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PROCEDURAL CODING SUBMISSIONS FOR INCLUSION IN THE 2021 MEDICAL DOCTORS’ CODING MANUAL (MDCM)
Zandile Dube – Senior Medical Coding Consultant
The Medical Coding Division at SAMA invites all the disciplines whose codes are represented in the MDCM to bring forward any changes that need to be implemented in the 2021 Medical Doctors’ Coding Manual (MDCM).
The Medical Doctors’ Coding Manual is updated on an annual basis. Submissions for changes, additions, discontinuation of codes and their respective interpretations are being considered on an annual basis. It is the responsibility of the various disciplines’, associations and societies to submit changes to SAMA. The changes to the coding structure then has to be approved by the Specialists Private Practice Committee (SPPC), In order to be implemented.
The best approach is to work through your Discipline’s society or association if you want to make a submission since individual submissions are not accepted. Forms for application to introduce new codes, revisions to existing codes or discontinuation of codes are printed in the 2020 MDCM book, or may be obtained from coding@samedical.org.
It is also important that the various disciplines regularly send SAMA updates of their coding structures. This would not only enable us to broaden the interpretations contained within the coding structure, but assist us in terms of accuracy when providing practices and funders with coding information.
All new codes to be considered must be supported by a valid CPT® code or range of codes.
No CPT® codes available:
If CPT® codes are not available, full motivation must be supplied including:
(1) An adequate definition or description of the nature, extent and need for the procedure/service or "medical necessity";
(2) In which respect is this service unusual or different in technique, compared to available procedures/services listed in the coding structure? Information regarding the nature and extent of the procedure/service, time and effort, special/dedicated equipment needed to provide this service, must be included in the report;
(3) Is this procedure/service medically appropriate under the circumstances? Explain why another procedure/service listed in the coding structure will not be appropriate in this case;
(4) A description of the complexity of the symptoms and concurrent problems must be supplied; (5) Final diagnosis supported by the appropriate ICD-10 code(s);
(6) Pertinent physical findings (size, location and number of lesions, if applicable);
(7) Make mention of any other diagnostic or therapeutic procedure(s)/service(s) provided at the same session;
(8) Any further diagnostic or therapeutic procedure(s)/service(s) to be provided in the follow-up period; and
(9) Description of the follow-up care needed.
All submissions must be motivated for in person at the Private Practice Committee meeting at a date to be determined by the Committee, otherwise the submissions will not be considered.
Submission forms have to be completed correctly and completely. Please ensure that the SAMA Coding Division receives your submissions no later than 24 January 2020. No late submissions will be accepted. Submissions with supporting documentation, if applicable, must be emailed to the SAMA Medical Coding Division coding@samedical.org.
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