DIAGNOSTIC PROCEDURES

Note: Items 015, 029, 031, 033, 037, 065, 071, 073, 075, 077, 079, 081, 083,

085, 087, 089, 091, 093, 095, 097, 099, 101, 115, 117, 119, 121, 129, 131, 133,

135, 137, 139, 141, 149, 167, 171 and 173 should be only be paid on condition that the radiographer submits the name of the supervising clinician and his/her BHF practice number. FUND should not pay the radiographer if she/he is supervised by a radiologist.

Rule

Rule Description

001

AM:The specified call-out fee may be charged for any bona-fide, justifiable emergency

occurring at any hour which requires the practitioner to travel to the patient.

The Compensation Fund requires a motivation to accompany the claim.

An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment/therapy and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.

002

Radiographer invoices will only be paid on condition that there is a referral letter from a treating practitioner.

Modifier

Modifier Description Standards

Rand

0001

Emergency fee

75.80

0084

Film Cost: The cost of film is included in the comprehensive procedure codes and is not billed separately

Addition

Modifier (AM)

This modifier will add a value by using a percentage value or a unit value to a

procedure code. The modifier should be quoted on a separate line with its own value instead of adding its value to the code.

Compound

Modifiers (CM)

The modifier should be quoted on a separate line with its own value at the end of the invoice instead of adding its value to the code. It should be indicated on each procedure code where the modifier is applicable.

Reduction

Modifiers (RM)

This modifier reduces the value of a procedure code/s by using a percentage or unit value. It should be quoted on the procedure codes where the modifier is applicable.

Information

Modifier (IM)

This modifier provides additional information to a procedure code and carries no financial value.It should be indicated on each procedure codes where the modifier is applicable.

0001

AM:The specified call-out fee may be charged for any bona-fide, justifiable emergency occurring at any hour which requires the practitioner to travel to the patient.

The Compensation Fund requires a motivation to accompany the claim.

An emergency medical condition means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical treatment/therapy and/or an operation. If the treatment is not available, the emergency could result in weakened bodily functions, serious and lasting damage to organs, limbs or other body parts, or even death.

0021

IM: Services rendered to hospital patients: Quote modifier 0021 on all accounts for services performed on hospital or day clinic patients.

0080

IM: Multiple examinations: Full fees

0081

IM: Repeat examinations: No reduction

0084

IM: Film Cost: The cost of film is included in the comprehensive procedure

codes and is not billed separately