Minutes of the meeting held on Thursday, 27th July 2006 (10h30 11h45)
Consumer Goods Council of SA (CGCSA)
Block B Hurlingham Office Park, Woodlands Avenue, Hurlingham Manor
|
Name |
Company |
Telephone Number |
e-mail Address |
|
Marlene van Vuren |
Community Health |
012 548 4622 |
|
|
Colleen Jones |
Netcare |
011 301 0262 |
|
|
George Sole |
Lancet |
082 652 5501 |
|
|
Erna van Rooyen |
Netcare |
082 942 1966 |
|
|
Brenda Saunders |
HSA |
084 424 6364 |
|
|
Magda van Wyk |
BHF |
011 537 0223 |
|
|
Edith Hittler |
Solutio-Medscheme |
011 671 2488 |
|
|
Cecilia Woker |
StanSA |
012 428 6718 |
|
|
Eddie Marais |
Interpharm |
012 673 1400 |
|
|
James Lawrence |
Providence |
041 395 4510 |
|
|
Madelyne Victor |
Providence |
041 395 4436 |
|
|
Heather Pereira |
MHS |
011 548 8060 |
|
|
Glenda de Beer |
SAMA |
012 481 2048 |
|
|
Kendrah da Silva |
CASA |
011 8051417 |
|
|
Christel Botes |
SASP |
012 335 8267 |
|
|
Nic Strauss |
Med-e-Mass |
011 265 5500 |
|
|
Matthew Dijkstra |
Medikredit |
011 770 6411 |
|
|
Estelle Robbertze |
Solutio Medscheme |
011 510 2653 |
|
|
Wynand Erasmus |
Medscheme |
011 671 2394 |
|
|
Gerrit Henning |
Health Sys Technol |
083 285 7172 |
|
|
Motlalentoa Motsoane |
Netcare |
011 301 0118 |
|
|
Brenda Gous |
Medihelp |
012 334 2047 |
|
|
Dalena Coetzee |
Medcodelink |
083 390 7213 |
|
|
Ansa Frylinck |
Smart Code |
082 498 3478 |
|
|
Lelanie Agenbag |
Medi-Clinic |
021 943 6059 |
|
|
Sunelle Lubbe |
Medi-Clinic |
021 809 6777 |
|
|
Faith Barter |
Life Healthcare |
011 219 9636 |
|
|
Heather Curran |
HST |
021 683 1506 |
|
|
Elna Jooste |
OTASA |
083 731 5258 |
|
|
Manono Mdoda |
Sovereign Health |
082 561 4259 |
|
|
Sheryl Mulder |
Discovery Health |
082 411 2886 |
|
|
Elaine Sauls |
MTC |
082 606 7757 |
|
|
Lynet Clarke |
MTC |
082 570 1021 |
|
|
Ronelle Smit |
KOH |
082 853 1408 |
|
|
Izelle van Deventer |
Discovery Health |
011 529 2076 |
|
|
Luisa Whitelaw |
Discovery |
011 529 2152 |
|
|
Sithara Satiyadev |
Africode |
082 461 7690 |
1. Welcome
Sithara Satiyadev opened the meeting and welcomed all attendees. Each member then introduced him/her self.
2. Apologies
Helen Matuszek
Dr Jenni Noble MediKredit
Vanessa Stuckenberg Discovery Health
David Jacobs Discovery Health
Crystal Wahid Discovery Health
Mark Beckenling Med-e-Mass
3. Minutes of the previous meeting held
Minutes were accepted as a true reflection of the meeting held in April 2006
4. Diagnostic Coding
ICD-10 Implementation Feedback
Operational (Luisa Whitelaw)
Luisa Whitelaw gave feedback on behalf of the Operational Sub-committee.
Main Actions
Circulars:
· Circular on the default codes is being finalized for distribution.
· Circular on the differences between Version 1 and Version 2 of ICD-10 is being finalized for distribution.
Draft Documents:
· General information to the Public on the use of ICD-10 such as an overview
· Document on the correction of the QRC circular. Information to include that QRC documents are not to be used by hospitals.
· Document on Medicine mixtures
· Final documentation on the accomplishments of the National Task Team (NTT) (Inclusive of all the subcommittees) is almost ready for circulation. Tuesday is the last date for feedback before the document is finalized.
Sithara
The ICD-10 Task Team responsibilities and activities are to be handed over to the National Department of Health (NDoH). The mandate of NTT (National Task Team) was to stay in place until June 2006. After discussions between the Council for Medical Schemes (CMS) and the NDoH, it was decided that the NTT will be managed by Council for Medical Schemes until December 2006 and the process be reviewed thereafter.
Any comments are to be directed to Patrick Matshidze.
Technical Task Team (Glenda de Beer)
The document on Coding Standards for South Africa is being finalized and will be circulated on completion.
The Technical Task Team (TTT) still has a lot of work to do in terms of chapter specific coding rules and guidelines and standardization for national guidance.
Sithara
In the event that the NTT no longer exist, ICD-10 coding work that still needs to be done can be continued under the auspice of PHISC under the Coding Technical Sub-committee of the Diagnostic and Procedural subcommittee.
Glenda
There is discussion around procedural coding for SA and the securing of a procedural coding schema for SA.
Training Subcommittee (Sithara Satiyadev)
The SA Recommended Training Standards for Basic Introduction to ICD-10 and Intermediate ICD-10 has been finalized.
Comments need to be made for the Advanced ICD-10 recommended standards before finalization.
South African Qualification Authorities (SAQA) Elaine Sauls
Elaine mentioned that SAQA is in the process of assigning a consultant to assist with the process of the allocation of unit standards for ICD-10 with work around positioning coding as a qualification in SA. SAQA is also investigating funding from INSETA for the process.
In order to speed up the process of this work, Elaine has requested that trainers and interested parties review the coding courses offered and start to work on the different modules in terms of learning design e.g. Overall Outcomes of the course, Specific Outcomes etc and use of the Blooms Taxonomy as a benchmark for pitching the level of the course. All information is to be forwarded to Elaine for collation and circulation before finalization.
Every stakeholder needs to be involved.
International Federation of Health Records Organization (IFHRO)
Elaine Sauls
IFHRO is in the process of evaluating content on ICD-10 and training material.
Elaine sent through course content for the Basic Introduction to ICD-10 and will circulate feedback received to the Industry to ensure Industry compliance to International standards and requirements.
Tertiary Institutions Sithara Satiyadev
Tertiary Institutions are keen to explore ICD-10.
Patrick has been tasked with exploring and engaging the tertiary institutions with regards to the above
UK ICD-10 Training Sithara Satiyadev
Recommendations received by Sue Eve Jones will be discussed at the Technical Task Team meeting. This includes Chapter by Chapter guidelines.
The definition of the Primary Diagnosis has been amended in terms of the wording and will be circulated to the Industry.
Luisa Whitelaw
Luisa mentioned that there seems to be a misunderstanding as to how many Primary diagnosis (PDX) and Primary procedures (PPX) you can have within an encounter.
It was clarified by the meeting that there can only be one PDX and one PPX per encounter.
This information will be added as a footnote to the definition of a Primary diagnosis.
5. Procedural Coding
Definition of Primary Procedure
The definition of a primary procedure needs to be reviewed. There is a PHISC definition. It may need to be amended. The definition will be circulated and possibly other definitions of a primary procedure from various countries. These need to be commented on, before finalization and standardization for use within the SA environment. Action: Sithara
Procedure Coding Glenda de Beer
The CCSA 2006 update and implementation was a smooth process.
Recommendations to PHISC that there be a delay in the CCSA update for 2007 and that the CCSA update should take place every 2nd year.
CCSA 2008 will be implemented in 2008 and all information for 2006 and 2007 will be brought into the 2008 product.
Brenda Gous confirmed that this was fine from a billing perspective.
Luisa Whitelaw confirmed that the ICD-10 Master Industry Table will be updated for implementation on March 1, 2007 and a change over to a new version of CCSA cannot happen at the same time.
6. DRG Feedback
Feedback on the meeting on Procedural Coding / DRG Luisa Whitelaw
Luisa gave feedback on the meeting held on procedural coding, on behalf of Warrick Sive.
Representatives:
National Department of Health (NDOH), Council for Medical Schemes (CMS), National Health Reference Price List (NHRPL) committee, Discovery Health, Life Health Care.
The discussion was around a suitable procedure coding schema for SA and software that could accommodate the codes diagnostic and procedural) in terms of a DRG as a National standard.
At this meeting, Luisa presented the grid work done for PHISC in May 2005 on various DRG software groupers comparing components such as:
· Who owns the groupers
· Licensing issues
· Operating platforms
· Coding schemas
A medium and long term plan for procedure coding was considered within the discussions.
Options:
1. Explore the NHRPL structure to see whether it can be adopted for data and billing purposes and whether it can be adopted for Public and Private sector.
2. Explore the use of CPT
3. Explore the Australian Classification System (ACHI Australian Classification of Health Intervention).
The aim was to look for a one stop coding schema for:
Hospitals, providers, data and billing purposes; public and private sectors.
ICHI (International Classification of Health Interventions) the WHO version of procedures is seconded to Australia, is based on ICHI and is currently in beta testing.
Currently there is a triple process running in the industry on procedural coding, namely:
1. PHISC process
2. SABS process
3. NHRPL process
The work can continue in these silos, and will be brought together under the banner of NDoH under a National Standards Body for SA.
With regards to a DRG standard for SA discussions ranged around options to plug into an international grouper or to consider the viability of building one for SA pending the above procedural schema deliberations.
Sithara wanted to know whether a National Standards Body was discussed. Luisa mentioned that there was a brief discussion that a Standards body would need to be put together for both diagnostic and procedural purposes.
Sithara asked whether a single procedure coding system was being looked at for both hospital use and other provider use. Luisa mentioned that if one procedural schema is found to be suitable to plug in all holes, then that possibly would be the best solution. With that, specific guidelines would have to be put in place for the different users of that schema.
Luisa mentioned that UPFS was not discussed at the meeting.
Glenda mentioned that time is a concern as Dr Khotu gave a 3 month period to legislate a procedure coding schema and requested that Cecilia Woker please raise this concern with Dr Khotu.
Luisa mentioned that the plan discussed at the above-mentioned meeting was in consideration of implementing a procedure coding system within a 2-5 year plan.
Cecilia to liaise with Dr Khotu with regards to concerns raised and the set up of the open forum meeting.
Standards for South Africa (STANSA) Cecilia Woker
Cecilia gave feedback on the request that came from Gauteng DOH for a standard procedure coding system.
This was followed by a meeting held at STANSA discussing procedural coding.
There was discussion on having a broader forum to make an industry decision.
Dr Khotu is to facilitate the meeting and confirm a venue and date.
7. Standard Claim Form
Standard Claim Form
This item has been moved to the Software Technical Subcommittee as this committee is a committee on its own and no longer falls under the Diagnostic and Procedural sub-committee. Item to be discussed at the main PHISC meeting.
8. General
Proposal for PCNS database redraft Magda
This agenda item will move to the Software Technical Subcommittee as of the next PHISC meeting
BHF is on a fact-finding mission and is visiting medical aid schemes for their requirements. They will also be getting input from switching companies and other parties before a final decision is made.
Glenda requested that the advisory forum be contacted with regards to these changes or plans.
Izelle proposed:
· Provider number for life
· Disciplines character
Magda confirmed that no changes on the 13 digit numbers for practitioners would be made.
The provider number will be for the employer.
(This discussion was moved to the Standard Claims Form Meeting Main PHISC)
Proposal for a new fee structure Glenda de Beer
Awaiting feedback for decisions to be made by the relevant bodies. At this stage it would appear as if nothing will change next year. There possibly may be a percentage increase change. Lots of discussions still need to take place.
Many of the disciplines of the medical groups indicated that they wanted to move to the CPT structure, which is:
· More specific
· Have worked out Relative Value Units (RVUs)
The impact on the anesthetic CPT-based structure has to be determined.
A circular was sent out by the CMS indicating that there will be a delay in the implementation of the new vascular coding structure that has 6 digits as radiology systems are not ready to deal with this..
Disposal Codes Sithara Satiyadev
Sithara explained the background and the use of disposal codes.
The last review of the disposal codes was done approximately 4 years ago. The codes need to be reviewed to see what is applicable.
Izelle will circulate the lists for feedback.
Elaine suggested that we look at the disposal code lists together with the separation lists that are used by the public sector that indicate e.g. discharge, transfer or death of patient, in order to collate the lists and make them applicable for both public and private sector.
Heather will send Elaine a contact person/number in the public sector to have access to the separation lists.
The use of the disposal codes have not been implemented across the healthcare sector.
Elaine asked whether the use of R99 to indicate that a patient had died was mandatory. The use of R99 is not mandatory.
9. Closure
Meeting closed and adjourned