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)

376.47

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)

244.04

04312

Two diagnostic procedures (Attach Motivation)

370.88

04313

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

488.09

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

737.81

04322

Two instances of immobilization or therapeutic exercises (Attach Motivation)

926.99

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

518.36

04332

Two treatment procedures

628.08

04333

Three treatment procedures

737.81

04334

Four treatment procedures

847.54

04335

Five treatment procedures

957.26

04336

Six treatment procedures

1065.10

5.                                Radiology

04049

Ankle - AP/LAT

301.35

04050

Ankle - Complete Study - 3 views

451.17

04051

Cervical - AP/LAT

301.08

04052

Cervical - AP/LAT/OBL

451.17

04053

Cervical study - 6 views

902.37

04054

Cervical - Davis Series -7 views

1052.15

04055

Elbow -AP/LAT

295.46

04056

Elbow - 3 views

451.17

04057

Foot - AP/LAT

301.08

04058

Foot - 3 views

451.17

04059

Femur - AP/LAT

601.55

04060

Hand - AP/LAT

301.08

04061

Hand - 3 views

451.17

04062

Hip unilateral - 1 view

210.62

04063

Hip - 2 views

420.93

04064

Knee - AP/LAT

301.08

04065

Knee - 3 views

451.17

04066

Lumbo-Sacral - 3 views

721.71

04067

Lumbar spine & pelvis - 5 views

1082.13

04068

Pelvis AP

301.08

04069

Pelvis - 3 views

661.75

04070

Ribs -Unilateral - 2 views

360.71

04071

Ribs -Bilateral - 3 views

541.05

04072

Radius/Ulna

301.08

04073

Spine -Full spine study - AP/LAT

1082.13

04074

Spine - 8 X 10- Single study

178.13

04075

Spine - 10 X 12- Single study

180.66

04076

Spine - 14 X 17- Single study

301.08

04077

Shoulder - 1 view

180.66

04078

Shoulder - 2 views

360.71

04079

Thoraco - Lumbar - AP/LAT

601.55

04080

Thoracic - AP

601.55

04081

Tibia/Fibula - AP/LAT

601.55

04082

Wrist - AP/LAT

301.08

04083

Wrist - 3 views

451.17

04084

Stress views - Lumbar

377.24

04100

Consumables

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