, (i) If the patient has been in labour for less than 6 hours, the general practitioner shall charge 50,00 clinical procedure units according to item 2614: Global obstetric care. GO If the patient has been in labour for more than 6 hours, the general practHioner shall charge 80,00 clinical procedure units according to item 2614: Global obstetric care, (b) When a general practitioner calb an obstetrician to help with a confinement, take over the management of a confinement, and treats the patient until after the post-partum visit, the obstetrician shall charge according to item 2614: Global obstetric care, (c) When a general practitioner calls an ob5tetrk;ian (specialist or general practitioner) to help with a confinement, or take over the management of a confinement, but the general practitioner treats the patient until after the post-partum visit, the obstetrician shall charge according to item 2616: Intrapartum ot)Stetrfe care by obstetrician in consultation, and the general practitioner according to item 2614: Global obstetric care.

06.52 06.52

(a) Electro-convulsive treatment: Vbits at hospital or nursing home during a course of electro-convulsive treatment are justified and may be charged for in addition to the fees for the procedure, (b) Except where othenwise indicated, the duration of a medical psychotherapeutic session is set at 20 minutes or part thereof, provided that such a part comprises 50% or more of the time of a session. This set duration is also applicable for psvchiatrk: examination methods

06.52

Y. Z. AA. EE.

Except where othenwbe indicated, radiologists are entitted to charge for contrast material used 06.52 No fee is subject to more than one reduction 06.52 Procedures to exclude cost of isotope 06.52 Ultrasound examinations: The international norm approved for use in South Africa for NORMAL PREGNANCY Is two ultrasound exams: (a) The first scan should preferably include a nuchal thk;kness estimation and be peifoimed between 10 and 14 weeks gestation. The second scan should be performed between 20 and 24 weeks and shoukJ include a full anatomical report. All subsequent ultrasound scans are excluded from the benefits unless accompanied by proper motivation. An ultrasound scan to assess an abnormal early pregnancy may be formed before 10 weeks but this scan may not be used to diagnose a normal uncomplicated pregnancy. Item 3618 b a gynaecological scan and its use is not approved for use in pregnancy, (b) In cases where the scan is performed by the attending practttioner, a clear indk:ation for such a scan must be entered on the account rendered, or a letter of motivation must be attached to the account (the practitioner must elect one of the two options), (c) In case of a referral, the referring doctor must submit a letter of motivation to the radiologist or other practitioner doing the scan. A copy of the letter of motivation must be attached to the first account rendered to the patient (by the radiologist or the other practitnner doing the scan) and must be attached to the first account submitted to the Fund by the patient or the doctor, as the case may be. (d) In case of a referral to a radiologist, no motivation should be required from the radiologist

06.52

FF. (a) When a cystoscopy precedes a related operation. Modifier 0013: Endoscopk: examination done at an operation, applies, e.g. cystoscopy foUovrad by transurethral (TUR) prostatectomy, (b) When a cystoscopy precedes an unrelated operation. Modifier 0005: Multiple procedures/operations under the same anaesthetic, applies, e.g. cystoscopy for urinary tract infection followed by inguinal hernia repair, (c) No modifier applies to item 1949: Cystoscopy, when performed together with any of items 1951 to 1973.

06.52

GG.

RRT

Capturing and recording of examinations: Images from all radiological, ultrasound and magnetic resonance imaging procedures must be captured during every examination and a permanent record generated by means of film, paper, or magnetic media. A report of the examinafion. Including the findings and diagnostfc comment, must be written and stored for five years

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The radiology section in this price list is not for use by registered specialist radiology practices (Pr No "O38'0 or nuclear medk;ine practices (Pr No "025"). but only for use by other specialist practices or general practitioners. A separate radiology schedule is for the exclusive use of registered specialist radiology practices (Pr No "038") and nuclear medicine practices (Pr No "025").

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Code Description Ver Add

XX.

YY.

Specialists

RVU Fee

General Practttionfefs / non-designated

Specialists : RVU Fee

Anaesthesiology

RVU Fee

Diagnostic services rendered to hospital inpatients: Quote Modifier 0091 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients officially admitted to hospital or day clinic Diagnostic services rendered to outpatients: Quote Modifier 0092 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients NOT officially admitted to hospital or day clinic (could be within the confines of a hospital)

06.52

06.52

MObiRERS QOVfeRNINO THE STRUCTURE 0002

0004

0005

0006

0007

0008

0009

0010

0011

Written report on X-rays: The lowest level code for a new patient ofTice (consulting rooms) visit is applicable only where a radiologist is requested to give a written report on X-rays taken elsewhere and submitted to him. The above mentioned item and the lowest level initial hospital visit code, as appropriate are not to be used for routine reporting of X-rays taken elsewhere Procedures performed in ovm procedure rooms: Procedures performed in doctors' own procedure rooms instead of in a hospital theatre or unattached theatre unit: as per fee for procedure + 100% (the value of modifier 0004 equals 100% of the value of the procedure performed). See Section V (Section G in SAMA's DBT) for a list of procedures, whk;h are often done in rooms to which Modifier 0004 should not be applied. Please note: Only the medical practitioner who owns the facility and the equipment may charge modifier 0004. Only one person may claim this modifier for procedures perfomned in doctors' own procedure rooms Multiple therapeutic procedures/operations under the same anaesthetk::

a) Unless otheiwise identified in the tariff when multiple therapeutic procedures/operations add significant time and/or complexity, and when each procedure/operation Is clearly Identified and defined, the following values shall prevail: 100% (full value) for the first or major procedure/operation, 75% for the second procedure/operation, 50% for the third procedure/operation, 25% for the fourth and subsequent procedures/operations. This modifier does not apply to purely diagnostic procedures.

b) In the case of multiple fractures and/or dislocations the above values shall prevail.

c)"+' Means that this item is used in addition to another definitive procedure and is therefore not subject to reduction according to Modifier 0005 (see also Modifier 0082) Visiting specialists performing procedures: Where specialists visit smaller centres to perform procedures, fees for these particular procedures are exclusive of after-care. The referring practitioner will then be entitled to subsequent hospital visits for after-care. If the referring practitioner is not available, the specialist shall, on consultation with the patient, choose an appropriate locum tenens. Both the surgeon and the practitfoner who handled the after-care, must in such instances quote Modifier 0006 with the partteular items which they use a) Use of ovim monitoring equipment in the rooms: Remuneration for the use of any type of own monitoring equipment in the rooms for procedures performed under intravenous sedation -15, 00 clinical procedure units irrespective of the number of items of equipment provided.

06.52

b) Use of own equipment in hospital theatre or unattached theatre unit: Remuneration for the use of any type of own equipment for procedures performed In a hospital theatre or unattached theatre unit when appropriate equipment is not provided by the hospital -15,00 clinical procedure units in-espective of the number of items of equipment provided. Specialist surgeon assistant: Where a procedure requires a registered specialist surgeon assistant, the fee is 33,33% (1/3) of the fee for the specialist surgeon

15.000 105.42 (92.47)

15.000 105.42 (92.47)

06.52

06.52

06.52

06.52

Assistant: The fee for an assistant Is 20% of the fee for the specialist surgeon, with a minimum of 36,00 clinical procedure units. The minimum fee payable may not be less than 36,00 clinical procedures units Local anaesthesic: (a) A fee for a local anaesthetic administered by the operator may only be charged for (1) an operation or procedure having a value greater than 30, 00 clinical procedure units Q.e. 31, 00 or more clinical procedure units allocated to a single Item) or (2) where more than one operation or procedure is done at the same time with a combined value greater than 50, 00 clinical procedure units, (b) The fee shall be calculated according to the basic anaesthetic units for the specific operation. Anaesthetk; time may not be charged for, but the minimum fee as per Modifier 0036: Anaesthetic administered by a general practitioner, shall be applicable In such a case, (c) Not applk:able to radiologk:al procedures (such as angiography and myelography, (d) No fee may be levied for topk:al application of local anaesthetic-, (e) Please note; Modifier 0010: Local anaesthetk; administered by the operator, may not t>e added on the surgeon's account for procedures that were performed under general anaesthetic.

Emergency procedures: Any bona fide, justifiable emergency procedure (all hours) undertaken in an operating theatre and/or in another setting in lieu of an operating theatre, will attract an additional 12,00 clinical procedure units per half-hour or part thereof of the operating time for all members of the surgical team. Modifier 0011 does not apply in respect of patients on scheduled lists. (A medical emergency Is any condition where death or irreparable hanri to the patient will result if there are undue delays In receiving appropriate medical treatment)

06.52

06.52

06.52

06.52

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0013

0014

Endoscopk: examinations done at operations: Where a related endoscopic examination is done at an operation by the operating surgeon or the attending anaesthesiologist, only 50% of the fee for the endoscopic examination may be charged ^

06.52

Operations previously performed by other surgeons: Where an operatnn is performed which has been previously performed by another surgeon, e.g. a revision or repeat operation, the fee shall be calculated accordlgq to the tariff for the full operation

06.52



Specialists

Anaesthesiology

RVU Fee RVU Fee RVU Fee

0015 Intravenous infusions: Where intravenous infusions (including blood and blood cellular products) are administered as part of the after-treatment after the operation or confinement, no extra fees shall be charged as this is included in the global operative or maternity fees. Should the practitioner doing the operation or attending to the maternity case prefer to asl< another practitioner to perform postoperative or post-confinement intravenous infusions, then the practitioner himself (and not the patient) shall be responsible for remunerating such practitioner for the infusions

06.52

0017 Injections administered by practitioners: When desensitisatlon, intravenous, intramuscular or subcutaneous injections are 06.52 administered by the practitioner hlm-/herself to patients who attend the consulting rooms, a first injection forms part of the consultation/visit and only all subsequent Injections for the same condition should be charged at 7.50 consultative services units using modifier 0017 to reflect the amount (not chargeable together with a consultation item)

7.500 85.12 (74.67) 7.500 85.12 (74.67)

0018 Surgical modifier for persons with a BMI of 35> (calculated according to kg/m2): Fee for procedure +50% for surgeons and a 50% increase in anaesthetic time units for anaesthesiologists 06.52 0019 Surgery on neonates (up to and including 28 days after birth) and low birth weight infants (less than 2500g) under general anaesthesia (excluding circumcision): per fee for procedure + 50% for

surgeons and a 50% increase in anaesthetic time units for anaesthesiologists 06.52

0046 Where in the treatment of a specific fracture or dislocation (compound or closed) an initial procedure is followed within one month by an open reduction, internal fixation, external skeletal fixation or bone grafting on the same bone, the fee for the initial treatment of that fracture or dislocation shall be reduced by 50%. Please note: This reduction does not include the assistant's fee where applcable. After one month, a full fee as for the initial treatment, is applicable

06.52

0047 A fracture NOT requiring reduction shall be charged on a fee per service basis 06.52

0048 Where in the treatment of a fracture or dislocation, an initial.closed reduction is followed within one month by further 06.52 closed reductions under general anaesthesia, the fee for sv'ch sutisequent reductions will be 27,00 clink:al procedure units (not including after-care) "''

27.000 189.76 (166.46)

27.000 189.76 (166.46)

0049 Except where otherwise specified, in cases of compound fractures, 77,00 clinical procedure units (specialists) and 77,00 06.52 cllncal procedure units (general practitioners) are to be added to the units for the fractures including debridement

77.000 541.16 (474.70)

77.000 541.16 (474.70)

0050 In cases of a compound fracture where a debridement is followed by internal fixation (excluding fixation with Kjrschner 06.52 wires, as well as fractures of hands and feet), the full amount according to either Modifier 0049: Cases of compound fractures, or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, may be added to the fee for the procedure Involved, plus half of the amount according to the second modifier (either Modifier 0049: Cases of compound fractures or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, as applicable)'

115.500 811.73 (712.04)

115.500 811.73 (712.04)

0051 Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting; Specialists add 77,00 06.52 clink:al procedure units. General practitioners add 77,00 clinical procedure units

77.000 541.16 (474.70)

77,000 541.16 (474.70)

0053 Fracture requiring percutaneous internal fixation [insertion and removal of fixatives (wires) in respect of fingers and toes 06.52 included]: Specialists and general practitioners add 32,00 clinical procedure units

32.000 224.90 (197.28)

32.000 224.90 (197.28)

0055 Dislocation requiring open reduction: Units for the specific joint plus 77,00 cKneal procedure units for specialists. General 06.52 practitioners add 77,00 clinKal procedure units

77.000 541.16 (474.70)

77.000 541.16 (474.70)

0057 Multiple procedures on feet: In multiple procedures on feet, fees for the first foot are calculated according to Modifier 0005: Multiple procedures/operations under the same anaesthetk:. Calculate fees for the second foot in the same way, reduce the total to 75% and add to the total for the first foot

06.52

0058 Revision operatton for total joint replacement and immediate re-substitution (infected or non-infected): per fee for total joint replacement + 100% 06.52 0061 Combined procedures on the spine: In cases of combined procedures on the spine, both the orthopaedic surgeon and the neurosurgeon are entitled to the full fee for the relevant part of the operation

performed 06.52

0063 Where two specialists work together on a replantation procedure, each shall be entitled to two-thirds of the fee for the procedure 06.52 0064 Where the replantation is unsuccessful, no further surgical fee is payable for amputation of the non-viable parts 06.52 0065 Additional operative procedures by same surgeon, under section 3.8.6: Spinal deformities, writhin a period of 12 months: 75% of scheduled fee for the lesser procedure, except where othenMse

specified elsewhere 06.52

0066 Mk;rosurgery of the fallopian-tubes and ovaries: Where mfero-surgical techniques are used, with the aid of a microscope, 25% may be added to the fee 06.52 0067

0069

Mk:rosurgery of the larynx: Add 25% to the fee of the operatk>n performed (For other operations requiring the use of an operation microscope, the fee include the use of the microscope, except where otherwise specified elsewhere in the Tariff) When endoscopic instruments are used during intranasal surgery: Add 10% of the fee of the procedure performed. Only applk;able to items 1025, 1027. 1030, 1033, 1035, 1036, 1039, 1047, 1054 and 1083

06.52

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Speejalists

Anaesthesiplpgy U 10

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0070 Add 45,00 cfinical procedure units to procedure(s) performed through a thorascope 06.52 45.000 316.26 (277.42)

45.000 316.26 (277.42)

0072 Non invasive peripheral vascular tests: The numtier of tests in a single case is restricted to two (2) per diagnosis. Tests are not justified in cases of uncomplicated varicose veins 06.52

0074 Endoscopic procedures performed with ovm equipment: The basic procedure fee plus 33.33% (1/3) of that fee C*' codes excluded) will apply where endoscopic procedures are performed with own equipment. :

06.52

0075 Endoscopic procedures performed In ovm procedure roonvr'The fee plus 21,00 clinical procedure units wiQ apply where 06.52 endoscopic procedures are performed in rooms with own equipment. This fee is chargeable by medical practitioners who ovm or rent the facility. Please note: Modifier 0075 is not applicat)le to any of the items for diagnostic procedures in the otorhinolaryrHiology sections of the tariff.

21.000 147.59 (129.46)

21.000 147.59 (129.46)

0077 Physical treatment: When two separate areas are treated simultaneously for totally different conditions, such treatment shall be regarded as two treatments for which separate fees may be charged. (Only applicable if services are provided by a specialist in physical medicine)

06.52

0079 When a first consultation/vist proceeds into, or is immediately followed by a medical psychotherapeutic procedure, fees for the procedure are calculated according to the appropriate individual psychotherapy code (Hems 2957, 2974 or 2975)

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0080 Multiple examinations: Full Fee 06.52

0081 Repeat examinations: No reduction 06.52 0082 ' * ' Means that this item is complementary to a preceding >em and is therefore not subject to reduction 06.52 0083 0084

0085

A reduction of 33.33% (1/3) in the fee will apply to radiological examinations as indicated in section 19: Radiology where hospital equipmerrt is used Film costs: In the case of radiological Items where films are used, practitioners should adjust the fee upwards or downwards in accordance with changes in the price of films in comparison with Novemt>er 1979; the calculation must be done on the basis that film costs comprise 10% of the monetary value of the unit (This information is obtainable from the Radiological Society of SA) 'Left Side' nwdifier to be added to vyhen items 6500 to 6519 are used wtien the left side is examined. Please note that the absence of this modifier indicates that the right side was examined

06.52 06.52

06.52 0086 Vascular groups: "Film series' and "Introduction of Contrast Media" are complementary and together constitute a single examination: neither fee is therefore subject to increase in terms of Modifier

0080: Multiple examinations 06.52

0090 Radiologist's fee for participation in a team: 30, 00 radiology units per % hour or part thereof for aH interventional radiological procedures, excluding any pre- or post-operative angiography, catheterlsation, CT-scanning, ultrasound-scanning or x-ray procedures. (Only to be charged if radiologist Is hands-on, and not for interpretation of images only)

06.52

0091 Diagnostic services rendered to hospiti!) inpatients: Quote Modifier 0091 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients officially admitted to hospital or day clinic (refer to Rule XX) ______^___

06.52

0092 Diagnostic services rendered to outpatients: Quote Modifier 0092 on all accounts for diagnostic services (e.g. MRI, X-rays, pathology tests) performed on patients NOT officially admitted to hospital or day cKnic (could be within the confines of a hospital) (refer to Rule VY)

06.52

0095

0097

Radiation materials: Exclusively for use virhere radiation materials supplied by the practice are used by clinical and radiation oncologists, modifier 0095 should be used to identify these materials. This medTicr is only chargeable by the practice responsible for the cost of this material and where the hospital did not charge therefore. Rease note that item 0201 should not be used for these materials Pathology tests performed by non-pathologists: Where items under Clinicat Pathology (section 21) and Anatomical Pathology (section 22) fail within the province of other specialists or general practltiorwrs, the fee Is to be charged at two-thirds of the pathologists fee

06.52

06.52

0160 Aspiration of biopsy procedure performed under direct ultrasound control by an ultrasound aspiration biopsy transducer (Static Realtime): Fee for part examined plus 30% of the units Use of contrast during uitrasound study add 6.00 ultrasound units 06.52 I I 6.000 40.19 (35.25)1 6.000| 40.19 (35.25)1

06.52 0165 5104 Ultrasound in pregnancy, multipla gestation, after twenty weeks: plus 30% 06.52 6100 In order to charge the full fee (600,00 magnetic resonance units) for an examination of a specific single anatomical region, it should be performed with the applicable radio frequency coil including T1

and T2 vwighted images on at least two planes 06.52

6101

6102

Where a limfted series of a specific anatomical region is performed (except bone tumour), e.g a T2 weighted image of a bone for an occult stress fracture, not more than two-thirds (2/3) of the fee may tie charged. Also applicatile to all radiotherapy planning studies, per region

06.52

All post-contrast studies (except bone tumour), including perfusion studies, to be charges at 50% of the fee 06.52 6103 Post-contrast study: Bone tumour: 100% of the fee 06.52 6104 Limited examination of the hypophysis e.g. where a coronal T1 and sagittal T1 series are performed, two-thirds (2/3) of the fee is applicable 06.52 6105 Where, In a imited hypophysis examination. Gadolinium is administered and coronal T1 and sagittal T1 series are repeated, a single full fee for the entire examination is applicable + cost of

Gadolinium * disposat)le items ^ , 06.52


Code Olscriptiorr Ver Add Specialists General Practitioners / non-designated

Specialists

Anaesthesiology


6106 Where a magnetic resonance angiography (MRA) of large vessels Is performed as primary examination, 100% of the fee is applicable. This modifier is only applicable if the series is performed by use of a recognised angiographic software package with reconstruction capability

06.52

6107 Where a magnetic resonance angiography (MRA) of the vessels is performed additional to an examination of a particular region, 50% of the fee is applicable for the angiography. This modifier is only applicable if the series is performed by use of a recognised angiographic software package with reconstruction capability

06.52

6108 Where only a gradient echo series is performed with a machine without a recognised angiographic software package with reconstruction ability, 20% of the full fee is applicable specifying that it is a flow sensitive series'

06.52

6109 Very Bmited studies to be charged at 33,33% of the full fee e.g. MR urography for renal colk:, diffusion studies of the brain additional to routine brain 06.52 6110 MRI spectroscopy: 50% of fee 06.52 6300 6301

If a procedure lasts less than 30 minutes, only 50% of the machine fees for Kerns 3536-3550 wiH be allowed (specify time of procedure on account) If a procedure is performed by a radiologist in a facility not owned by himself, the fee will be reduced by 40% (I.e. 60% of the fee will be charged)

06.52 06.52

8302 When the procedure is performed by a non-radiologist, the fee vwll be reduced by 40% (i.e. 60% of the fee will be charged) 06.52

6303 When a procedure is performed entirely by a non-radiologist in a facility owned by a radiologist, the radiologist owning the facility may charge 55% of the procedure units used. Modifier 6302 applies to the non radiotoglst performing the procedure

06.52

6305 When multiple catheterisation procedures are used (items 3557, 3559, 3560, 3562) and an angiogram investigation Is performed at each level, the unit value of each such multiple procedure will be reduced by 20,00 radiologieal units for each procedure after the initial catheterisation. The first calheterlsation is charged at 100% of the unit value

06.52

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Consultative Services l.a General Practitioner visits

T.b.r Specialists tiered consultation structure New and estatilished patients: ConsultationsMsits by psychiatrists (22) only

Code Description Ver Add Specialists General Practitioners / non-idestgnated

Specialists

Anaesthesiology


0161 Psychiatry 022'): New and established patients: Consultation/visit of new or established patient with problem focused history, dinksal examination and straightforward decision making for minor problem. Typksally occupies the doctor personally with the patient between 10 and 20 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

06.52 15.000 203.00 (178.10)

0162 Psychiatry f22'): New and established patients: ConsultationA^sit of new or established patient with detailed history, clincal examination and straightfonvard decision making and counselling. Typically occupies the doctor personally with the patient behween 21 and 35 minutes (for hospital consultation/visit by psychiatrist - refer to items 0166-0169)

06.52 27.500 372.20 (326.50)

0163 Psychiatry ('22'): New and established patients: Consultation/visit of new or established patient with detailed history, complete clinical examination and moderately complex decision making and counselling. Typlcaly occupies the doctor personally with the patient between 36 and 45 minutes (for hospital consuKatkin/vlsit by psychiatrist - refer to items 0166-0169)

06.52 40.000 541.40 (474.90)

0164 Psychiatry ('22'): New and established patients: Consultation/visit of new or established patient with comprehensive history and clinical examination for complex prot>lem requiring complex decision making and counselling. Typically occupies a doctor personally with the patient Iwtween 46 and 60 minutes (for hospital consultation/visit by psychiatrist -refer to Hems 0166-0169)

06.52 52.500 710.60 (623.30)

0166 Psychiatry (22): First hospital consultationAnsit with problem focused history, clinical examination and straightforvtrard decision making for minor problem. Typically occupies the doctor personally with the patient for between 10 and 20 minutes ;

06.52 15.000 203.00 (178.10)

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0167 Psychiatry (22): First hospital consuRationAnsit with detailed history, clinical examination and straightforward decision making and counselling. Typically occupies the doctor personally vwth the patient for betvroen 21 and 35 minutes

06.52 27.500 372.20 (326.50)


Code Description Ver Add Specialists General Practitioners / noh-desighated

Specialists

Anaestheslology

RVU : • • - • . , , . F e e . . RVU Fee RVU Fee

0168 Psychiatry (22): First hospital consultation/visit with detailed history, complete clinical examination and moderately 06.52 complex decision making and counselling. Typically occupies the doctor personally with the patient for between 36 and 45 minutes

40.000 541.40 (474.90)

0169 Psychiatry (22): First hospital consultation/visit with comprehensive history and clinical examination for complex problem 06.52 requiring complex decision making and counselling. Typk;ally occupies a doctor personally with the patient for between 46 and 60 minutes

52.500 710.60 (623.30)

i;c' -^ (S( riferk(fri<rfitiji>r«r.and-specialist-s*rvices-V./v^^^^^^ 0190 New and established patient: Consultation/visit of new or established patient of an average duration and/or complexity. Includes counselling vinth the patient and/or family and co-ordination with

other health care providers or liaison with third parties on behalf of the patient (for hospital consuKationArisit - refer to item 0173-0175 or item 0109) - not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetk; structure

06.52

0191 New and established patient: Consultation/visit of new or established patient of a mo co-ordination with other health care providers or liaison with third parties on behalf of anaesthetic assessment followed by the appropriate anaesthetics - refer to new anae

derately above average duration and/or complexity. Includes the patient (for hospital consultation/visit - refer to item 0173-sthetic structure duration and/or high complexity. Includes counselling with the spital consultation/visit - refer to item 0173-0175 or item 0109 lure

counselling with the patient and/or family and 0175 or Item 0109) - not appropriate for pre-

06.52

0192 New and established patient: Consultation/visit of new or established patient of long other health care providers or liaison with third parties on behalf of the patient (for ho assessment follovi/ed by the appropriate anaesthetics - refer to new anaesthetic struc

derately above average duration and/or complexity. Includes the patient (for hospital consultation/visit - refer to item 0173-sthetic structure duration and/or high complexity. Includes counselling with the spital consultation/visit - refer to item 0173-0175 or item 0109 lure

patient and/or family and co-ordination w^th ) - not appropriate for pre-anaesthetic

06.52

0173 First hospital consultation/visit of an average duration and/or complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison vinth third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure)

06.52

0174

0175

0109

First hospital consultation/visit of a moderately above average duration and/or complexity. Includes counselling v/ith the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure) First hospital consultation/visit of long duration and/or high complexity. Includes counselling with the patient and/or family and co-ordination with other health care providers or liaison with third parties on behalf of the patient (not appropriate for pre-anaesthetic assessment followed by the appropriate anaesthetics - refer to new anaesthetic structure) Hospital follow-up visit to patient in ward or nursing facility - Refer to general rule G(a) for post-operative care) (may only be charged once per day) (not to be used vinth Items 0111, 0145, 0146. 0147 or ICU items 1204-1214)

06.52

06.52

06.52

0111 Paediatric hospital follow-up visits (excluding neonates) by paediatricians or paediatric cardiologists (may only be charged once per day) (not to be used with items 0109 or ICU items 1204-1214). For a healthy neonate please use item 0109 for a hospital follow-up visit

06.52

0129 Prolonged face-to-face attendance to a patient: ADD to either Item 0192, Item 0175, item 0164 or item 0169 as appropriate, for each 15-minute period only if service extends 10 minutes or more Into the next 15-mlnute period following on the first 60 minutes

06.52 +

+ 0145 For consultation/visit away from the doctor's home or rooms (non-emergency): ADD only to the consultation/visit items 0190-0192, Items 0173-0175, items 0161-0164 or items 0166-0169, as appropriate. Note: Only one of Items 0145, 0146 or 0147 may be charged and not combinations thereof

06.52

+

+

0146 For an unscheduled emergency consultation/visit at the doctors' home or rooms, all hours: ADD only to the consultation/visit items 0190-0192, items 0161-0164 or items 0151-0153, as appropriate (refer to general rule B). Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

06.52 +

0147 For an unscheduled emergency consultation/visit away from the doctor's home or rooms, all hours: ADD only to the consultation/visit items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or Hems 0151-0153, as appropriate. Note: Only one of items 0145, 0146 or 0147 may be charged and not combinations thereof

06.52 +

0148 For elective afler-hours servces on request of the patient or family (non emergency) (refer to general rule B): ADD 50% of the fee for the appropriate consultation/visit item (only to be used with items 0190-0192. Items 0173-0175, items 0161-0164, Items 0166-0169 or Items 0151-0153) and reflect this as a separate item 0148. Usage: This Item is used when, for example, a patient or the family request the doctor for a non-emergency consultation/vlsit outside of the normal hours period as reflected In general rule B.

06.52 +

0149 After-hours bona fide emergency consultation/visit (21:00-6:00 daHy): ADD 25% of the fee for the appropriate consultation/visit item (only to be used with items 0190-0192, items 0173-0175, items 0161-0164, items 0166-0169 or items 0151-0153) and reflect this as a separate item 0149. Note: The after-hour period applicable to this item is from Monday to Sunday 21 00-600

06.52

••::®*:;';;::;;: .:-s:----fSS^ibfetyp^S^ MimmtiWiiim '••>^^teM'Hi'i :.<:'ims>-:^.. : 0i74 0176 0109 0111 0129 0145 0146 0147 0148 0149 Anaestheslology 192.90 192.90

(169.20) (169.20) 192.90

(169.20) 192.90

(169.20) 192.90

(169.20) 192.90

(169.20) Cardiology 295.10 295.10

(258.90) (258.90) 295.10

(258.90) 295.10

(258.90) 295.10

(258.90) 295.10

(258.90)

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Code Description Ver Add Specialists General Practitioneri / non-designated

Specialists

> Anaesthesiolbgy

RVU Pee RVU Fee RVU : Fee

Cardlothoracic Surgery 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Dermatology 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Gastroenterology 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

General Medical Practice 190.80 190.80 (167.40) (167.40)

190.80 (167.40)

190.80 (167.40)

190.80 (167.40)

190.80 (167.40)

170.20 (149.30)

170.20 (149.30)

68.10 (59.70)

90.80 (79.60)

158.90 (139.40)

- -

Medical Oncology 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (256.90)

Medicine (Specialist Physician) 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Neurology 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Neurosurgery 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Nuclear Medicine 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Obstetrics and Gynaecology 204.30 204.30 (179.20) (179.20)

204.30 (179.20)

204.30 (179.20)

204.30 (179.20)

204.30 (179.20)

Opthalnnology 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Orthopaedics 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Otorhinolaryngology 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Paedlatric Cardiology 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

255.40 (224.00)

Paediatrics 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

255.40 (224.00)

Pathology (Anatomical) 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Pathology (Clinical)

Physical Medicine

Plastic and Reconstructive Surgery

192.90 192.90 (169.20) (169.20)

295.10 295.10 (258.90) (258.90)

192.90 192.90 (169.20) (169.20)

192.90 (169.20)

295.10 (258.90)

192.90 (169.20)

192.90 (169.20)

295.10 (258.90)

192.90 (169.20)

192.90 (169.20)

295.10 (258.90)

192.90 (169.20)

192.90 (169.20)

295.10 (258.90)

192.90 (169.20)

Psychiatry 203.00 (178.10)

203.00 (178.10)

81.20 (71.20)

108.30 (95.00)

189.50 (166.20)

- -

Pulmonology 295.10 295.10 (258.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Radiation Oncology 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

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Specialists

Anaesthesioiogy

RVU Fee RVU Fee RVU ; • ^ ^ ^

Radiology 192.90 192.90 (169.20) (189.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Rheumatology 295.10 295.10 (256.90) (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

295.10 (258.90)

Specialists 170.20 (149.30)

170.20 (149.30)

68.10 (59.70)

90.8C (79.60

) 158.90 (139.40)

Surgery 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

Urology 192.90 192.90 (169.20) (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

192.90 (169.20)

fce^i-is.* l?»*ransi*iirihetii: assessnierjt:; i > 0151 Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient (aU hours). Problem focused history and clinical 06.52

examination and straightforward decision making for minor problem. Typically occupies the doctor face-to-face with the patient for between 10 and 20 minutes

16.000 181.60 (159.30)

16,000 181.60 (159.30)

0152 Pre-anaesthetic assessment Pre-anaesthetic assessment of patient (al hours). Detailed history and clinical examination 06.52 and straightforward decision making and counselling. Typically occupies the doctor face-to-face with the patient for between 20 and 35 minutes

16.000 181.60 (159.30)

16.000 181.60 (159.30)

0153 Pre-anaesthetic assessment: Pre-anaesthetk: assessment of patient or other consultative service. Consultation vrith 06.52 detailed history, complete examination and moderate complex decision making and counselling. Typically occupies the doctor face-to-face for between 30 and 45 minutes

16.000 181.60 (159.30)

16.000 181.60 (159.30)

lif'S-Hi-:.: i>rehataf*lstts;aBdne^:te(jfii[:afiteii^ 0113 Newborn attendance: Emergency attendance to newijom at all hours (once per patient) (items 0107, 0109, 0111, 0145, 06.52

0146 and/or 0147 may not be added to Hem 0113) 45.000 510.7C

(448.00 > 45.000 510.70

(448.00)

i^i&: <S6hsluiiiative services: Mfscellaneous 0130 Telephone consultation (all hours) 06.52 0132 Consulting servne e.g. writing of repeat scripts or requesting routine pre-authorisation without the physical presence of the patient (needs not be face-to-face contact) ("Consultation* via SMS or

electronic media included) 06.52

0133 Wriing of special motivations for procedures and treatment without the physical presence of a patient (includes report on the clinical condition of a patient) requested by or on behalf of a third party funder or its agent

06.52

:|::,:;:;:;;:yfkt:::4;:::i;'l ^ i:^>"i^MmoiM:. ^'E'Mm,}: .;• nd'::-:!:y---:y Anaesthesioiogy 136.20(119.50) Cardiology 204.30 (179.20) Cardlothoracic Surgery 192.90 (169.20) Dermatology 136.20(119.50) Gastroenterology 204.30 (179.20) General Medical Practice 136.20(119.50) 56.70 (49.70) 102.10 (89.60) Medical Oncology Medicine (Specialist Physician)

204.30(179.20) 204.30 (179.20)

Neurology 204.30(179.20) Neurosurgery 204.30(179.20) Nuclear Medicine Obstetrics and Gynaecology

204.30(179.20) 136.20(119.50)

Opthalmology 136.20(119.50)

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Anaesthesiology

RVU Fee RVO Fee RVU Fee

Orthopaedics 136.20(119.50)

Otorhinolaryngologv 136.20(119.50) Paedtatric Cardiology 204.30(179.20)

Paediatrics 204.30(179.20) Pathology (Anatomical) 136.20(119.50) Pathology (Olnical) 136.20(119.50) Physical Medicine 204.30(179.20)

Plastic and Reconstructive Surgery 136.20(119.50) Psychiatry Pulnwnology

162.40(142.50) 204.30 (179.20)

67.70 (59.40) 135.40(118.80)

Radiation Oncology 136.20(119.50) Radioloay 136.20(119.50)

Rheumatology 204.30(179.20) Specialists 56.70 (49.70) 102.10(89.60)

Surgery 136.20(119.50)

Urology 136.20(119.50)

II. Mo(flcine> motoriat fupplies artcl useof own equlprnent l U Mcdicim pontes 11,8.1 Dispensing of tnedicin« by ilcer)9«<t«Rsp«risiMn medical practitioners 0197 Licensed dispensing medical practitioners: Dispensing cost - R16.00 for medicine wth a cost of R100, 00 or more (VAT 06.52

inclusive), or 16% for medicine costing less than R100, 00 (VAT inclusive). Add to each Nappi code to provide for the dispensing cost.

it,a.2 Once-off administration of medicifie used during ji con«uitaii«n 0198 Onco-off administration of medicines: This item provides for medicines used at a consultation, viz, once off administration 06.52

of medicine, special medicine used in treatment, or emergency dispensing. Charge for medictne used according to the Single Exit Price (SEP) PLUS R16,00 for medicine with a cost of RIOO.OO or more, or 16% for medicine costing less than R100,00 PLUS VAT on the 16%/R16,00. (Where applicable, VAT should be added to the 16%/R 16.00 only and not to the SEP, since the SEP is VAT inclusive). [According to Section 18(8) of the Medicines and Related Substances Act (Act 101 of 1965) compounding and dispensing does not refer to a medicine requiring preparation for a once-off administration to a patient during a consultation]. The appropriate Ethical Medicine Nappi code(s), selected from those codes commencing with 7, 8 or 9 (provided that ft is not a reiference code), should be added applicable to the medicine used. Please note: Refer to item 0201 for cost of material used in treatment.

m>mM i(^4Sift^ii<^<i*:iiS:^§S mms i!r§5itJw!*tS'iM((w:-l^ 0200 Prosthesis and/or internal fixation: This item provides for a charge for prosthesis and/or internal fixation. Charge for 06.52

prosthesis and/or internal fixation at cost price PLUS 26% (up to a maximum of R 26,00). (WKiere applicable, VAT should be added to the atrove). The appropriate Nappi code(s), where applicable, for the prosthesis and/or Internal fixation used, must be provided.

Wmi:i: iiSfijiiiSitiiSsi^liSlii^ l i l i l ® f SisiBF^K^ 0201 Cost of material in treatment: This item provides for a charge for material used in treatment. Charge for material at cost 06.52

price PLUS 26% (up to a maximum of R26,00). (Where applicable, VAT should be added to the above). The appropriate Surgical and Material Nappi code(s), selected from ttiose codes commencing with 4, 5, 6, where applicable, for the material used, must t>e provided. Please note: Refer to item 0198 for once off administration of medicine.

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Specialists

Anaesthesiology


n.c Setting of sterile tray

0202 Setting of sterile tray: A fee of 10,00 clinical procedure units may be charged for the setting of a sterile tray where a 06.52 sterile procedure is performed in the rooms. Cost of stitching material, if applicable, shall be charged for according to item 0201, as appropriate

10.000 70.30 (61.70) 10.000 70.30(61.70)

ll.d:.:;::.:i Oi™:leijinprheiW-iised ih-treiftrri6^^ 5930 Surgical laser apparatus: Hire fee for own equipment 06.52 109.000 766.10

(672.00) 109.000 766.10

(672.00)

5932 Candella laser apparatus: Hire fee for own equipment (Rates by arrangement with the scheme concerned) 06.52

• 1 1 1 . - • ; . : • •;• PRtMSebURES 6999 Unlisted procedure/service: A procedure/service may be provided that is not hsted in this edition of the coding structure. 06.52

Refer to General Rule C for the criteria to use item 6999 1 GiiNERAl, MODIFIERS GOVERNING "WIS SECTION 0011 Emergency procedures: Any bona fide, justifiable emergency procedure (all hours) undertai<en in an operating theatre and/or in another setting in lieu of an operating theatre, will attract an additional

12,00 clinical procedure units per half-hour or part thereof of the operating time for all members of the surgical team. Modifier 0011 does not apply in respect of patients on scheduled lists. (A medical emergency is any condition where death or irreparable harm to the patient will result if there are undue delays in receiving appropriate medical treatment)

06.52

0013 Endoscopic examinations done at operations: Where a related endoscopic examination is done at an operation by the operating surgeon or the attending anaesthesiologist, only 50% of the fee for the endoscopic examination may be charged

06.52

0014 Operations previously performed by other surgeons: Where an operation Is performed which has been previously performed by another surgeon, e.g. a revision or repeat operation, the fee shall be calculated according to the tariff for the full operation

06.52

:MbJ5IFieRSeetVERNlNG^iSEGTI0tS(: !•« 0015 Intravenous infusions: Where intravenous infusions (including blood and blood cellular products) are administered as part of the after-treatment after the operation or confinement, no extra fees shall

be charged as this is included m the global operative or matemity fees. Should the practitioner doing the operation or attending to the maternity case prefer to asl< another practitioner to perform postoperative or post-confinement intravenous infusions, then the practitioner himself (and not the patient) shall be responsible for remunerating such practitioner for the infusions

06.52

0017 Injections administered by practitioners: When desensitisation, intravenous, intramuscular or subcutaneous injections are 06.52 administered by the practitioner him-/herself to patients vtrho attend the consulting rooms, a first injection forms part of the consuKation/vis'it and only all subsequent injections for the same condition should be charged at 7.50 consultative services units using modifier 0017 to reflect the amount (not chargeable together with a consultation item)

7.500 85.12 (74.67) 7.500 85.12 (74.67)

i\-.S.-i::: Oienerat lil:;:;.:::-: Injections, infusions and Inhalation Sedation Treatment 0203 Inhalation sedation: Use of analgesic nitrous oxide for alcohol and other withdrawal states: First quarter-hour or part 06.52

thereof 6.000 42.20 (37.00) 6.000 42.20 (37.00)

0204 Inhalation sedation: pier additional quarter-hour or part thereof 06.52 3.000 21.10(18.50) 3.000 21.10(18.50) 0205 Intravenous treatment: Intravenous infusions (cut-down or push-in) (patients under three years): Cut-down and/or 06.52

insertion of cannula - chargeable once per 24 hours 12.000 84.30 (73.90) 12.000 84.30 (73.90)

0206 Intravenous treatment: Intravenous infusions (push-in) (patients over three years): Insertion of cannula - chargeable once 06.52 per 24 hours

6.000 42.20 (37.00) 6.000 42.20 (37.00)

0207

0208

Intravenous treatment: Intravenous infusions (cut-down) (Ratients over three years): Cut-down and insertion of cannula - 06.52 chargeable once per 24 hours "'

8.000 56.20 (49.30) 8.000 56.20 (49.30) 0207

0208 Venesection: Therapeutic venesection (Not to be used when blood is drawn for the purpose of laboratory investigations) 06.52 6.000 42.20 (37.00) 6.000 42.20 (37.00) 0209 Umbilical artery cannulation at birth 06.52 18.000 126.50

(111.00) 18.000 126.50

(111.00) 0210 Collection of blood specimen(s) by medical practitioner for pathology examination, per venesection (not to be used by 06.52

pathologists) 3.250 22.80 (20.00) 3.250 22.80 (20.00)

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Code Description Ver: Add Specialists General Practitipriers / ribn-designated

. : Specialists

Anaesthesiology

RVU Fee HVti Fee RVU Fee

0211 Exchange transfusion: First and subsequent (including after-care) 06.52

Note: HOW TO CHARGE FOR INTRAVENOUS INFUSIONS: Practitioners are entitled to charge according to the appropriate item whenever they personally insert the cannula (but may only charge for this service once every 24 hours). For managing the infusion as such, e.g. checking It when visiting the patient or prescribing the substance, no fee may be charged since this service Is regarded as part of the services the doctor renders during consultations (not applicable to item 0205)

06.52

80.000 562.20 (493.20)

80.000 562.20 (493.20)

MODIFIERS Q Q V E > W I N 0 THE AOMINlSTRATIOKl OF ALfc PROCEbURES AND OPERATIONS

0020

0021

0023

0024

0025

0027

Conscious sedation: Any case that is conducted outside of a hospital theatre shall be coded with the relevant procedure code. To Identify these cases, the above modifier should be used to indicate tq^the Fund that there will be no hospital/theatre account.

Determination of anaesthetic fees: Anaesthetic fees are detemnined by obtaining the sum of the basic anaesthetic units (allocated to each procedure that might be performed under anaesthetic as indicated in the "Anaesthetic Performed" column) plus the time units (calculated according to the formula in Modifier 0023) and the appropriate modifers (see Modifiers 0037-0044). In cases of operative procedures on the musculoskeletal system, open fractures and open reduction of fractures or dislocations add units as laid down by Modifiers 5441 to 5448

The basic anaesthetic units are laid down In the tariff and are reflected in the anaesthetic column. These basic anaesthetic units reflect the additional anaesthetic risk, the technical skill required of the anaesthesiologist/anaesthetist and the scope of the surgical procedure, but exclude the value of the actual time spent administering the anaesthetk;. The time units (indicated by "T) will be added to the listed basic anaesthetk: units In all cases on the following basis: Anaesthetic time: The remuneration for anaesthetk; time shall be per 15 minute period or part thereof, calculated from the commencement of the anaesthetic, i.e. 2,00 anaesthetic units per 15 minute period or part thereof, provided that shoukl the duration of the anaesthetic be longer than one (1) hour the number of units shall, after one (1) hour, be 3,00 anaesthetk: units per 15 minute period or part thereof.

Pre-operatlve assessments not followed by procedures: If a pre-operative assessment of a patient by the anaesthesiologist/anaesthetist is not followed by an operation, it will be regarded as a visit at hospital or nursing home and the appropriate hospital visit item should be charged.

Calculation of anaesthetic time: Anaesthetic time Is calculated from the time the anaesthesiologist/anaesthetist begins to prepare the patient for the induction of anaesthesia In the operating theatre or in a similar equivalent area and ends when the anaesthesiologist/anaesthetist is no longer required to give his/her personal professional attention to the patient, i.e. when the patient may, with reasonable safety, be placed under the customary post-operative supen/ision. Where prolonged personal professional attention is necessary for the vrell-being and safety of such patient, the necessary time will be valued on the same basis as indteated above for the anaesthetic time. The anaesthesiologist/anaesthetist must show on his/her account the exact anaesthetic time, including the supervision time spent with the patient.

More than one procedure under the same anaesthetic: Where more than one operation is performed under the same anaesthetic, the basic anaesthetic units will be that of the major operation with the highest number of units

06.52

06.52

06.52

06.52

06.52

06,52

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0029

0030

0031

lndk:ator for use of low flow anaesthetic technique less thah 1 litre/minute: Fresh gas flow of less than 1 litre/minute

Assistant anaesthesiologists: When rendered necessary ^y the scope of the anaesthetic, an assistant anaesthesiologist may be employed. The remuneration of the assistant anaestheslologist shall be calculated on the same basis as in the case where a general practitioner administers the anaesthetic

06.52

Indicator for use of low flow anaesthetic technique 1-2 litre/minute: Fresh gas flow of 1 to 2 litre/minute 06.52 Intravenous drips and transfusions: Treatment with Intravenous drips and transfusions is considered part of the normal treatment In administering an anaesthetic. No additional fees may be charged for such services when rendered either prior to, or during actual theatre or operating time

06.52

06.52 0032

0033

Patients in prone position: Anaesthesia administered to patients In the prone position shall have a minimum of 4,00 basic anaesthetic units. When the basic anaesthetic units for the procedure Is 3, 00, one extra anaesthetic unit should be added. If the basic anaesthetk: units for the procedure is 4,00 or more, no extra units should be added

PartKipating in general care of patients: When an anaesthesiologist/anaesthetist is required to participate in the general care of a patient during a surgical procedure, but does not administer the anaesthetk;, such servk;es may be remunerated at full anaesthetic rate, subject to the provisos of modifier 0035: Anaesthetic administered by an anaesthesiologist/anaesthetist. and modifier 0036: Anaesthetk: administered by general practitioners. . .

06.52

0034 Head and neck procedures: All anaesthetk:s administered for diagnostic, surgical or X-ray procedures on the head and neck shall have a minimum of 4,00 bask: anaesthetk: units. When the basic anaesthetk: units for the procedure is 3,00, one extra anaesthetic unit should be added. If the basic anaesthetic units for the procedure is 4,00 or more, no extra units should be added

Anaesthetic administered by an anaesthesiologist/anaesthetist: No anaesthetic administered shall have a total value of less than 7,00 anaesthetic units (bask; units, time units plus appropriate modifiers).

06.52

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Specialists

Anaestliesiology


0036 Anaesthetic administered by general practitioners: The units (basic units plus time plus the appropriate modifiers) used to calculate the fee for an anaesthetic administered by a general practitioner lasting one hour or less shall be the same as that for an anaesthesiologist. For anaesthetic lasting more than one hour, the units used to calculate the fee for an anaesthetic administered by a general practitioner will be 4/5 (80%) of the total number of units (basic units plus time [refer to modifier 0023] plus the appropriate modifiers) applicable to an anaesthesiologist. Please note that the 4/5 (80%) principle will be applied to all anaesthetics administered by general practitioners with the proviso that no anaesthetic with a total number of units higher than 11.00 will be reduced to less than 11,00 units in total. The monetary value of the unit is the same for both an anaesthesiotogist/anaesthetist.

06.52

0037 Body hypothermia: Utilisation of total body hypothennia: Add 3,00 anaesthetic units 06.52 3.000 132.33 (116.08)

0038 Peri-operative blood salvage: Add 4,00 anaesthetic units for intra-operative blood salvage and 4,00 anaesthetic units for post-operative blood salvage 06.52

0039 Control of blood pressure: Deliberate control of the tilood pressure: All cases up to one hour: Add 3,00 anaesthetic units, thereafter add 1,00 (one) additional anaesthetic unit per quarter hour or part thereof

06.52

0040 Phaeochromocytoma: The tiasic anaesthetic units for procedures performed for phaeochromocytoma shall be 15,00 anaesthetic units 06.52 0041 Hyperbaric pressurisation: Utilisation of hyperbaric pressurisation: Add 3,00 anaesthetic units 06.52 3.000 132.33

(116.08) 0042 Extracorporeal circulation: Utilisation of extracorporeal circulation: Add 3,00 anaesthetic units 06.52 3.000 132.33

(116.08) 0043 Patients under one year of age: For all cases where the patient is under one year of age - 3,00 anaesthetic units to be 06.52

added ;' 3.000 132.33

(116.08) 0044

0100

Neonates (i.e up to and including 28 days after birth): 3,Qd anaesthetic units to be added to the basic anaesthetic units for 06.52 the particular procedure. This modifier is charged in addition to ModlTter 0043: Cases under one year of age tntra-aortic balloon pump: Where an anaesthesiologist would be responsible for operating an intra-aortic balloon pump, a fee of 75,00 cl'mical procedure units is applk:able.

3.000 132.33 (116.08)

06.52 Modifiers 5441 to 5448 Modification of ttie anaesthetic fee in cases of operative procedures on the musculo-skeletal system, open fractures and open reduction of fractures and dislocations is governed by adding units indicated by modifiers 5441 to 5448. (The letter "M* is annotated next to the number of units of the appropriate items, for bcllitating identification of the relevant items)

•06.52

5441 Add one (1,00) anaesthetic unit, except where the procedure refers to the bones named in Modifiers 5442 to 5448 06.52 1.000 44.11 (38.69) 5442 Shoulder, scapula, clavicle, humerus, elbow joint, upper 1/^ tibia, knee joint, patella, mandible and tempero-mandibular 06.52

joint: Add tvw) (2,00) anaesthetk: units 2.000 88.22 (77.39)

5443 Maxillary and orbital bones: Add three (3,00) anaesthetk: units 06.52 3.000 132.33 (116.08)

5444 Shaft of femur Add four (4,00) anaesthetk: units 06.52 4.000 176.44 (154.77)

5445 Spine (except coccyx), pehris, hip, neck of femur: Add ftve (5,00) anaesthetic units 06.52 5.000 220.55 (193.46)

5448 Sternum and/or ribs and musculo-skelâl procedures whteh involve an intra-thoracic approach: Add eight (8,00) 06.52 anaesthetic units

8.000 352.88 (309.54)

ilNiigiliîiiSM 0045 Post-operative alleviation of pain:

(a) Whan a regional or nerve block procedure is performed, the appropriate procedure tern to patient in ward or nursing facility, can be charged, provkled that It is not the primary anaesthetic technkiue

(b) When a second medical practitioner has administered the regional or nenê block for post-operative alleviation of pain, it shall be charged according to the particular procedure for instituting therapy. Revisits shall t>e charged according to the appropriate hospital follow-up visit to patient in ward or nursing facility.

(c) None of the above is applk:able for routine post-operative pain management i.e. intramuscular, intravenous or subcutaneous administration of opiates or NSAID (non-steroidal anti-inflammatory drug)

06.52

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Specialists

Anaesthesiolpgy


2 tntegumentary System

2.2 Skin (general) 0222 Intraleslonal Injection into areas of pathology e.g. Keloid: Single 06.52 4.000 28.10 (24.60) 4.000 28.10 (24.60) 0223 Intralesional Injection into areas of pathology e.g. Keloids: Multiple 06.52 8.000 56.20 (49.30) 8.000 56.20 (49.30) 0233 Biopsy without suturing: First lesion 06.52 6.000 42.20 (37.00) 6.000 42.20 (37.00) 3.000 132.30

(116.10) 0234 Biopsy without suturing: Subsequent lesions (each) 06.52 3.000 21.10(18.50) 3.000 21.10(18.50) 3.000 132.30

(116.10) 0235 Biopsy without suturing: Maximum for multiple additional lesions 06.52 18.000 126.50

(111.00) 18.000 126.50

(111.00) 3.000 132.30

(116.10)

0237 Deep skin bk>psy by surgical incisk>n with local anaesthetk: and suturing 06.52 12.000 84.30 (73.90) 12.000 84.30 (73.90) 3.000 132.30 (116.10)

0244 Repair of nail bed 06.52 30.000 210.80 (184.90)

30.000 210.80 (184.90)

3.000 132.30 (116.10)

0255 Drainage of subcutaneous abscess onychia, paronychia, pulp space or avulsion of nail 06.52 20.000 140.60 (123.30)

20.000 140.60 (123.30)

3.000 132.30 (116.10)

0257 Drainage of major hand or foot infection: Drainage of major abscess with necrosis of tissue, Involving deep fascia or requiring debridement; complete excision of pilonidal cyst or sinus

06.52 87.000 611.40 (536.30)

87.000 611.40 (536.30)

3.000 132.30 (116.10)

0259 Removal of foreign body superfKial to deep fascia (except hands) 06.52 20.000 140.60 (123.30)

20.000 140.60 (123.30)

3.000 132.30 (116.10)

0261 Removal of foreign body deep to deep fascia (except hands) 06.52 31.000 217.90 (191.10)

31.000 217.90 (191.10)

3.000 132.30 (116.10)

2 ; 3 " • • • • Iti^oWi^stio'rei^!r::v :;•: 0289 Large skin grafts, composite skin grafts, large full thickness free skin grafts 06.52 234.000 1644.60

(1442.60) 187.200 1315.60

(1154.00) 4.000 176.40

(154.70) 0290 Reconstructive procedures (including al stages) and skin graft by myo-cutaneous or fasck>-cutaneous flap 06.52 410.000 2881.50

(2527.60) 328.000 2305.20

(2022.10) 4.000 176.40

(154.70) 0291 Reconstructive procedures (including all stages) grafting by micro-vascular re-anastomosis 06.52 800.000 5622.40

(4931.90) 640.000 4497.90

(3945.50) 4.000 176.40

(154.70) 0292 Distant flaps: First stage 06.52 206.000 1447.80

(1270.00) 164.800 1158.20

(1016.00) 4.000 176.40

(154.70) 0293 Contour grafts (excluding cost of material) 06.52 206.000 1447.80

(1270.00) 164.800 1158.20

(1016.00) 4.000 176.40

(154.70) 0294 Vascularised bone graft with or v/ithout soft tissue with one or more sets of micro-vascular anastomoses 06.52 1200.00

0 8433.60

(7397.90) 960.000 6746.90

(5918.30) 6.000 264.70

(232.20) 0295

0296

0297

Local skin flaps (large, complk:ated)

Other procedures of major technk:al nature

Subsequent mijor procedures for repair of same lesion

06.52

06.52

06.52

206.000

206.000

104.000

1447.80 (1270.00)

1447.80 (1270.00)

730.90 (641.10)

164.800

164.800

104.000

1158.20 (1016.00)

1158.20 (1016.00)

730.90 (641.10)

4.000

4.000

4.000

176.40 (154.70)

176.40 (154.70)

176.40 (154.70)

0298 Lower at>dominal dermo-lipectomy 06.52 170.000 1194.80 (1048.10)

136.000 955.80 (838.40)

5.000 220.60 (193.50)

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Specialists

Anaesthesiology

RVO Fee RVU Fee RVU Fee

0299 Major abdominal llpectomy with repositioning of umbilicus 06.52 275.000 1932.70 (1695.40)

220.000 1546.20 (1356.30)

5.000 220.60 .1193.5_0)

m ::.;:.v Laijeratittns^ .starsjitumourW^c 0300 stitching of soft-tissue injuries: Stitching of wound (with or without local anaesthesia): Including normal after-care) 06.52 14.000 98.40 (86.30) 14.000 98.40 (86.30) 3.000 132.30

(116.10)

0301 StitcNng of soft-tissue Injuries: Additional wounds stitched at same session (each) 06.52 7.000 49.20 (43.20) 7.000 49.20 (43.20) 3.000 132.30 (116.10)

0302 Stitching of soft-tissue injuries: Deep laceration Involving limited muscle damage 06.52 64.000 449.80 (394.60)

64.000 449.80 (394.60)

4.000 176.40 (154.70^

0303 StitcNng of soft-tissue Injuries: Deep laceration Involving extensive muscle damage 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

4.000 176.40 (154.70)

0304 Major debridement of wound, sloughectomy or secondary suture 06.52 50.000 351.40 (308.20)

50.000 351.40 (308.20)

3.000 132.30 (116.10)

0305 Needle biopsy - soft tissue 06.52 25.000 175.70 (154.10)

25.000 175.70 (154.10)

3.000 132.30 (116.10)

0307 Excision and repair by direct suture; excision nail fold or other minor procedures of similar magnitude 06.52 27.000 189.80 (166.50)

27.000 189.80 (166.50)

3.000 132.30 (116.10)

0308 Each additional small procedure done at the same time 06.52 14.000 98.40 (86.30) 14.000 98.40 (86.30) 3.000 132.30 (116.10)

0310 Radical excision of nailbed 06.52 38.000 267.10 (234.30)

38.000 267.10 (234.30)

3.000 132.30 (116.10)

0314 Requiring repair by large skin graft or large local flap or other procedures of similar magnitude 06.52 104.000 730.90 (641.10)

104.000 730.90 (641.10)

4.000 176.40 (154.70)

0315 Requiring repair by small skin graft or small local flap or other procedures of similar magnitude 06.52 55.000 386.50 (339.00)

55.000 386.50 (339.00)

3.000 132.30 (116.10)

2.6 Breasts 0316 Fine needle aspiration for soft tissue (all areas) 06.52 15.000 105.40

(92.50) 15.000 105.40

(92.50) 0317 Aspiration of cyst or tumour 06.52 9.000 63.30 (55.50) 9.000 63.30 (55.50) 3.000 132.30

(116.10) 0319 Mastotomy with exploration, drainage of abscess or removal of mammary implant 06.52 42.000 295.20

(258.90) 42.000 295.20

(258.90) 3.000 132.30

(116.10) 0321 Biopsy or excision of cyst, benign tumour, aberrant breast tissue, duct papilloma 06.52 94.200 662.00

(580.70) 94.200 662.00

(580.70) 3.000 132.30

(116.10) 0323 Subareolar cone excision of ducts of wedge excision of breast 06.52 90.000 632.50

(554.80) 90.000 632.50

(554.80) 3.000 132.30

(116.10) 0324 Wedge excision of breast and axillary dissection 06.52 225.000 1581.30

(1387.10) 180.000 1265.00

(1109.60) 5.000 220.60

(193.50) 0325 Total mastectomy 06.52 155.000 1089.30

(955.50) 124.000 871.50

(764.50) 5.000 220.60

(193.50) 0327 Total mastectomy with axillary gland biopsy 06.52 185.000 1300.20

(1140.50) 148.000 1040.10

(912.40) 5.000 220.60

(193.50) 0329 Total mastectomy with axillary gland dissection 06.52 275.000 1932.70

(1695.40) 220.000 1546.20

(1356.30) 5.000 220.60

(193.50)

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Specialists

Anaei^thesiotogy


0330 Nipple and areola reconstruction 06.52 95.000 667.70 (585.70)

95.000 667.70 (585.70)

4.000 176.40 (154.70)

0331 Subcutaneous mastectomy for disease of breast; including reconstruction but excluding cost of prosthesis: Unilateral 06.52 234.000 1644.60 (1442.60)

187.200 1315.60 (1154.00)

4.000 176.40 (154.70)

0333 Subcutaneous mastectomy for disease of breast; including reconstruction but excluding cost of prosthesis; Bilateral 06.52 410.000 2881.50 (2527.60)

328.000 2305.20 (2022.10)

4.000 176.40 (154.70)

0334 Removal of breast implant by means of capsulectomy; Per breast 06.52 234.000 1644.60 (1442.60)

187.200 1315.60 (1154.001

4,000 176.40 (154.70)

0335 Implantation of intemal subpectoral mammary prosthesis in post mastectomy patients 06,52 150.000 1054.20 (924.70)

120.000 843.40 (739.80)

4,000 176.40 (154.70)

2.6 Bufns.i,.:.-.-..-., .:,V:i::A ,.::•::. • '.: 0351 Major Burns; Resuscitation (including supervision and intravenous therapy - first 48 hours) 06.52 276.000 1939.70

(1701.50) 220.800 1551.80

(1361.20) 5,000 220.60

(193.50)

0353 Tangential excision and grafting: Small 06.52 100.000 702.80 (616.50)

100.000 702.80 (616.50)

5.000 220.60 (193.50)

0354 Tangential excision and grafting: Large 06.52 200.000 1405.60 (1233.00)

160.000 1124.50 (986.40)

5,000 220.60 (193.50)

2.7-..,• -.. HandsXskin):-, :•,:•.: 0355 Skin flap in acute hand injuries where a flap is taken from a site remote from the injured f nger or in cases of

advancement flaq e.g. Cutler 06.52 147.400 1035.90

(908.70) 120.000 843,40

(739.80) 4.000 176,40

(154.70) 0357 Small skin graft in acute hand injury 06.52 45.000 316.30

(277.50) 45.000 316,30

(277.50) 3.000 132.30

(116.10) 0359 Release of extens'n/e skin contracture and/or excision of scar tissue with major skin graft resurfacing 06.52 192.000 1349.40

(1183.70) 153.600 1079.50

(946.90) 3.000 132.30

(116.10) 0361 Z-plasty 06.52 220.100 1546.90

(1356.90) 176.080 1237.50

(1085.50) 3.000 132.30

(116.10) 0363 Local flap and skin graft 06.52 150.000 1054.20

(924.70) 120.000 843.40

(739.80) 3,000 132.30

(116.10) 0365 Cross finger flap (all stages) 06.52 192.000 1349.40

(1183.70) 153.600 1079.50

(946.90) 3.000 132.30

(116.10) 0367 Palmar flap (all stages) 06.52 192.000 1349.40

(1183.70) 153.600 1079,50

(946.90) 3.000 132.30

(116.10) 0369 Distant flap; First stage 06.52 158.000 1110.40

(974.00) 126.400 888.30

(779,20) 3.000 132.30

(116.10) 0371 Distant flap; Subsequent stage (not subject to general modifier 0007) 06.52 77.000 541.20

(474.70) 77.000 541,20

(474.70) 3.000 132.30

(116.10) 0373 Transfer neurovascular island flap 06.52 230.500 1620.00

(1421.10) 184.400 1296,00

(1136.80) 3,000 132.30

(116.10) 0374 Syndactyly; Separation of, including skin graft for one web (with skin flap and graft) 06.52 242.400 1703.60

(1494.40) 193.920 1362.90

(1195,50) 3.000 132.30

(116.10) 0375 Dupuytren's contracture; Fasciotomy 06.52 51.000 358.40

(314.40) 51.000 358,40

(314.40) 3.000 132.30

(116.10) 0376 Oupuytren's contracture; Fasciectomy 06.52 218.000 1532.10

(1343.90) 174.400 1225.70

(1075.20) 3,000 132.30

(116.10)

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Anaesthesiology


RULES GOVERNING THE SECTION ACUPUNCTURE

3 V Musculchskeletal System MODIFIERS GOVERNING ORTHOPAEDIC OPERATIONS AND ANAESTHETIC FEES FOR ORTHOPAEDIC OPERATIONS 0047 A fracture NOT requiring reduction shall be charged on a fee per service basis 106.52

0048 Where in the treatment of a fracture or dislocation, an initial closed reduction is followed within one month by further closed reductions under general anaesthesia, the fee for such subsequent reductions wil be 27,00 clinical procedure units (not including after-care)

06.52 27.000 189.76 (166.46)

27.000 189.76 (166.46)

0049 Except where otheiwise specified, in cases of compound fractures, 77,00 clinical procedure units (specialists) and 77,00 clinical procedure units (general practitioners) are to be added to the units for the fractures including debridement

06.52 77.000 541.16 (474.70)

77.000 541.16 (474.70)

0050 In cases of a compound fracture where a debridement is followed by internal Fixation (excluding fixation with Kirschner wires, as well as fractures of hands and feet), the full amount according to either Modifier 0049: Cases of compound fractures, or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or bone grafting, may be added to the fee for the procedure involved, plus half of the amount according to the second modifier (either Modifier (X)49: Cases of compound fractures or Modifier 0051: Fractures requiring open reduction, internal fixation, external skeletal fixation and/or t>one grafting, as applteable)

06.52 115.500 811.73 (712.04)

115.500 811.73 (712.04)

0051 Fractures requiring open reductk>n, intemal fixation, external skeletal fixation and/or bone grafting: Specialists add 77,00 clink:al procedure units. General practitioners add 77,(X) clinical procedure units

06.52 77.000 541.16 (474.70)

77.000 541.16 (474.70)

0053 Fracture requiring percutaneous internal fixation [insertion and removal of fixatives (wires) in respect of fingers and toes included]: Specialists and general practitioners add 32,00 clinical procedure units

06.52 32.000 224.90 (197.28)

32.000 224.90 (197.28)

0055 Dislocation requiring open reduction: Units for the specific joint pkis 77,(X} clink:al procedure units for specialists. General practitioners add 77,00 clincal procedure unKs

06.52 77.000 541.16 (474.70)

77.000 541.16 (474.70)

0057 Multiple procedures on feet: In multiple procedures on feet, fees for the first foot are calculated according to Modifier 0(X}5: Multiple procedures/operations under the same anaesthetic, for the second foot in the same way, reduce the total to 75% and add to the total for the first foot

Cak;ulate fees 06.52

0058 Revision operation for total joint replacement and immediate re-substitution (infected or non-infected): per fee for total joint replacement + 100% 06.52 3.1 Bones 3.1.1 Bones: Fractur6$ (reduction under general anaesthetic - refer to modifier 0047) 0383 Fracture (reduction under general anaesthetic): Scapula 06.52 - - - - 3.000 132.30

(116.10) 0387 Fracture (reduction under general anaesthetic): Clavk;le 06.52 77.000 541.20

(474.70) 77.000 541.20

(474.70) 3.000 132.30

(116.10) 0388 Percutaneous pinning of supracondylar fracture: Elbow • stand alone procedure 06.52 175.700 1234.80

(1083.20) 140.560 987.90

(866.60) 3.000 132.30

(116.10) 0389 Fracture (reduction under general anaesthetic): Humerus 06.52 111.600 784.30

(688.00) 111.600 784.30

(688.00) 3.000 132.30

(116.10) 0391 Fracture (reduction under general anaesthetic): Radius and/or Ulna 06.52 77.000 541.20

(474.70) 77.000 541.20

(474.70) 3,000 132.30

(116.10) 0392 Fracture (reduction under general anaesthetic): Open reduction of both radius and ulna (modifier 0051 not applicable) 06.52 210.000 1475.90

(1294.60) 168.000 1180.70

(1035.70) 3.000 132.30

(116.10) 0402

0403

Fracture (reduction under general anaesthetic): Carpal bone

Fracture (reduction under general anaesthetic): Bennett fracture-dislocation

06.52

06.52

64.000

51.000

449.80 (394.60)

358.40 (314.40)

64.000

51.000

449.80 (394.60)

358.40 (314.40)

3.000

3.000

132.30 (116.10)

132.30 (116.10)

0405 Fracture (reduction under general anaesthetic): Open treatment of metacarpal: Simple 06.52 118.300 831.40 (729.30)

118.300 831.40 (729.30)

3.000 132.30 (116.10)

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Specialists

Anaesthesiology


0409 Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Simple 06.52 - - • - - 3.000 132.30 (116.10)

0411 Fracture (reduction under general anaesthetic): Finger phalanx: Distal: Compound 06.52 52.000 365.50 (320.60)

52.000 365.50 (320.60)

3.000 132.30 (116.10)

0413 Fracture (reduction under general anaesthetic): Proximal or middle: Simple 06.52 48.000 337.30 (295.90)

48.000 337.30 (295.90)j

3.000 132.30 (116.10)

0415 Fracture (reduction under general anaesthetic): Proximal or middle: Compound 06.52 102.000 716.90 (628.90)

102.000 716.90 (628.90)

3,000 132.30 (116.10)

0417 Fracture (reduction under general anaesthetic): Pelvis fracture: Closed 06.52 - - - - 3.000 132.30 (116.10)

0419 Fracture (reduction under general anaesthetic): Pelvis: Operative reduction and fixation 06.52 320.000 2249.00 (1972.80)

256.000 1799.20 (1578.20)

3.000 132.30 (116.10)

0421 Fracture (reduction under general anaesthetic): Femur Neck or Shaft 06.52 237.000 1665.60 (1461.10)

189.600 1332.50 (1168.90)

3.000 132.30 (116.10)

0425 Fracture (reduction under general anaesthetic): Patella 06.52 51.000 358.40 (314.40)

51.000 358.40 (314.40)

3.000 132.30 (116.10)

0429 Fracture (reduction under general anaesthetic): Til>ia with or without fibula 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0433 Fracture (reduction under general anaesthetic): Fibula shaft 06.52 - - - - 3.000 132.30 (116.10)

0435 Fracture (reduction under general anaesthetic): Malleolus of ankle 06.52 58.000 407.60 (357.50)

58.000 407.60 (357.50)

3.000 132.30 (116,10)

0437 Fracture (reduction under general anaesthetic): Fracture-dislocation of ankle 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

3,000 132.30 (116.10)

0438 Fracture (reduction under general anaesthetic): Open reduction Talus fracture (modifier 0051 not applicable) 06.52 198.700 1396.50 (122500)

158.960 1117.20 (980.00)

3.000 132.30 (116.10)

0439 Fracture (reduction under general anaesthetic): Tarsal bones (excluding talus and calcaneus) 06.52 64.000 449.80 (394.60)

64.000 449.80 (394.60)

3.000 132.30 (116.10)

0440 Fracture (reduction under general anaesthetic): Open reduction Calcaneus fracture (modifier (X)51 not applicable) 06.52 403.500 2835.80 (2487.50)

322.500 2266.50 (1988.20)

3.000 132.30 (116.10)

0441 Fracture (reduction under general anaesthetic): Metatarsal 06.52 41.800 293.80 (257.70)

41.800 293.80 (257.70)

3.000 132.30 (116.10)

0443

0445

0447

Fracture (reduction under general anaesthetic): Toe phalanx: Distal Simple

Fracture (reduction under general anaesthetic): Toe phalanx: Compound

Fracture (reduction under general anaesthetic): Other: Simple

06.52

06.52

06.52

32.000

26.000

224.90 (197.30)

182.70 (160.30)

32.000

26.000

224.90 (197.30)

182.70 (160.30)

3.000

3.000

3.000

132.30 (116.10)

132.30 (116.10)

132.30 (116.10)

0449 Fracture (reduction under general anaesthetic): Other: Compound 06.52 52.000 365.50 (320.60)

52.000 365.50 (320.60)

3.000 132.30 (116.10)

0451 Fracture (reduction under general anaesthetic): Sternum and/or ribs: Closed 06.52 - - - - 3.000 132.30 (116.10)

0452 Fracture (reduction under general anaesthetic): Sternum and/or ribs: Open reduction and fixation of multiple fractured ribs for flail chest

06.52 230.000 1616.40 (1417.90)

184.000 1293.20 (1134.40)

3.000 132.30 (116.10)

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Specialists

Anaesthesiology


0455 Fracture (reduction under general anaesthetic): Spine: With or without paralysis: Cervical 06.52 - - - - 3.000 132.30 (116.10)

0456 Fracture (reduction under general anaesthetic): Spine: With or without paralysis: Rest 06.52 - - - - 3.000 132.30 (116.10)

0461 Fracture (reduction under general anaesthetic): Compression fracture: Cervical 06.52 - - - - 3.000

3.000

132.30 (116.10)

0462 Fracture (reduction under general anaesthetic): Compression fracture: Rest 06.52 - - - -

3.000

3.000 132.30 (116.10)

0463 Fracture (reduction under general anaesthetic): Spinous or transverse processes: Cervical 06.52 - - - - 3.000 132.30 (116.10)

0464 Fracture (reduction under general anaesthetic): Spinous or transverse processes: Rest 06.52 - - - 3.000 132.30 (116.10)

3,1,1.1 Bottes; Ffactutes (redijctlon uildergetiiiraf anaesthetic - refer t^

0465 Fractures Involving large joints Oncludes the Item for the relative bone) (this item may not be used as a modifier) 06.52 288.000 2024.10 (1775.50)

230.400 1619.30 (\420.A0)

302.20 (265.10)

3.000

3.000

3.000

132.30 (116.10)

0473

0475

Percutaneous insertion plus subsequent removal of Kirschner wires or Steinmann pins (no after-care) (modifier 0005 not applicable)

06.52 43.000 302.20 (265.10)

43.000

1619.30 (\420.A0)

302.20 (265.10)

3.000

3.000

3.000

132.30 (116.10)

0473

0475 Bonegrafting or internal fixation for malunion or non-union: Femur, Tibia, Humerus, Radius and Ulna 06-52 282.000 1981.90 (1738.50)

1082.30 (949.40)

225.600 1585.50 (1390.80)

3.000

3.000

3.000 132.301 (116.10)

0479 Bonegrafting or internal fixation for malunion or non-union: Other bones 06.52 154.000

1981.90 (1738.50)

1082.30 (949.40)

123.200 865.80 (759.50)

3.000 132.30 (116.10)

3.1.2 Bony Operations 3.1,2i1 epriyoi>ei-atrbrts:'Bone grafting •''':-^^::.'•' 0497 Resection of bone or tumour with or without grafting (benign) 06.52 282.000 1981.90

(1738.50) 225.600 1585.50 3.000

(1390.80;^ 132.30

(116.10) 0498 Resection of bone or tumour with or without grafting (malignant) - does not include digits 06.52 340.000 2389.50

(2096.10) 272.000

153.600

1911.60 1 _(1676.80)

3.000 132.30 (116.10)

0499 Grafts to cysts: Large bones 06.52 192.000 1349.40 (1183.70)

272.000

153.600 1079.50 (946.90)

3.000 132.30 (116.10)

0501 Grafts to cysts: Small bones 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0503 Grafts to cysts: Cartilage graft 06.52 206.000 1447.80 (1270.00)

164.800 1158.20 (1016.00)

3.000 132.30 (116.10)

0505 Grafts to cysts: Inter-metacarpal bona graft 06.52 147.000 1033.10 (906.20)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0507 Removal of autogenous bone for grafting (not subject to general modifier 0005) 06.52 50.000 351.40 (308.20)

. 50.000 351.40 (308.20)

3.000 132.30 (116.10)

MM- Bdrty.:operMI6riife: Ac(We-or :eiit iTife ib^ 0509 Acute or chronic osteomyelitis: Conservative treatment 06.52 . . - . 0511 Acute or chronic osteomyelitis: Operation: Tariff which would be applicable for compound fracture of the bone involved,

including six weeks post-operative care 06.52

0512 Acute or chronic osteomyelitis: Sternum sequestrectomy and drainage: Including six weeks after-care 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0)

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Code :...Description. . Ver Add : Specialists General Practitioners / non-designated

Specialists

Anaesthesiology


3.1.2.3 Bony operations: Osteotomy 0514 Osteotomy: Sternum: Repair of pectus excavatum 06.52 330.000 2319.20

(2034.40) 264,000 1855,40

(1627.50) 3,000 132.30

(116.10)

0515 Osteotomy: Sternum: Repair of pectus carinatum 06.52 330.000 2319.20 (2034.40)

264.000 1855.40 (1627,50)

3.000 132.30 (116,101

0516 Osteotomy: Pelvic 06.52 320.000 2249.00 (1972.80)

256,000 1799.20 (1578,20)

3,000 132,30 (116,10)

0521 Osteotomy: Femoral: Proximal 06.52 320.000 2249.00 (1972.80)

256,000 1799,20 (1578,20)

3.000 132.30 (116.10)

0527 Osteotomy: Knee region 06.52 320.000 2249.00 (1972.80)

256,000 1799,20 (1578,20)

3.000 132,30 (116,10)

0528

0530

Osteotomy: Os Calcis (Dwyer operation) 06.52 115.000 808.20 (708.90)

115,000 808,20 (708,90)

3,000 132,30 [116J0^

0528

0530 Osteotomy: Metacarpal and phalanx: Corrective for malunion or rotation 06,52 120.000 843.40 (739.80)

120,000 843,40 (739,80)

3,000 132,30 (116,10)

0531 Rotational osteotomy of tibia and fibula - stand alone procedure 06.52 278.900 1960.10 (1719.40)

223,120 1568,10 (1375,50)

3,000 132,30 (116,10)

0532 Osteotomy: Rotation osteotomy of the Radius, Ulna or Humerus 06.52 160.000 1124.50 (986.40)

421.70 (369.90)

128,000 899.60 (78a 10)

421,70 (369,90)

3.000 132,30 (116,10)

0533 Osteotomy: Single metatarsal 06.52 60.000

1124.50 (986.40)

421.70 (369.90)

60,000

899.60 (78a 10)

421,70 (369,90)

3,000 132,30 (116,10)

0534 Osteotomy: Multiple metatarsal osteotomies 06.52 150.000 1054.20 (924.70)

120.000 843,40 (739.80)

3,000 132,30 (116,10)

3.1.i.4 BDnyoperations^ E}^st6sis.. 0535 Exostosis: Excision: Readily accessible sites 06.52 60.000 421.70

(369.90) 60,000 421,70

(369,90) 3,000 132,30

(116,10) 0537 Exostosis: Excision: Less accessible sites 06.52 96.000 674.70

(591.80) 96,000 674,70

(591,80) 3,000 132.30

(116,10) 3.1.2:6 Bony otjeratibhst: Biopsy. 0539 Needie Biopsy: Spine (no after-care) (modifier 0005 not applicable) 06.52 50.000 351.40

(308.20) 50,000 351.40

(308,20) 4,000 176,40

(154.70) 0541 Needle Biopsy: Other sites (no after-care) (modifier 0005 not applicable) 06.52 32.000 224.90

(197.30) 32,000 224,90

(197,30) 4,000 176,40

(154,70) 0543 Biopsy: Open (modifier 0005 not applicable): Readily accessible site 06.52 64.000 449.80

(394.60) 64,000 449,80

(394,60)

176,40 (154,70)

0545 Biopsy: Ooen (modifier 0005 not applicable): Less accessible site 06.52 96.000 674.70 (591.80)

96,000 674,70 (591,80)

3.2 JoiSi"'•;;•'•::::;•: "Si-ir'-^.^"^^^^^^ :;>'. T^ •''W:-:;.' I.V : •" .: . ;• •'V

3>2.i Joints::Oislocations-.:::::...V.. •':!•:; •••::;:;::,:;..,/ ,,;..;:;, 0547 Joint: Dislocation: Clavicle either end 06.52 38.000 267.10

(234.30) 38,000 267,10

(234,30) 3,000 132,30

(116.10) 0549 Joint: Dislocation: Shoulder 06.52 51.000 358.40

(314.40) 51,000 358,40

(314,40) 3,000 132,30

(116.10)

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Code Description Ver Add Specialists General Praotitioners / non-designated

Specialists

Anaesthesiology

RVU Pee RVU Fee RVU Fee

0551 Joint: Disloc^ion: Elbow 06.52 51.000 358.40 (314.40)

51.000 358.40 (314.40)

3.000 132.30 (116.10)

0552 Joint: Dislocation: Wrist 06.52 77.000 541.20 (474.70)

77.000 541.20 (474.70)

3.000 132.30 (116.10)

0553 Joint: Dislocation: Perilunar trans-scaphoid fracture dislocation 06.52 130.000 913.60 (801.40)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0555 Joint: Dislocation: Lunate 06.52 77.000 541.20 (474.70)

77.000 541.20 (474.70)

3.000 132.30 (116.10)

0556 Joint: Dislocation: Carpo-metacarpo dislocation 06.52 51.000 358.40 (314.40)

51.000 358.40 (314.40)

3.000 132.30 (116.10)

0557 Joint Dislocation: Metacarpo-phabngeal or interphalangeal (hand) 06.52 26.000 182.70 (160.30)

26.000 182.70 (160.30)

3.000 132.30 (116.10)

0559 Joint: Dislocation: Hip 06.52 109.000 766.10 (672.00)

109.000 766.10 (672.00)

3.000 132.30 (116.10)

0561 Joint: Dislocation: Knee 06.52 96.000 674.70 (591.80)

96.000 674.70 (591.80)

3.000 132.30 (116.10)

0563 Joint: Dislocation: Patella 06.52 32.000 224.90 (197.30)

32.000 224.90 (197.30)

3.000 132.30 (116.10)

0S6S Joint Dislocation: Anide 06.52 90.000 632.50 (554.80)

90.000 632.50 (554.80)

3.000 132.30 (116.10)

0567 Joint: Dislocation: Sub-Talar dislocation 06.52 90.000 632.50 (554.80)

90.000 632.50 (554.80)

3.000 132.30 (116.10)

0569 Joint: Dislocsttlon: inteitarsal or Tarsometatarsal or Mid4arsai 06.52 77.000 541.20 (474.70)

77.000 541.20 (474.70)

3.000 132.30 (116.10)

0571 Joint: Dislocation: Metatarsophalangeal or interphalangeal joints (foot) 06.52 14.000 98.40 (86.30) 14.000 98.40 (86.30) 3.000 132.30 (116.10)

0573 Joint: Dislocation: Spine with or without paralysis 06.52 - . -S.2.4 Joints;. OpittBtfona fpf <Jjslocsjiti; S :;SM^ 0578 Operations for dislocations: Recurrent dislocation of shoufder 06.52 200.000 1405.60

(1233.00) 160.000 1124.50

(986.40) 3.000 132.30

(116.10) 0579 Operations for dislocations: Recurrent dislocation of all other joints 06.52 161.000 1131.50

(992.50) 128.800 905.20

^94.00) 3.000 132.30

(116.10)

wmm 3iMiSsK^iiiiisJffiJlii!;«iji^ 0582 Capsulotoniy or arthrotonny or biopsy or drainage of joint: Sniall Joint Cmcluding three weeks after-care) 06.52 51.000 358.40

(314.40) 51.000 358.40

(314.40) 3.000 132.30

(116.10) 0583 Capsulotomy or arthrotomy or biopsy or drainage of joint: Large joint Ondudlng three weeks after-care) 06.52 96.000 674.70

(591.80) , 96.000 674.70

(591.80) 3.000 132.30

(116.10) 0585 Capsulectoniy digital joint 06.52 64.000 449.80

(394.60) 64.000 449.80

(394.60) 3.000 132.30

(116.10) 0586 Multiple percutaneous capsulotomies of metacarpophalangeal joints 06.52 90.000 632.50

(554.80) 90.000 632.50

(554.80) 3.000 132.30

(116.10) 0587 Release of digital joint contracture 06.52 128.000 899.60

(789.10) 120.000 843.40

(739.80) 3.000 132.30

(116.10)

s z p u .a. lO (O

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Code Oescription Ver Add Specialists General Practitioners / non-designated

Specialists

Anaesfhesioiogy


3.2.4 Joints: Synovectomy 05S9 Synovectomy: Digital Joint 06.52 77.000 541.20

(474.70) 77.000 541.20

(474.70) 3.000 132.30

(116.10) 0592 Synovectomy: Large joint 06.52 160.000 1124.50

(986.40) 128.000 899.60

(789.10) 3.000 132.30

(116.10) 0593 Tendon synovectomy 06.52 203.700 1431.60

(1255.80) 162.960 1145.30

(1004.60) 3.000 132.30

(116.10)

îMM;-•aiiiiiiitiSJ/iilflji deil*;^;: ''-^ 0597 Arthrodesis: Shoulder 06.52 224.000 1574.30

(1381.00) 179.200 1259.40

(1104.70) 3.000 132.30

(116.10) 0598 Arthrodesis: Elbow 06.52 180.000 1265.00

(1109.60) 144.000 1012.00

(88770) 3.000 132.30

(116.10) 0599 Arthrodesis: Wrist 06.52 180.000 1265.00

(1109.60) 144.000 1012.00

(887.70) 3.000 132.30

(116.10) 0600 Arthrodesis: Digital joint 06.52 128.000 899.60

(789.10) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0601 Arthrodesis: Hip 06.52 320.000 2249.00

(1972.80) 256.000 1799.20

(1578.20) 3.000 132.30

(116.10) 0602 Arthrodesis: Knee 06.52 180.000 1265.00

(1109.60) 144.000 1012.00

(887.70) 3.000 132.30

(116.10) 0603 Arthrodesis: Ankle 06.52 180.000 1265.00

(1109.60) 144.000 1012.00

(887.70) 3.000 132.30

(116.10) 0604 Arthrodesis: Sut^talar 06.52 130.000 913.60

(801.40) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0605 Arthrodesis: Stabilisation of foot Qriple-arthrodesis) 06.52 180.000 1265.00

(1109.60) 144.000 1012.00

(887.70) 3.000 132.30

(116.1(? 0607 Arthrodesis: Midârsal wedge resection 06.52 180.000 1265.00

(1109.60) 144.000 1012.00

(88770) 3.000 132.30

(116.10)

M^m îîiKiMieiiiîs^t^MiSMf^^ 0614 Arthroplasty: Debridement large joints 06.52 160.000 1124.50

(986.40) 128.000 899.60

(789.10) 3.000 132.30

(116.10) 0615 Arthroplasty: Excision medial or lateral end of clavicle 06.52 116.000 815.20

(715.10) 116.000 815.20

(715.10) 3.000 132.30

(116.10) 0617 Shoulder: Acromioplasty 06.52 192.000 1349.40

(1183.70) 153.600 1079.50

(946.90) 3.000 132.30

(116.10) 0619 Shoulder: Partial replacement 06.52 277.000 1946.80

(170770) 221.600 1557.40

(1366.10) 5.000 220.60

(193.50) 0620 Shoulder: Total replacement 06.52 416.000 2923.60

(2564.60) 332.800 2338.90

(2051.70) 5.000 220.60

(193.50) 0621 Elbow: Excision head of radius 06.52 96.000 674.70

(591.80) 96.000 674.70

(591.80) 3.000 132.30

(116.10) 0622 Elbow: Excision 06.52 192.000 1349.40

(1183.70) 153.600 1079,50

(946.90) 3.000 132.30

(116.10)

w

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Specialists

Anaesthesiology


0623 Elbow: Partial replacement 06.52 188.000 1321.30 (1159.00)

150.400 1057.00 (927.20)

3.000 132.30 (116.10)

0624 Elbow: Total replacement 06.52 282.000 1981.90 (1738.50)

225.600 1585.50 (1390.80)

3.000 132.30 (116.10)

0625 Wrist: Excision distal end of ulna 06.52 96.000 674.70 (591.80)

96.000 674.70 (591.80)

3.000 132.30 (116.10)

0626 Wrist: Excision single bone 06.52 110.000 773.10 (678.20)

110.000 773.10 (678.20)

3.000 132.30 (116.10)

0627 Wrist; Excision proximal row 06.52 166.000 1166.60 (1023.30)

132.800 933.30 (818.70)

3.000 132.30 (116.10)

0631 Wrist: Total replacement 06.52 249.000 1750.00 (1535.10)

199.200 1400.00 (1228.10)

3.000 132.30 (116.10)

0635 Digital Joint: Total replacement 06.52 192.000 1349.40 (1183.70)

153.600 1079.50 (946.90)

3.000 132.30 (116.10)

0637 Hip: Total replacement 06.52 416.000 2923.60 (2564.60)

332.800 2338.90 (2051.70)

3.000 132.30 (116.10)

0641 Hip: Prosthetic replacement of femoral head 06.52 288.000 2024.10 (1775.50)

230.400 1619.30 (1420.40)

3.000 132.30 (116.10)

0643 Hip: GIrdlestone 06.52 320.000 2249.00 (1972.80)

256.000 1799.20 (1578.20)

3.000 132.30 (116.10)

0645 Knee: Partial replacement 06.52 277.000 1946.80 (1707.70)

221.600 1557.40 (1366.10)

3.000 132.30 (116.10)

0646 Knee: Total replacement 06.52 416.000 2923.60 (2564.60)

332.800 2338.90 (2051.70)

3.000 132.30 (116.10)

0649 Ankle: Total replacement 06.52 290.400 2040.90 (1790.30)

232.320 1632.70 (1432.20)

3.000 132.30 (116.10)

0650 Ankle: Astragalectomy 06.52 154.000 1082.30 (949.40)

123.200 865.80 (759.50)

3.000 132.30 (116.10)

3.2.7 Joints: Miscellarteous (joints) 0661 Aspiration of joint or intra-articular injection (not including after-care) (modifier 0005 not applicable) 06.52 9.000 63.30 (55.50) 9.000 63.30 (55.50) 3.000 132.30

(116.10) 0663 Multiple intra-articular injections for rheumatoid arthritis (excluding after-care) (modifier 0005 not applicable): First joint 06.52 7.500 52.70 (46.20) 7.500 52.70 (46.20) 3.000 132.30

(116.10) 0665 Multiple intra-articular injections for rheumatoid arthritis (excluding after-care) (modifier 0005 not applicable): Additional

(each) 06.52 4.000 28.10(24.60) 4.000 28.10(24.60) 3.000 132.30

(116.10) 0667 Arthroscopy (excluding after-care) (modifiers 0005 and 0013 not applicable) 06.52 60.000 421.70

(369.90) 60.000 421.70

(369.90) 3.000 132.30

(116.10) 0669 Manipulation large joint under general anaesthetic (not including after-care) (modifier 0005 not applicable) 06.52 14.000 98.40 (86.30) 14.000 98.40 (86.30) 3.000 132.30

(116.10) 0669a

0670

0670a

Manipulation large joint under general anaesthetic (not including after-care) (modifier 0005 not applicable)

Only the consultation fee shoukl be charged when manipulation of a large joint is performed with or without local anaesthetic The consultation fee only should be charged when manipulation of a large joint is performed with or without local anaesthetic

06.52

06.52

06.52

14.000 98.40(86.30) 14.000 98.40 (86.30) 4.000

3.000

4.000

176.40 (154.70)

132.30 (116.10)

176.40 (154.70)

U1

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lO o o


Code Oescription

... . .. . . y

Ver Add Specialists General PractUipners / non-designated

Specialists

Anaesthesiolo^y

RVU Fee RVU Fee, RVU Fee

0673 Meniscectomy or operation for other internal derangement of knee 06.52 109.000 766.10 (672.00)

109.000 766.10 (672.00)

3.000 132.30 (116.10)

3.2.8 Joints: J0iHtrtaamerit,«icbristirucirt<»a;orsutufe.. •:;-•-•-;• ^

0675 Joint ligament reconstruction or suture: Ankle: Collateral 06.52 160.000 1124.50 (986.40)

128.000 899.60 (789.10)

3.000 132.30 (116.10)

0677 Joint ligament reconstruction or suture: Knee: Collateral ' 06.52 160.000 1124.50 (986.40)

128.000 899.60 (789.10)

3.000 132.30 (116.10)

0678 Joint ligament reconstruction or suture: Knee: Cruciate 06.52 160.000 1124.50 (986.40)

128.000 899.60 (789.10)

3.000 132.30 (116.10)

0679 Joint ligament reconstruction or suture: Ligament augmentation procedure of knee 06.52 280.000 1967.80 (1726.10)

224.000 1574.30 (1381.001

3.000 132.30 (116.10)

0680 Joint ligament reconstruction or suture: Digital joint ligament 06.52 165.000 1159.60 (1017.20)

132.000 927.70 (81380)

3.000 132.30 (116.10)

3:3—.: i mputations'•:•:••••x .^.i;:..\.-;:-: •::•;*•:.':;?: v^ 3.3.1 ::> Aitlpiit^i<3n^^S|j«cif)C'Arrl0utattons:^:.:::' '^ 0682 Amputation: Fore-quarter amputation 06.52 294.000 2066.20

(1812.50) 235.200 1653.00

(1450.00) 9.000 397.00

(348.20) 0683 Amputation: Through shoulder 06.52 148.000 1040.10

(912.40) 120.000 843.40

(739.80) 5.000 220.60

(193.50) 0685 Amputation: Upper arm or fore-arm 06.52 116.000 815.20

(715.10) 116.000 815.20

(715.10) 3.000 132.30

(116.10) 0687 Partial amputation of the hand: One ray 06.52 102.000 716.90

(628.90) 102.000 716.90

(628.90) 3.000 132.30

(116.10) 0691 Amputation: Whole or part of finger 06.52 116.800 820.90

(720.10) 116.800 820.90

(720.10) 3.000 132.30

(116.10) 0693 Hindquarter amputation 06.52 420.000 2951.80

(2589.30) 336.000 2361.40

(2071.40) 6.000 264.70

(232.20) 0695 Amputation: Through hip joint region 06.52 192.000 1349.40

(1183.70) 153.600 1079.50

(946.90) 6.000 264.70

(232.20) 0697 Amputation: Through thigh 06.52 205.000 1440.70

(1263.80) 164.000 1152.60

(1011.10) 6.000 264.70

(232.20) 0699 Amputation: Below knee, through knee or Syme 06.52 194.000 1363.40

(1196.00) 155.200 1090.70

(95680) 5.000 220.60

(193.50) 0701 Amputation: Trans-metatarsal or trans-tarsal 06.52 142.000 998.00

(875.40) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0703 Amputation: Foot: One ray 06.52 97.000 681.70

(598.00) 97.000 681.70

(598.00) 3.000 132.30

(116.10) 0705 Amputation: Toe 06.52 66.000 463.80

(406.80) 66.000 463.80

(406.80) 3.000 132.30

(116.10) 3.3.2 Amputations; Post-arttputatlon recbnstrticfion 0706 Post-amputation reconstruction: Skin flap taken from a site remote from the injured finger or in cases of an advanced flap

e.g. Cutler 06.52 75.000 527.10

(462.40) 75.000 527.10

(462.40) 1158.20

(1016.00)

3.000 132.30 (116.10)

0707 Post-amputation reconstruction: Krukenberg reconstruction 06.52 206.000 1447.80 (1270.00)

164.800

527.10 (462.40) 1158.20

(1016.00) 3.000 132.30

(116.10)

V)

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Specialists

Anaesthesiology


0709 Post-amputation reconstruction: Metacarpal transfer 06.52 192.000 1349.40 (1183.70)

153.600 1079.50 (946.90)

3.000 132.30 (116.10)

0711 Post-amputation reconstruction: PolHcisation of the finger (to include ai stages) 06.52 262.000 1981.90 (1738.50)

225.600 1585.50 (1390.80)

3.000 132.30 (116.10)

0712 Post-amputation reconstruction: Toe to thumb transfer 06.52 800.000 5622.40 (4931.90)

640.000 4497.90 (3945.50)

3.000 132.30 (116.10)

MmMi MuiSesi^Sferaibcis^ih^^ ':

amiB ttiiiiSil!KSi;i(i!iii(iohi«"ar^ 0713 Electromyography 06.52 75.000 527.10

(462.40) 75.000 527.10

(462.40) 3.000 132.30

(116.10) 0714 Electro-myographic neuromuscular junctional study, including edrophonium response (not to be used with item 2730) 06.52 57.000 400.60

(351.40) 57.000 400.60

(351.40) 3.000 132.30

(116.10) 0715 Strength duration curve per session 06.52 10.500 73.80 (64.70) 10.500 73.80 (64.70) 3.000 132.30

(116.10) 0717 Electrical examination of single nerve or muscle 06.52 9.000 63.30 (55.50) 9.000 63.30 (55.50) 3.000 132.30

(116.10) 0718 Oxidative study for mitochondrial function 06.52 64.000 449.80

(394.60) 64.000 449.80

(394.60) 0721 Voltage integration during isometric contraction 06.52 12.000 84.30 (73.90) 12.000 84.30 (73.90) 3.000 132.30

(116.10) 0723 Tonometry with edrophonium 06.52 8.000 56.20 (49.30) 8.000 56.20 (49.30) 3.000 132.30

(116.10) 0725 isometric tension studies with edrophonium 06.52 10.000 70.30 (61.70) 10.000 70.30(61.70) 3.000 132.30

(116.10) 0727 Cranial reflex study (both early and late responses) supra occutofac'ial or comeofacial or fiabellofacial: Unilateral 06.52 8.000 56.20 (49.30) 8.000 56.20 (49.30) 3.000 132.30

(116.10) 0728 Cranial reflex study (both early and late responses) supra occulofacial or comeofacial or flabeliofacial: Biateral 06.52 14.000 98.40 (86.30) 14.000 98.40 (86.30) 3.000 132.30

(116.10) 0729 Tendon reflex time 06.52 7.000 49.20 (43.20) 7.000 49.20 (43.20) 3.000 132.30

(116.10) 0730 Limb tvain somatosensory studies (per limb) 06.52 49.000 344.40

(30Z10) 49.000 344.40

(302.10) 0731 Vision and audio-sensory studies 06.52 49.000 344.40

(302.10) 49.000 344.40

(302.10) 0733 Motor nerve conduction studies (single nerve) 06.52 26.000 182.70

(160.30) 26.000 182.70

(160.30) 0735 Examinations of sensory nerve conduction by sweep averages (single nerve) 06.52 31.000 217.90

(191.10) 31.000 217.90

(191.10) 3.000 132.30

(116.10) 0737 Biopsy for motor nerve terminals and end plates 06.52 20.000 140.60

(123.30) 20.000 140.60

(123.30) 3.000 132.30

(116.10) 0739 Combined muscle biopsy with end plates and nerve terminal biopsy 06.52 34.000 239.00

(209.60) 34.000 239.00

(209.60) 8.000 352.90

(309.60) 0740 Muscle fatigue studies 06.52 20.000 140.60

(123.30) 20.000 140.60

(123.30) 3.000 132.30

(116.10)

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Code Description Ver Add Specialists General Pracfiti oners / non-designated

Specialists

Anaesthesioiogy

- RVU Fee RVU Fee RVU Fee

0741 Muscle biopsy 06.52 20.000 140.60 (123.30)

20.000 140.60 (123.30)

8.000 352.90 (309.60)

0742 Global fee for all muscle studies, including histochemical studies 06.52 262.000 1841.30 (1615.20)

4701 Biochemical estimations on muscle biopsy specimens: Creatine Icinase 06.52 20.250 142.30 (124.80)

4703 Biochemical estimations on muscle t)iopsy specimens: Adenylate kinase 06.52 33.300 234.00 (205.30)

4705 Biochemical estirrattens on muscle biopsy specimens: Pyruvate Idnase 06.52 5.700 40.10 (35.20)

4707 4709

Biochemical estimations on muscle biopsy specimens: Lactate dehydrogenase Biochemical estimations on muscle biopsy specimens: Adenylate deaminase

06.52 06.52

1.600 11.20(9.82) 9.900 69.60(61.10)

4711 Biochemical estimations on muscle t)iopsv specimens: Phosphoglycerate Idnase 06.52 13.700 96.30 (84,50) 4713 Biochemical estimations on muscle biopsy specimens: Phosphoglycerate mutase 06.52 25.900 182.00

(159.60) 4715 Biochemical estimations on muscle biopsy specimens: Enolase 06.52 32.700 229.80

(201.60) 4717 Biochemical estimations on muscle biopsy specimens: Phosphofructoldnase 06.52 37.700 265.00

(232.50) 4719 Biochemical estimations on muscle biopsy specimens: Aldolase 06.52 15.750 110.70

(97.10) 4721 Biochemical estimations on muscle biopsy specimens: Glyceraldehyde 3 phosphate dehydrogenase 06.52 11.060 77.70(68.20) 4723 Biochemicai estimations on muscle t>lopsy specimens: Phosphorylase 06.52 34.700 243.90

(213.90) 4725 Blochemicai estimations on muscle biopsy specimens: Phosphogkicomutase 06.52 40.300 283.20

(248.40) 4727 Biodwmicai estimations on muscle biopsy specimens: Phosphohexose Isomerase 06.52 28.800 202.40

(177.50) 4729 Biochemical estimations on muscle k)iopsy specimens: Muscle biopsy for muscle tension study 06.52 43.000 302.20

(265.10) 4731 Biochemical estimations on musde biopsv specimens: H-response study (per nerve) 06.52 14.000 98.40 (86.30) 4733 Biochemical estimations on muscle biopsy specimens: l^e response study (per nerve) 06.52 20.000 140.60

(123.30) 4735 Biochemicai estimations on muscle biopsy specimens: Single fibre studies 06.52 71.000 499.00

(437.70) 4737 Biochemical estimations on muscle biopsy specimens: Somatosensory study Oimb-spine) 06.52 69.000 484.90

(425.40) 4739 Biochemical estimations on muscle biopsy specimens: Dystrophin estimation 06.52 82.000 576.30

(505.50) 4745 Biochemical estimations on muscle biopsy specimens: Electron microscopy 06.52 75.000 527.10

(462.40) 3.4.2 Ntis<»e*> t««id«n»m<f fthHHMi Deeompreiislort Operations 0743 Major compaitmentat decompression 06.52 132.000 927.70 120.000

(813.80) 843.40

(739.80) 3.000 132.30

(116.10)

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Specialists

Anaesthesiology


0744 Decompression operation: Fasciotomy only 06.52 60.000 421.70 (369.90)

60.000 421.70 (369.90)

3.000 132.30 (116.10)

3.4.3 Muscles, terfdons and fa$ciae; Muscle and tendon r^air 0745 Muscle and tendon repair: Biceps humeri 06.52 109.000 766.10

(672.00) 109.000 766.10

(672.00) 3.000 132.30

(116.10) 0746 Muscle and tendon repair: Removal of calcification in Rotator cuff 06.52 96.000 674.70

(591.80) 96.000 674.70

(591.80) 3.000 132.30

(116.10)

0747 Muscle and tendon repair: Rotator cuff 06.52 134.000 941.80 (826.10)

120.000 843.40 (739.80)

4.000 176.40 (154.70)

0748 Muscle and tendon repair: Debridement rotator cuff 06.52 139.700 981.80 (861.20)

120.000 843.40 (739.80)

4.000 176.40 (154.70)

0749 Muscle and tendon repair: Scapulopexy - stand alone procedure 06.52 271.900 1910.90 (1676.20)

217.520 1528.70 (1341.00)

4.000 176.40 (154.70)

132.30 (116.10)

0755 Muscle and tendon repair: Infrapatellar of quadriceps tendon 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

3.000

176.40 (154.70)

132.30 (116.10)

0757 Muscle and tendon repair: Achilles tendon repair 06.52 197.600 1388.70 (1218.20)

158.080 1111.00 (974.60)

4.000 176.40 (154.70)

0759 Muscle and tendon repair: Other single tendon 06.52 77.000 541.20 (474.70)

77.000 541.20 (474.70)

3.000 132.30 £116.10)

132.30 (116.10)

0763 Muscle and tendon repair: Tendon or ligament injection 06.52 9.000 63,30 (55.50) 9.000 63.30 (55.50) 3.000

132.30 £116.10)

132.30 (116.10)

0767 Hand: Rexor tendon suture: Primary (per tendon) 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0769 l and: Flexor tendon suture: Secondary (per tendon) 06.52 160.000 1124.50 (986.40)

128.000 899.60 (789.10)

3.000 132.30 (116.10)

0771 Extensor tendon suture: Primary (per tendon) 06.52 129.700 911.50 (799.60)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0773 Extensor tendon suture: Secondary (per tendon) 06.52 80.000 562.20 (493.20)

80.000 562.20 (493.20)

3.000 132.30 (116.10)

0774 Repair of Boutonniere deformity or Mallet finger with graft 06.52 183.700 1291.00 (1132.50)

146.960 1032.80 (906.00)

3.000 132.30 (116.10)

3v4 ;4 :•:••: MiiScJeSi/tehdbnsand-teSiiiaev-TT^^ 0775 Free tendon graft 06.52 160.000 1124.50

(986.40) 128.000 899.60

(789.10) 3.000 132.30

(116.10) 0776 Reconstmction of pulley for flexor tendon 06.52 50.000 351.40

(308.20) 50.000 351.40

(308.20) 3.000 132.30

(116.10) 0777 Tendon graft: Finger: Flexor 06.52 192.000 1349.40

(1183.70) 153.600 1079.50

(946.90) 3.000 132.30

(116.10) 0779 Tendon graft: Finger: Extensor 06.52 122.000 857.40

(752.10) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0780 Two stage flexor tendon graft using silastic rod 06.52 240.000 1686.70

(1479.60) 192.000 1349.40

(1183.70) 3.000 132.30

(116.10)

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Anaesthesiology


3.4.5 Muscles, tendons and fasciae: Tendolysis

0781 Tendon freeing operation, except where specified elsewhere 06.52 64.000 449.80 (394.60)

64.000 449.80 (394.60)

3.000 132.30 (116.10)

0782 Carpal tunnel syndrome 06.52 98.700 693.70 (608.50)

98.700 693.70 (608.50)

3.000 132.30 (116.10)

0783 Tenolysis; De Quervain 06.52 38.000 267.10 (23430)

38.000 267.10 (234.30)

3.000 132.30 (116.10)

0784 Trigger finger 06.52 38.000 267.10 (234.30)

38.000 267.10 (234.30)

3.000 132.30 (116.10)

0785 Flexor tendon freeing operation following free tendon graft or suture 06.52 186.800 1312.80 (1151.60)

149.440 1050.30 (921.30)

3.000 132.30 (116.10)

0787 Extensor tendon freeing operation following graft or suture in finger, hand or forearm, each tendon 06.52 180.900 1271.40 (1115.30)

144.720 1017.10 (892.20)

3.000 132.30 (116.10)

0788 Intrinsic tendon release per finger 06.52 64.000 449.80 (394.60)

64.000 449.80 (394.60)

3.000 132.30 (116.10)

0789 Central tendon tenotomy for Boutonniere deformKy 06.52 64.000 449.80 (394.60)

64.000 449.80 (394.60)

3.000 132.30 (116.10)

3.4.6 Muscles;:tendons andfeiscijje: Tenodesis" '''•--••-•::.'• 0790 Tenodesis: Digital joint 06.52 90.000 632.50

(554.80) 90.000 632.50

(554.80) 3.000 132.30

(116.10) 3.4.7 : Museiesi tendons and fiasciae:;Musbleteiid6n and facia traiisfer ; 0791 Single tendon transfer 06.52 96.000 674.70

(591.80) 96.000 674.70

(591.80) 3.000 132.30

(116.10) 0792 Multiple tendon transfer 06.52 128.000 899.60

(789.10) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0793 Hamstring to quadriceps transfer 06.52 141.000 990.90

(869.20) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0794 Pectoralis major or Latissimus dorsi transfer to biceps tendon 06.52 320.000 2249.00

(1972.80) 256.000 1799.20

(1578.20) 5.000 220.60

(193.50) 0795 Tendon transfer at elbow 06.52 116.000 815.20

(715.10) 116.000 815.20

(715.10) 3.000 132.30

(116.10) 0802 Radial club hand repair - stand alone procedure 06.52 360.300 2532.20

(2221.20) 288.240 2025.80

(1777.00) 3.000 132.30

(116.10) 132.30

(116.10) 0803 Hand tendons: Single tendon transfer (first) 06.52 96.000 674.70

(591.80) 96.000 674.70

(591.80) 3.000

132.30 (116.10)

132.30 (116.10)

0809 Hand tendons: Sut>st'itution for intrinsic paralysis of hand 06.52 224.000 1574.30 (1381.00)

179.200 1259.40 (110470)

3.000 132.30 (116.10)

0811 Hand tendons: Opponens tendon transfer (including obtaining of graft) 06.52 220.600 1550.40 (1360.00)

176.480 1240.30 (1088 00)

3.000 132.30 (116.10)

3.4.8 Musdes;, tendons and fasciae: Muscle slide operations and tendon lengthening 0812 Percutaneous Tenotomy: All sites 06.52 38.000 267.10

(234.30) 38.000 267.10

(23430) 3.000 132.30

(116.10) 0813 Torticollis 06.52 96.000 674.70

(591.80) 96.000 674.70

(591.80) 5.000 220.60

(193.50)

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Specialists.

Anaesthesiology

RVO Pee RVU Fee RVU Fee

0815 Scalenotomy 06.52 132.000 927.70 (813.80)

120.000 843.40 (739.80)

5.000 220.60 (193.50)

0817 Scalenotomy with excision of first rib 06.52 190.000 1335.30 (1171.30)

152.000 1068.30 (937.10)

3.000 132.30 (116.10)

0821 Tennis elbow 06.52 96.000 674.70 (591.80)

96.000 674.70 (591.80)

3.000 132.30 (116.10)

0822 Open release elbow (Mitals) - stand alone procedure 06.52 278.200 1955.20 (1715.10)

222.560 1564.20 (1372.10)

3.000 132.30 (116.10)

0823 Excision or slide for Volknnann's Contracture 06.52 192.000 1349.40 (1183.70)

153.600 1079.50 (946.90)

3.000 132.30 (116.10)

0825 Hip: Open muscle release 06.52 116.000 815.20 (715.10)

116.000 815.20 (715.10)

7.000 308.80 (270.90)

0829 Knee: Quadriceps plasty 06.52 160.000 1124.50 (986.40)

128.000 899.60 (789.10)

3.000 132.30 (116.10)

0831 Knee: Open tenotomy 06.52 141.000 990.90 (869.20)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0835 Calf 06.52 96.000 674.70 (591.80)

96.000 674.70 (591.80)

4.000 176.40 (154.70)

0837 Open elongation tendon Achilles 06.52 96.000 674.70 1591.80)

96.000 674.70 (591.80)

4.000 176.40 (154.70)

0838 Percutaneous *Hoke* elongation tendo Achiles 06.52 79.300 557.30 (488.90)

79.300 557.30 (488.90)

4.000 176.40 (154.70)

0845 Foot: Plantar fasciotomy 06.52 70.000 492.00 (431.60)

70.000 492.00 (431.60)

3.000 132.30 (116.1(5

0846 Foot: Postero-medial release for ctut>-foot 06.52 192.000 1349.40 (1183.70)

153.600 1079.50 (946.90)

3.000 132.30 (116.10)

9.6 Burtaeandaanglia 0847 Excision: Semimembranosus 06.52 90.000 632.50

(554.80) 90.000 632.50

(554.80) 4.000 176.40

(154.70) 0849 Excision: Prepatellar 06.52 45.000 316.30

(277.50) 45.000 316.30

(277.50) 3.000 132.30

(116.10) 0851 Excision: Olecranon 06.52 81.800 574.90

(504.30) 81.800 574.90

(504.30) 3.000 132.30

(116.10) 0853 Excision: Small bursa or ganglion 06.52 80.900 568.60

(498.80) 80.900 568.60

(498.80) 3.000 132.30

(116.10) 0855 Excision: Compound palmar ganglion or synovectomy 06.52 128.000 899.60

(789.10) 128.000 899.60

(789.10) 3.000 132.30

(116.10) 0857 Bursae and ganglia: Aspiration or injection (no after-care) (modifier 0005 not applicable) 06.52 9.000 63.30 (55.50) 9.000 63.30 (55.50) 3.000 132.30

(116.10)

iiSiii;. iStiipiiifeiitoiaiUSi^

wmm iMfiSSiifoSWiilSiiWSirt^ 0859 Leg equalisation and congenital hips and feet: Leg shortening 06.52 282.000 1981.90 225.600

(1738.50) 1585.50

(1390.80) 1 3.000 132.30

(116.10)

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Code Oesoription Ver Add Specialists General Practitioners / norvdesignated

Specialists

Anaesthesidogy

RVU Fee RVU Pee RVU Fee

0861 Leg equalisation and congenitai hips and feet: Leg lengthening 06.52 416.000 2923.60 (2564.60)

332.800 2338.90 (2051.70)

3.000 132.30 (116.10)

0863 Leg equalisation and congental hips and feet: Epiphysiodesis at one level 06.52 116.000 815.20 (715.10)

116.000 815.20 (715.10)

3.000 132.30 (116.10)

0865 Congenial dislocation of hip: Initial non-operative reduction and application of plaster cast: One hip 06.52 109.000 766.10 (672.00)

109.000 766.10 (672.00)

3.000 132.30 (116.10)

0867 Congenital dislocation of hip: Initial non-operative reduction and application of plaster cast: Both hips 06.52 160.000 1124.50 (986.40)

128.000 899.60 (789.101

3.000 132.30 (116.10)

0868 Open reduction of congenital dislocation of the hip 06.52 186.000 1307.20 (1146.70)

148.800 1045.80 (917.40)

3.000 132.30 (116.10)

0869 Subsequent plasters 06.52 32.000 224.90 (197.30)

32.000 224.90 (197.30)

0873 Congenital club foot: Manipulation and plaster: One foot 06.52 26.000 182.70 (160.30)

26.000 182.70 (160.30)

3.000 132.30 (116.10)

0874 Ponseti technique assistant (medical practitioner) 06.52 13.000 91.40(80.20) 13.000 91.40(80.20)

3.6.2 MdiSUi&iil^iSbrtiiVlfeiSnfe^ 0883 Removal of internal fixatives or prosthesis: Readily accessible 06.52 36.600 257.20

(225.60) 36.600 257.20

(225.60)

0884 Removal of intemal fixatives: Less accessible 06.52 75.500 530.60 (465.40)

75.500 530.60 (465.40)

0885 Removal of prosthesis for infection soon after operation 06.52 128.000 899.60 (789.10)

120.000 843.40 (739.80)

0886 Late removal of infected or not irrfected total joint replacemecrt prosthesis Qncluding six weeks after-care): ADD to the item for total joint replacement of the specific ioint

06.52 + 64.000 449.80 (394.60)

64.000 449.80 (394.60)

6.000 264.70 (232.20)

Mmm WiiiSSiiii?i(«iSiasM 0887 Limb cast (excluding after-care) (mo<Sfier 0005 not applicatile) 06.52 13.000 91.40(80.20) 13.000 91.40(8020) 3.000 132.30

(116.10) 0889 Spica, plaster jacket or hinged cast brace (excluding after-care) 06.52 32.000 224.90

(197.30) 32.000 224.90

(197.30) 4.000 176.40

(154.70) 0891 TurnbucMe cast for scolosis (excluding after-care) 06.52 51.000 358.40

(314.40) 51.000 358.40

(314.40) 5.000 220.60

(193.50) 0893 Adjustment or repair of tumbuckle cast for scoliosis (exckiding after-care) 06.52 19.000 133.50

(117.10) 19.000 133.50

(117.10) 5.000 220.60

(193.50)

SiSiPsfi iW^»^cS|]^<^jwifjs smM Mii»iiif:iffiiig;iiiiiSiSii^ 0895 Club foot: Revision dub foot release - stand alone procedure 06.52 302.700 2127.40

(1866.10) 242.160 1701.90

(1492.90) 3.000 132.30

(116.10) 0896 Club foot: Posterior release only - stand alone procedure 06.52 159.300 1119.60

(982.10) 127.440 895.60

(78560) 3.000 132.30

(116.10) 0900 Excision tarsal coalition - stand alone procedure 06.52 141.500 994.50

(872.40) 120.000 843.40

(739.80) 3.000 132.30

(116.10) 0901 Tenotomy: Single tendon 06.52 63.300 444.90

(390.30) 63.300 444.90

(390.30) 3.000 132.30

(116.10)

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Anaesthesiology


0903 Hammertoe: One toe 06.52 99.500 699.30 (613.40)

99.500 699.30 (613.40)

3.000 132.30 (116.10)

0905 Filleting of toe or Ruiz-IUIora procedure 06.52 99.500 699.30 (613.40)

99.500 699.30 (613.40)

3.000 132.30 (116.10)

0906 Arthrodesis Hallux 06.52 148.000 1040.10 (912.40)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0907 Silver bunionectomy or similar for Hallux Valgus 06.52 126.200 886.90 (778.00)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0909 Excision arthroplasty 06.52 145.200 1020.50 (895.20)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

0910 Cheilectomy or metatarsophangeal implant Hallux 06.52 183.000 1286.10 (1128.20)

146.400 1028.90 (902.50)

3.000 132.30 (116.10)

0911 Metatarsal osteotomy or Lapidus or similar or Chevron - stand alone procedure 06.52 189.200 1329.70 (1166.40)

151.360 1063.80 (933.20)

3.000 132.30 (116.10)

5730 Hallux Valgus double osteotomy etc. 06.52 182.600 1283.30 (1125.70)

146.080 1026.70 (900.60)

3.000 132.30 (116J01

132.30 (116.10)

5731 Distal soft tissue procedure for Hallux Valgus 06.52 173.600 1220.10 (1070.30)

138.880 976.00 (856.10)

3.000

132.30 (116J01

132.30 (116.10)

5732 Aitkin procedure or similar 06.52 166.800 1172.30 (1028.30)

133.440 937.80 (822.60)

3.000 132.30 (116.10)

5734 Removal bony prominence foot e.g. bunionette (6 Bunionette not applicable to COID) 06.52 91.000 639.50 (561.00)

91.000 639.50 (561.00)

3.000 132.30 (116.10)

5735 Repair angular deformity toe (lesser toes) 06.52 97.200 683.10 (599.20)

97.200 683.10 (599.20)

3.000 132.30 (116.10)

5736 Sesamoidectomy 06.52 97.800 687.30 (602.90)

97.800 687.30 (602.90)

3.000 132.30 (116.10)

5737 Repair major foot tendons e.g. Tib Post 06.52 147.300 1035.20 (908.10)

120.000 843.40 (739.80)

3.000 132.30 (116.10)

5738 Repair of dislocating peroneal tendons 06.52 173.200 1217.20 (1067.70)

138.560 973.80 (854.20)

3.000 132.30 (116.10)

5739 Forefoot reconstruction for rheumatoid arthritis: Clayton or similar: One foot 06.52 202.300 1421.80 (1247.20)

161.840 1137.40 (997.70)

3.000 132.30 (116.10)

5740

5741

5742

Steindler strip - plantar fascia

Kelildan syndactilly (one web space)

Tendon transfer foot

06.52

06.52

06.52

97.200

97.200

172.000

683.10 (599.20)

683.10 (599.20) 1208.80

(1060.401

97.200

97.200

137.600

683.10 (599.20)

683.10 (599.20)

967.10 (848.30)

3.000

3.000

3.000

132.30 (116.10)

132.30 (116.10)

132.30 (116.10)

5743 Capsulotomy metatarsophalangeal Joints: Foot 06.52 86.800 610,00 (535.10)

86.800 610.00 (535.10)

3.000 132.30 ni6.10)

3.8,2 Big te>6 (refer to section 3,8.1 for procedures or» big (oe)

3.8.3 Special areas; Reimplantations 0912 Replantation of amputated upper limb proximal to wrist joint 06.52 730.000 5130.40

(4500.40) 584.000 4104.40

(3600.40) 3.000 132.30

(116.10)

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Code Oescriptjon Ver Add Specialists General Practitioners / non-designated

Specialists

Anaesthesiology


0913 Replantation of thumb 06.52 670.000 4708.80 (4130.50)

536.000 3767.00 (3304.40)

3.000 132.30 (116.10)

0914 Replantation of a single digit (to be motivated), for multiple digits (modifier 0005 applicable) 06.52 580.000 4076.20 (3575.60)

464.000 3261.00 (2860.50)

3.000 132.30 (116.10)

0915 Replantation operation through the palm 06.52 1270.00 0

8925.60 (7829.50)

1016.00 0

7140.40 (6263.50)

3.000 132.30 (116.10)

3,8.4 i^peciilariiisrHands; (Notie:;Skm: SiBe liiteSi^^ 0922 Removal of foreign bodies requiring incision: Under local anaesthetic

1

06.52 19.000 133.50 (117.10)

19.000 133.50 (117.10)

3.000 132.30 (116.10)

0923 Removal of foreign bodies requiring incision: Under general or regional anaesthetic 06.52 32.000 224.90 (197.30)

32.000 224.90 (197.30)

3.000 132.30 (116.10)

0924 Crushed hand Injuries: Initial extensive soft tissue toilet under general anaesthetic (sliding scale) - Minimum 06.52 37.000 260.00 (228.10)

37.000 260.00 (228.10)

3.000 132.30 (116.10)

Item 0924: The number of units chargeable under this item ranges from 37.00 to 110.00 for Specialists and General Practitioners.

06.52

0925 Crushed hand injuries: Subsequent dressing changes under general anaesthetic 06.52 16.000 112.40 (98.60)

16.000 112.40 (98.60)

3.000 132.30 (116.10)

3.8.6 Speic)ai:ari^iis: Spine'-. iiv;:;;-.;.;•:•-•.•,-- :••;., .;-;: . • Please note the following with regard to section 3.8.5: Spine

a) Modifier OOOS (multiple procedures/operations under the same anaesthetic) is not applicable If the following procedures are performed together:

1. Bone graft procedures and Instrumentation are to be charged in addition to arthrodesis.

2. When vertebral procedures are performed by arthrodesis, bone grafts and instrumentation may be charged for In addition.

b) Modifier 0005 (multiple procedures/operations under the same anaesthetic) vrauld be applicable wrhen arthrodesis is performed in addition to another procedure, e.g. Osteotomy, laminectomy.

06.52

0927 Excision of one vertebral body, for a lesion within the body (no decompression) 06.52 207.000 1454.80 (1276.10)

165.600 1163.80 (1020.90)

3.000 132.30 (116.10)

0928 Excision of each additional vertebral segment for a lesion within the body (no decompression) 06.52 + 42.000 295.20 (258.90)

42.000 295.20 (258.90)

3.000 132.30 (116.10)

0929 Manipulation of spine under general anaesthetic: (no after-care) (modifier 0005 not applicable) 06.52 14.000 98.40(86.30) 14.000 98.40 (86.30) 5.000 220.60 (193.50)

0930 Posterior osteotomy of spine: One vertebral segment 06.52 339.000 2382.50 (2089.90)

271.200 1906.00 (1671.90)

3.000 132.30 (116.10)

0931 Posterior spinal fusion: One level 06.52 385.000 2705.80 (2373.50)

308.000 2164.60 (1898.80)

3.000 132.30 (116.10)

0932 Posterior osteotomy of spine: Each additional vertebral segment 06.52 + 103.000 723.90 (635.00)

103.000 723.90 (635.00)

3.000 132.30 (116.10)

0933 Anterior spinal osteotomy with disc removal: One vertebral segment 06.52 315.000 2213.80 (1941.90)

252.000 1771.10 (1553.60)

3.000 132.30 (116.10)

0936 Anterior spinal osteotomy with disc removal: Each additional vertebral segment 06.52 + 103.000 723.90 (635.00)

103.000 723.90 (635.00)

3.000 132.30 (116.10)

0938 Anterior fusion base of skull to C2 06.52 449.000 3155.60 (2768.10)

359.200 2524.50 (2214.50)

4.000 176.40 (154.70)

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CONTINUES ON PAGE 161 —PART 2

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