MEDICAL DOCTORS’ CODING MANUAL (MDCM) BOOK – 2021
The SAMA Medical Doctors’ Coding Manual (MDCM) book, previously known as the Doctors’ Billing Manual (DBM) is back by popular demand. The book, which has been in use as a reference guide for allocating procedure codes and generating claims data, is updated and maintained by the Medical Coding Division of the South African Medical Association in cooperation with the different medical doctor disciplines/groups.
It should be noted that every effort should be made to code as accurately as possible even if third party funders do not grant benefits for all services rendered. In these cases patients should be held responsible for payment for services. Please remember that third parties may elect not to directly remuneration the medical practitioner for the services rendered and make the payment for the service (even at the benefit amount) directly to the patient (their member).
- Only medical doctors may use the codes, descriptions and units for consultations, procedures, services, etc. published in the SAMA Medical Doctors’ Coding Manual (MDCM).
- Any other healthcare professional must use the coding structure and information from their own Association/Society.
- The current procedural coding system is arranged according to an anatomical structure and not per discipline. It is unfortunately not possible to allocate codes per discipline because that would mean duplication of codes.
- It is important to identify medical schemes where codes are limited to a specific discipline. The message should be very clear that codes in the MDCM are not limited to a specific discipline, unless explicitly specified, for instance radiology, pathology and psychiatry.
- Please be advised that not all medical schemes are granting benefits for the new or revised codes included in the MDCM since 2007 – some schemes are only recognising the coding structure as was published in 2006. When procedures are planned using those codes that were introduced or amended after 2006, the patient and the relevant medical scheme should be informed and an agreement reached for benefits to be paid for the services rendered.
2021 MEDICAL DOCTORS’ CODING MANUAL (MDCM) INCLUDES:
- All code related interpretations come with the code for easier and quicker reference.
- All changes and updates dating back to 2009.
The Interpretations and/or Comments, included in this publication, do not cover all possible scenarios and are only included to assist where there could be uncertainty regarding the use of some codes and will from time to time be amended. These are reflected at the item and are indicated in italics.
- The Scale of Fees for Compensation for Occupational Injuries and Diseases Act (COID) published by the Department of Labour in a Government Gazette – VAT inclusive amounts
- The Road Accident Fund tariffs (RAF) for emergency care where the RAF is liable for compensation in terms of the Road Accident Fund Act (Act nr 56 of 1996) as amended - published by the Department of Transport – VAT inclusive amounts
The inclusion of the COID and RAF lists in the Medical Doctors’ Coding Manual should not be seen as an endorsement of, or agreement with these lists. Care has been taken to provide you with accurate information regarding 3rd parties. Please note that SAMA does not accept responsibility for any amounts published in this MDCM or the eMDCM that might differ from the actual amounts paid by the different institutions.
Please direct any coding queries to our Coding Department on 012 481 2073 or email email@example.com and we will gladly assist you.
SAMA's Medical Coding Division
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