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.

003

Patients Hospitalised following an emergency injury on duty will not require pre-authorisation for rehabilitation services. However, the Physiotherapist must submit monthly progress reports, a Referral letter from the Medical Doctor and an initial treatment plan with the invoice to the Compensation Fund.

All the cases are subject to case management.

004

AM and PM treatment sessions, applicable only to hospitalised patients, should be specified and medically motivated for on the Annexure F (Motivation for twice a day Physiotherapy)

005

Out - patients will be allowed up to 20 sessions without pre-authorization. This includes Return to work rehabilitation.

If further treatment is necessary after a series of 20 treatment sessions for the same condition, the Physiotherapist must submit a motivation with treatment plan to the Compensation Fund for authorisation with a recent referral from the treating doctor. The Physiotherapist must submit monthly progress report to the CF.

Modifier 0015 must be quoted.

006

"After hour treatment" shall mean all physiotherapy performed where emergency treatment and /or essential continuation of care is required after working hours, before 08:00 and after 17:00 on weekdays, and any treatment over a weekend or public holiday. In cases where the Physiotherapist's scheduled working hours extend after 17:00 and before 08:00 during the week or weekend, the above rule shall not apply, and the treatment fee shall be that of the normal listed tariff.

The fee for all treatment under this rule shall be the total fee for the treatment plus 50 percent. Modifier 0006 must then be quoted after the appropriate tariff code to indicate that this rule is applicable.

Where emergency treatment is provided:

007

The Physiotherapist shall submit his / her account for treatment directly to the Fund using available electronic means.

008

When an employee is referred for physiotherapy treatment after a surgical procedure, a new treatment plan needs to be provided to the Fund.

009

When more than one condition requires treatment and each of these conditions necessitates an individual treatment, they shall be charged as individual treatments.

Full details of the nature of the treatments and the diagnosis or diagnostic codes shall be stated.

Modifier 0009 must be quoted.

010

When the treatment times of two completely separate and different conditions overlap, the fee shall be the full fee for one condition and 50% of the fee for the second condition. Both conditions must be specified.

Modifier 0010 must then be quoted after the appropriate code number to indicate that this rule is applicable.

011

Cost of external material used in therapy. It is recommended that, when such items are used during a procedure or issued to a patient on discharge will only be reimbursed if the appropriate code is supplied on the account (72939).

012

An invoice for services rendered will be assessed and added without VAT. VAT is then calculated and added to the final payment amount.

013

When a physiotherapist performs treatment away from the treatment rooms, travelling costs being more than 5 kilometres, to be charged at R4,84 per km for each kilometre travelled in own car e.g. 19 km total = 19X R4,84 = R91.96.

If more than one employee is attended to during the course of a trip, the full travelling expenses must be pro rata between the relevant employees (the physiotherapist will claim for one trip).

A Physiotherapist is not entitled to charge any travelling expenses or travelling time to his I

her rooms.

Modifier 0013 must be quoted.

014

Physiotherapy services rendered in a hospital, Modifier 0014 must be quoted after each tariff code.

015

The services of a Physiotherapist shall be approved only on referral from the treating medical practitioner. Where a Physiotherapist's letterhead is used as a referral letter, it must bear the medical practitioner's signature, date, and stamp.

The referral letter for any physiotherapy treatment provided should be submitted to the Compensation Commissioner with the account for such services.