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

Pre-authorisation for Chiropractor services may only be granted if the primary medical practitioners written referral letter clearly indicates the reason for the referral, relationship to the original injury. The referral may be on the Chiropractors or medical practitioners letterhead, provided it is signed by the referring doctor.

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 and/or consultation.

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 5 treatments in respect to one patient for the same condition, the Chiropractor should refer the patient/employee back to the treating medical practitioner concerned to report to the Compensation Fund if further treatment is necessary. Payment for treatment in excess of the stipulated number may be granted by the Compensation Fund after receipt of motivation letter from the treating medical practitioner concerned.

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 - including the taking of a full case history or pertinent history, but excluding remedies, immobilisation and manipulation procedures

Consultation includes history taking, guidance, education, health promotion and/or consultation.

Code may be charged only once per visit per claim.

(Refer to Rule 003)

355.16

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. Use form WCL5 to submit your motivation.

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)

230.23

04312

Two diagnostic procedures (Attach Motivation)

349.81

04313

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

460.46

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

696.05

04322

Two instances of immobilization or therapeutic exercises (Attach Motivation)

874.52

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

489.02

04332

Two treatment procedures

592.53

04333

Three treatment procedures

696.05

04334

Four treatment procedures

799.56

04335

Five treatment procedures

903.08

04336

Six treatment procedures

1004.81

Radiology

04049

Ankle - AP/LAT

284.30

04050

Ankle - Complete Study - 3 views

425.63

04051

Cervical - AP/LAT

284.04

04052

Cervical - AP/LAT/OBL

425.63

04053

Cervical study - 6 views

851.30

04054

Cervical - Davis Series -7 views

992.59

04055

Elbow -AP/LAT

278.73

04056

Elbow - 3 views

425.63

04057

Foot - AP/LAT

284.04

04058

Foot - 3 views

425.63

04059

Femur - AP/LAT

567.50

04060

Hand - AP/LAT

284.04

04061

Hand - 3 views

425.63

04062

Hip unilateral - 1 view

198.70

04063

Hip - 2 views

397.10

04064

Knee - AP/LAT

284.04

04065

Knee - 3 views

425.63

04066

Lumbo-Sacral - 3 views

680.86

04067

Lumbar spine & pelvis - 5 views

1020.88

04068

Pelvis AP

284.04

04069

Pelvis - 3 views

624.29

04070

Ribs -Unilateral - 2 views

340.29

04071

Ribs -Bilateral - 3 views

510.43

04072

Radius/Ulna

284.04

04073

Spine -Full spine study - AP/LAT

1020.88

04074

Spine - 8 X 10- Single study

168.05

04075

Spine - 10 X 12- Single study

170.43

04076

Spine - 14 X 17- Single study

284.04

04077

Shoulder - 1 view

170.43

04078

Shoulder - 2 views

340.29

04079

Thoraco - Lumbar - AP/LAT

567.50

04080

Thoracic - AP

567.50

04081

Tibia/Fibula - AP/LAT

567.50

04082

Wrist - AP/LAT

284.04

04083

Wrist - 3 views

425.63

04084

Stress views - Lumbar

355.89

04100

Consumables

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