General Rules

Rule

Rule Description

001

Unless timely steps are taken (at least two hours) to cancel an appointment for a consultation the relevant consultation fee shall be payable by the employee.

002

Chiropractors are allowed a total of 10 sessions, however a written referral letter from a treatment doctor is require, must clearly indicate the reason for the referral and relation to the original injury.

Submission of a report is required after every consultation, treatment and/or therapy services rendered with the applicable codes

Chiropractor services only applicable for outpatient

Only one visit per day and a maximum of 5 visits per claim is allowed.

003

The consultation code may be charged only once per day and once per claim. Consultation includes history taking, guidance, education, health promotion.

Subsequent visits are considered as follow-up to the initial visits

004

A maximum of three diagnostic procedures may be charged at the same consultation or visit. Diagnostic procedures include physical examination, neurological examination, orthopaedic examination, ergonomical analysis and postural analysis.

005

A maximum of three types of treatment procedures (modalities and/or methods) may be charged at the same consultation or visit for any single diagnosis.

Treatment procedures include, inter alia: spinal or extra-spinal manipulation, acupuncture, cold applications, non-heating modalities, deep heating radiation, soft tissue manipulation, superficial heating therapy and therapeutic exercises (other than in relation to preparation or fitting of appliances).

006

After a series of 10 treatments,  a written motivation from the treating doctor is required by the Compensation Fund if further treatment is needed.

Payment for treatment in excess of the stipulated number may be granted by the Compensation Fund after the request.

007

X-ray films: Chiropractor practitioners to use x-ray results from referring medical practitioner

Tariff Codes

Code

Code Description

RAND

1.

CONSULTATIONS

04301

Initial consultation:

Includes taking of a full case history, pertinent history, guidance, education, health promotion but excluding remedies, immobilisation and manipulation procedures.

Tariff code may be charged only once per visit per claim.

(Refer to Rule 003)

399.06

2.

DIAGNOSTIC PROCEDURES

Only a single item from this section may be charged per patient encounter. Diagnostic procedures included in the scope of practice are; physical examination, neurological examination

Initial consultation - charge 04313 (may only be used once per episode of injury )

Follow up consultation - use 04311 or 04312 only

When using 04312 at a subsequent consultation, a motivation detailing why two diagnostic are required at a follow up treatment.

Only one of items 311, 312 or 313 can be used per visit

(Refer to rule 004)

04311

Single diagnostic procedure (May be used with up to three treatment/therapeutic codes) (Refer to Rule 004)

258.69

04312

Two diagnostic procedures (Attach Motivation)

393.04

04313

Three diagnostic procedures (May only be used on an initial Consultation )

517.38

3.

IMMOBILISATION OR THERAPEUTIC EXERCISE IN RELATION  TO PREPARATION  OR FITTING OF APPLIANCES

Only a single item from this section may be charged per patient encounter.

Only one of items 321 or 322 can be used per visit

04321

Single instance of immobilization or therapeutic exercises

782.08

04322

Two instances of immobilization or therapeutic exercises (Attach Motivation)

982.61

4.

TREATMENT (THERAPEUTIC PROCEDURES)

Only a single item from this section may be charged per patient encounter

Only one of items 331, 332, 333, 334, 335 or 336 can be used per visit

04331

Single treatment procedure

549.46

04332

Two treatment procedures

665.77

04333

Three treatment procedures

782.08

04334

Four treatment procedures

898.39

04335

Five treatment procedures

1014.70

04336

Six treatment procedures

1129.00

5.                                Radiology

04049

Ankle - AP/LAT

319.43

04050

Ankle - Complete Study - 3 views

478.24

04051

Cervical - AP/LAT

319.14

04052

Cervical - AP/LAT/OBL

478.24

04053

Cervical study - 6 views

956.52

04054

Cervical - Davis Series -7 views

1115.27

04055

Elbow -AP/LAT

313.18

04056

Elbow - 3 views

478.24

04057

Foot - AP/LAT

319.14

04058

Foot - 3 views

478.24

04059

Femur - AP/LAT

637.64

04060

Hand - AP/LAT

319.14

04061

Hand - 3 views

478.24

04062

Hip unilateral - 1 view

223.26

04063

Hip - 2 views

446.19

04064

Knee - AP/LAT

319.14

04065

Knee - 3 views

478.24

04066

Lumbo-Sacral - 3 views

765.02

04067

Lumbar spine & pelvis - 5 views

1147.06

04068

Pelvis AP

319.14

04069

Pelvis - 3 views

701.45

04070

Ribs -Unilateral - 2 views

382.35

04071

Ribs -Bilateral - 3 views

573.52

04072

Radius/Ulna

319.14

04073

Spine -Full spine study - AP/LAT

1147.06

04074

Spine - 8 X 10- Single study

188.82

04075

Spine - 10 X 12- Single study

191.50

04076

Spine - 14 X 17- Single study

319.14

04077

Shoulder - 1 view

191.50

04078

Shoulder - 2 views

382.35

04079

Thoraco - Lumbar - AP/LAT

637.64

04080

Thoracic - AP

637.64

04081

Tibia/Fibula - AP/LAT

637.64

04082

Wrist - AP/LAT

319.14

04083

Wrist - 3 views

478.24

04084

Stress views - Lumbar

399.87

04100

Consumables

Radiation Control Council Certificate number to be on account if X-Rays charged