Itap Managed Care Working Group Task Team 1: Chronic

Home , Florbetapir (18F), Fluciclovine (18F), Fluorodopa, Flutemetamol (18F), Iodocholesterol, Ioflupane (123I)

ITAP TT1 MC - Glaucoma – Sept 17

ITAP MANAGED CARE WORKING GROUP

TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL’s)

– GLAUCOMA –

Explanatory note to the Managed Care minimum reporting data specification (excel spreadsheet)

The aim of the project is to measure the value added by managed care organisations, by means of capturing, measuring and reporting on clinical process indicators to demonstrate the clinical outcome/s achieved. Hence this is by no means a representation of the full protocol, policy or guideline on Glaucoma management.

Additionally, these process indicators and or outcomes achieved will be reported on within the Annual statutory returns.

1 ITAP TT1 MC - Glaucoma – Sept 17

Meetings and discussions were held with industry representatives and subject matter experts prior to finalising the minimum data specification.

1) Goal

The value of managing a disease is to establish measurable goals that result in quality of care. (Diagnosis, treatment and care of all beneficiaries should be in line with evidence base medicine, cost effectiveness and affordability).

· Maintain the individuals visual function and related quality of life at a sustainable cost. · Lower IOP and slow rate of visual field deterioration. Target IOP is specific to each individual. · Prevent complications and optimally manage the progression of disease.

2) Identification of beneficiaries that have Glaucoma / or registered on a managed care program

Please ensure the relevant consent has been obtained and confidentially maintained when obtaining personal health information.

Identification of beneficiaries registered on the program may include · Registered on chronic and or disease management programs · ICD-10 Codes or other relevant clinical coding · Anatomical Therapeutic Chemical Classification System (ATC Class) · National stock numbers (State stock code)

3) Minimum data specification: Process indicators, clinical outcomes and data

The level of Active Management of Glaucoma will depend on the nature of the contract, the level of services covered and the fee structure for those services, e.g. screening, medication, procedures etc.

2 ITAP TT1 MC - Glaucoma – Sept 17

The minimum required fields for the effective collection of appropriate data to demonstrate the value of the managed care interventions for the below mentioned categories are detailed by way of process indicators (see attached spreadsheet).

· Diagnosis

The diagnosis of Glaucoma is made by the specified registered practitioner. o Congenital Glaucoma o Closed Angle Glaucoma o Open Angle Glaucoma

· Investigations o Tonometry o Fundus examination o Gonooiscopy o Disc and Nerve Fibre layer analysis o Disc Photography o Optical coherence tomography o Central corneal thickness measurement

· Discipline Type

The service providers must be registered with their relevant statutory bodies and as indicated by discipline coded list provided by BHF.

4) Treatment – Glaucoma

Congenital Glaucoma Closed Angle Glaucoma Open Angle Glaucoma

Surgery / Medication Medication, Laser and / or Drainage / Medication (first line / Second line) Cataract Surgery Drainage surgery

3 ITAP TT1 MC - Glaucoma – Sept 17

Medication:

- S01E - Antiglaucoma preparations and miotics

* Please note these recommendations do not replace the published algorithms, PMB entitlements etc. It is a means of measuring the value and quality of care provided.

* The above is merely the initial phase of the ITAP Task Team 1- CDL project and as such is not exhaustive.

Full details can be seen on the accompanying excel spreadsheets.

5) Clinical Outcomes measures

· Number of all cause admissions · Number of admissions for Glaucoma · Number of Beneficiaries treated on medication alone · Number of Beneficiaries that had surgery · Number of beneficiaries that had repeated surgery / theatre · Cost of medication pre-surgery versus post-surgery

* Information in regards to ICD-10 coding may be found on the following site http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11

6) Reporting (MCO and Scheme) *Definitions will be the same utilised within the Annual statutory returns – see Circular 10 of 2015. For full details http://www.medicalschemes.com/files/Circulars/Circular10Of2015.pdf

All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to the service rendered by your organisation.

4 ITAP TT1 MC - Glaucoma – Sept 17

6.1 By Managed Care Organisation: Management out of hospital

- Time period: Benefit year (Reporting period – Start and end) - Per benefit option - Per Scheme - Member - Beneficiary - Service Date (Benefit Year) - Gender – Male / Female - Age (Age of the beneficiary is to be calculated as the Year of Reporting - Year of Birth)

a) Program Demographics

Actual number of beneficiaries registered for Glaucoma on the Pharmacy Benefit and or Active Number of new registrations in Number of beneficiaries who left Year: Bi- disease management program the period program * Annual (Longer than 6 months on program) Male Female Male Female Male Female Under 1 1 to 4 4 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34

5 ITAP TT1 MC - Glaucoma – Sept 17

35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 and above Total

*Left the program – This may include various reason codes i.e. left the scheme, death, suspensions etc. b) Clinical Management

Total Number of beneficiaries Total Number of Beneficiaries that Total Number of Beneficiaries Year: treated with medication only had surgery (Laser / Drainage identified with 2 or more co- Annual Surgery) morbidities

Age Female Male Female Male Male Female Groups Under 1 1 to 4 4 to 9 10 to 14 6 ITAP TT1 MC - Glaucoma – Sept 17

15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 and above Total

Co-morbidities o Hypertension o Diabetes o Eye Injury o Cortisone use

6.2 Management in Hospital

- Time period: 1 January to 31 December (Service dates / financial year), define per quarter - Per benefit option - Per Scheme - Hospital Admissions:

7 ITAP TT1 MC - Glaucoma – Sept 17

o All cause admissions o Glaucoma admissions - Hospital Category o Day Admission o Long Stay o Readmission - Gender - Age

Admission definitions

§ Glaucoma related admission - please refer to attached list of ICD10 Codes. § Mortality / Exit codes – Where a hospital notifies the schemes / MCO / Administrator that a member is deceased. See attached § Emergency room – Definition as per Circular 10 of 2015 § Hospital admission · A day case is when admission day is same as discharge date · A long stay is when discharge date is after the admission day. · A re-admission is when a patient from hospital is readmitted within 90 days of previous discharge date.

8 ITAP TT1 MC - Glaucoma – Sept 17

a) Hospital Category: Day Case

Scheme Total number Total number Admission per category Mortality Claimed Risk of of admissions Surgical Medical Paediatric Emergency (Exit amount paid admissions (Glaucoma) Room (Only) Codes = amount (All Cause) Related Expire)

Male Female Male Female Male Female Male Female

b) Hospital Category: Long Stay

Scheme Total number Total number Admission per category Mortality Claimed Risk of of related (Exit amount paid admissions admissions Surgical Medical Paediatric Emergency Codes = amount (All Cause) (Glaucoma) Room (Only) Expire)

Male Female Male Female Male Female Male Female

c) Hospital Category: Re-admission

Male Female Male Female Male Female Male Female

7) References · Task Team 1 of the Managed Care ITAP working group; · Standard treatment guidelines and Essential medicine list · Circular 10 of 2015 · South African Glaucoma Society

9 Entry and Process Disease Management Verification Indicators Program Algorithm Outcomes Data Spec ICD10 Description ATC Class ATC Class Investigation Tariff Code Tariff Description Program Algorithm Outcome Data specs H40 Glaucoma S01E Antiglaucoma preparations and miotics Initial Diagnosis Date of Diagnosis CDL Algorithm No of hosp admissions (All Cause) Membership H40.0 Glaucoma suspect 3009 Basic capital equipment used in own rooms by ophthalmologists. Only to be charged at first and follow-up consultations. Not to be charged for post-operative follow-up consultations Date of Registration No of hosp admissions (Glaucoma) Scheme name H40.1 Primary open-angle glaucoma 3014 Tonometry per test with maximum of 2 tests for provocative tonometry (one or both eyes) Number of beneficiaries treated with medication only Option name H40.2 Primary angle-closure glaucoma 3003 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 or item 3012) Numer of beneficiaries that underwent surgery Member No H40.3 Glaucoma secondary to eye 3002 trauma Gonioscopy Dependent code H40.4 Glaucoma secondary to eye 3026 Digital Tomography of optic nerve with Scanning Laser Ophthalmoscope (SLO). inflammation Limited to two exams per annum Number of beneficiaries who post surgery Date of birth H40.5 Glaucoma secondary to other eye 3027 disorders Fundus photography 0-5 days post-operative procedure - Theatre revisist Gender H40.6 Glaucoma secondary to drugs 3028 Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye - annual Repeat surgery - 60 to 360 days post initial surgery H40.8 Other glaucoma 3017 Retinal threshold test inclusive of computer disc storage for Delta of Statpak programs - annual Claims H40.9 Glaucoma, unspecified 3020 Special eye investigations: Pachymetry: Only when own instrument is used, per eye. Only in addition to corneal surgery (once per life) Number of drops before vs after surgery (180days) Date of service H42.8 Glaucoma in other diseases classified elsewhere Cost of drops before surgery versus cost of drops after surgery Doctor type Q15.0 Congenital glaucoma Management Practice number 3026 Digital Tomography of optic nerve with Scanning Laser Ophthalmoscope (SLO). Limited to two exams per annum (Old technology) ICD -10 Code Other 3027 Fundus photography (Annually) DSP: Y or N H42 Glaucoma in diseases classified 3028 elsewhere Optical Coherent Tomography (OCT) of Optic nerve or macula: Per eye Tariff Code / UPFS H42.0 Glaucoma in endocrine, 3018 nutritional and metabolic diseases Retinal threshold trend evaluation (additional to item 3017) (Annually) Nappi codes

Special eye investigations: Pachymetry: Only when own instrument is 3020 used, per eye. Only in addition to corneal surgery (Once in life time) ATC Class 3009 Basic capital equipment used in own rooms by ophthalmologists. Only to be charged at first and follow-up consultations. Not to be charged for post-operative follow-up consultations. (x3 per year) CPT Code 3014 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 or item 3012) (x3 per year) Claimed Amount 3003 Fundus contact lens or 90 D lens examination (not to be charged with item 3004 or item 3012) (x3 per year) Benefit Amount 3002 Gonioscopy. (x3 per year) Member Amount 3017 Retinal threshold test inclusive of computer disc storage for Delta of Statpak programs. (x2 per year) Length of Stay Level of Care Surgery Exit Reason code Special eye investigations: Retinal function assessment including refraction after ocular surgery (within four months), maximum two examinations. 3021 (x2 per year) Examination of eyes under general anaesthetic where no surgery is done. 3080 (x4 per year) Clinical results FEV1 Glaucoma 3061 Drainage operation Surgery Implantation of aqueous shunt device/seton in glaucoma (additional to 3062 item 3061) 3063 Cyclocryotherapy or cyclodiathermy Program 3064 Laser trabeculoplasty Date of Diagnosis 3065 Removal of blood from anterior chamber Date of Registration 3067 Goniotomy 3149 Iridectomy or iridotomy by open operation as isolated procedure Iridectomy or iridotomy by laser or photocoagulation as isolated 3153 procedure (maximum one procedure) 3157 Division of anterior synechiae as isolated procedure 3158 Repair iris as in dialysis: Anterior chamber reconstruction 3199 Repair of conjunctiva by grafting 3196 Diamond knife: Use of own diamond knife during intraocular surgery Laser apparatus (ophthalmic): Hire fee for one or both eyes done in one 3201 sitting (Not to be used with IOL Master) CPT Code Description 65855 Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series) 66150 Fistulisation of sclera for glaucoma; trephination with iridectomy 66155 Fistulisation of sclera for glaucoma; thermocauterisation with iridectomy 66160 Fistulisation of sclera for glaucoma; sclerectomy with punch or scissors, with iridectomy 66165 Fistulisation of sclera for glaucoma; iridencleisis or iridotasis 66170 Fistulisation of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery 66172 Fistulisation of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents) ITAP TT1 MC - Haemophilia _Sept 2017

ITAP MANAGED CARE WORKING GROUP

TASK TEAM 1: CHRONIC DISEASE CONDITIONS (CDL’s)

– HAEMOPHILIA –

Explanatory note to the Managed Care minimum reporting data specification (excel spreadsheet)

Additionally, these process indicators and or outcomes achieved will be reported on within the Annual statutory returns.

1 ITAP TT1 MC - Haemophilia _Sept 2017

Meetings and discussions were held with industry representatives and subject matter experts prior to finalising the minimum data specification.

1) Goal

· Prevent complications and optimally manage the progression of disease.

2) Identification of beneficiaries that have Haemophilia/ or registered on a managed care program

Please ensure the relevant consent has been obtained and confidentially maintained when obtaining personal health information.

3) Minimum data specification: Process indicators, clinical outcomes and data

The level of Active Management of Haemophilia will depend on the nature of the contract, the level of services covered and the fee structure for those services, e.g. screening, medication, procedures etc.

2 ITAP TT1 MC - Haemophilia _Sept 2017

· Diagnosis

The diagnosis of Haemophilia is made by the specified registered practitioner. Distinguish between hereditary and acquired haemophilia

· Investigations Pathology (Blood) o Factor VIII related antigen o Coagulation factors: Quantitative o Full blood count o Platelet count o Fibrinogen titre o Partial thromboplastin time o Prothrombin index o Therapeutic drug level: Dosage o Bleeding time o Blood volume, dye method o Coagulation factor inhibitor assay

Screening Due to continuation treatment and receiving plasma product, beneficiaries to be screened for o HIV o Hepatitis

Pregnancy – beneficiaries that are at risk to be screened and offered genetic counselling.

· Discipline Type

The service providers must be registered with their relevant statutory bodies and as indicated by discipline coded list provided by BHF.

4) Treatment – Haemophilia 3 ITAP TT1 MC - Haemophilia _Sept 2017

ATC Description

B02AA02 Tranexamic acid B02BD02 Coagulation factor VIII B02BD03 Factor VIII inhibitor bypassing activity B02BD08 Eptacog Alfa (Activated) B02BD04 Coagulation factor IX Von Willebrand factor and coagulation factor VIII in B02BD06 combination H01BA Vasopressin and analogues H01BA02 Desmopressin

* Please note these recommendations do not replace the published algorithms, PMB entitlements etc. It is a means of measuring the value and quality of care provided.

* The above is merely the initial phase of the ITAP Task Team 1- CDL project and as such is not exhaustive.

Full details can be seen on the accompanying excel spreadsheets.

5) Clinical Outcomes measures

· Number of all cause admissions · Number of admissions for haemophilia § Major Bleeds § Minor Bleeds · Number of beneficiaries with target joints 4 ITAP TT1 MC - Haemophilia _Sept 2017

· All-cause mortality

* Information in regards to ICD-10 coding may be found on the following site http://www.health.gov.za/index.php/shortcodes/2015-03-29-10-42-47/2015-06-10-09-23-36/2015-06-10-09-26-11

All reports to be submitted to the Scheme for inclusion in the Annual Statutory Returns. Please complete the section relevant to the service rendered by your organisation.

6.1 By Managed Care Organisation: Management out of hospital

a) Program Demographics

Actual number of beneficiaries registered for Haemophilia on the Year: Bi- Number of new registrations in Number of beneficiaries who left Pharmacy Benefit and or Active Annual the period program * disease management program (Longer than 6 months on 5 ITAP TT1 MC - Haemophilia _Sept 2017

program) Male Female Male Female Male Female Under 1 1 to 4 4 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 and above Total

*Left the program – This may include various reason codes i.e. left the scheme, death, suspensions etc. b) Clinical Management

6 ITAP TT1 MC - Haemophilia _Sept 2017

Number of beneficiaries Number of beneficiaries with Total Number of Beneficiaries Year: Number of beneficiaries with treated with Radio-Isotopes Minor /Major Bleeds identified with 2 or more co- Annual target joints admissions morbidities

Age Female Male Female Male Female Male Male Female Groups Under 1 1 to 4 4 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 and above Total

6.2 Management in Hospital

- Time period: 1 January to 31 December (Service dates / financial year), define per quarter 7 ITAP TT1 MC - Haemophilia _Sept 2017

- Per benefit option - Per Scheme - Hospital Admissions: o All cause admissions o Haemophilia admissions - Hospital Category o Day Admission o Long Stay o Re-admission - Gender - Age

Admission definitions

§ Haemophilia related admission - please refer to attached list of ICD10 Codes. § Mortality / Exit codes – Where a hospital notifies the schemes / MCO / Administrator that a member is deceased. See attached § Emergency room – Definition as per Circular 10 of 2015 § Hospital admission · A day case is when admission day is same as discharge date · A long stay is when discharge date is after the admission day. · A re-admission is when a patient from hospital is readmitted within 90 days of previous discharge date.

8 ITAP TT1 MC - Haemophilia _Sept 2017

a) Hospital Category: Day Case

Scheme Total number of Total number of Admission per category Mortality Claimed Risk admissions (All admissions (Exit Codes amount paid Surgical Medical Paediatric Emergency Cause) (Haemophilia = Expire) amount Room (Only) Related)

Male Female Male Female Male Female Male Female

b) Hospital Category: Long Stay

Scheme Total number Total number Admission per category Mortality Claimed Risk of of related (Exit amount paid admissions admissions Surgical ICU / SICU / Medical Paediatric Emergency Codes = amount (All Cause) (Haemophilia) HC Room (Only) Expire)

Male Female Male Female Male Female Male Female Male Female

c) Hospital Category: Re-admission

Scheme Total number Total number of Admission per category Mortality Claimed Risk of admissions related admissions (Exit Codes amount paid (All Cause) (Haemophilia) Surgical Medical Paediatric Emergency = Expire) amount Room (Only)

Male Female Male Female Male Female Male Female

7) References · Task Team 1 of the Managed Care ITAP working group; · Standard treatment guidelines and Essential medicine list · Circular 10 of 2015 · Haemophiliac Society

9 Disease Management Entry and Verification Process Indicators Program Algorithm Outcomes Data Spec ICD10 Description - Haemophilia ATC Class ATC Class Investigation Tariff Code Tariff Description Program Algorithm Outcome Data specs D66 Hereditary factor VIII deficiency Haemophilia (Hereditary) Diagnostic Date of Diagnosis CDL Alogrithm No of hosp admissions (All Cause) Membership D67 Hereditary factor IX deficiency B02AA02 Tranexamic acid FBC 3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) Date of Registration No of hosp admissions (Hemophilia) Scheme name B02BD02 Coagulation factor VIII Platelets 3797 Platelet count Casualty visits Option name Platelet function Haemophilia (Acquired) B02BD03 Factor VIII inhibitor bypassing activity studies 3795 Platelet aggregation per aggregant (require a min of 6) Mortality (all cause) Member No D68.4 Acquired coagulation factor deficiency B02BD08 Eptacog Alfa (Activated factor VIIa) Fibrogen 3825 Fibrinogen titre Number of Surgeries (Frequency) Dependent code Von Willebrand 3758 B02BD04 Coagulation factor IX factor Factor VIII related antigen (determine severity) (initial workup) Number of Radio Isotopes (frequency) Date of birth Von Willebrand factor and coagulation factor VIII in Factor XIII 3757 Number of beneficiaries with 'complications' (See secondary codes B02BD06 combination Quantitive Coagulation factors: Quantitative tab) per system Gender Factor XIII H01BA02 Desmopressin Qualitative 3744 Fibrin stabilizing factor (urea test) Number of beneficairies with target joints PTT 3837 Partial thromboplastin time (Mixing studies x3) Claims Radio Isotopes See attached Thrombin time 3841 Thrombin time (screen) ATC codes Number of beneficiaries treated with radio-Isotopes Date of service Ristocetin cofactor 3857 Ristocetin Cofactor Doctor type INR 3805 Prothrombin index Practice number Drug Levels 3806 Therapeutic drug level: Dosage ICD -10 Code D-Dimer (qualitative) 3854 XDP (Dimer test or equivalent latex slide test) DSP: Y or N D- Dimer (Quantatitive) 3856 D-Dimer (quantitative) Tariff Code / UPFS FDP 3853 Fibrin degeneration products (latex slide) Nappi codes ATC Class Radiology X-rays Fractures / target joint CPT Code MRI On motivation Claimed Amount Benefit Amount Management Member Amount INR 3724 Coagulation factor inhibitor assay Length of Stay FBC 3755 Full blood count (including items 3739, 3762, 3783, 3785, 3791) Level of Care Platelets 3797 Platelet count Arthropathy Exit Reason code INR 3805 Prothrombin index Factor XIII 3757 Quantitive Coagulation factors: Quantitative (per algorithm) Clinical results Factor XIII Qualitative 3744 Fibrin stabilizing factor (urea test) FEV1

Screening (Plasma products given hence screening) - Annually HIV antibodies 3932 Antibodies to human immunodeficiency virus (HIV): ELISA Program Liver Function 3999 Albumin Date of Diagnosis Test (annual) 4001 Alkaline phosphatase Date of Registration 4131 Alanine aminotransferase (ALT) 4009 Bilirubin: Total 4010 Bilirubin: Conjugated 4117 Protein: Total 4130 Aspartate aminotransferase (AST) 4134 Gamma glutamyl transferase (GGT) 4531 Hepatitis: Per antigen or antibody Hepatitis 3942 Hepatitis Rapid Viral Ab

Genetic testing (Factor 8 and 9) - Once off (Maternity to be screened) Genetic councellor

Dental 8101 Oral examination Screening (Bi- 8102 Comprehensive oral examination

Rehabilitation where the pathology requires the undivided attention of the 501 physiotherapist. Rule 008 does not apply. Duration: 30min. Hydrotherapy where the pathology requires the undivided attention of the Physiotherapy - physiotherapist. Rule 008 does not apply. Duration: 30min. Rehabilitation 502

Home RX Nursing - 88 practice Where a consultation was not performed and the nurse attended to or visited the patient with the sole purpose of administering intramuscular or intravenous medication. The route of administration of medication to be stated, as well as the name of the medication. Oral, rectal, vaginal medication excluded as well as the Nurse (88) 030 application of topical medicine.

Note: * first 20 exposures to be performed in a facility with emergency facilities A target joint is a joint in which 3 or more spontaneous bleeds have occurred within Target joint a consecutive 6-month period. Tariff CodeTariff Description

3641 Tracer test 3642 Repeat of further tracer tests for same investigation: Half of above fee If both tracer and therapeutic procedures are done, half fee of tracer test to be charged 3643 plus therapeutic fee 3645 Other organ scanning with use of relevant radio isotopes

WHOATC Description V09 Diagnostic radiopharmaceuticals V09A Central nervous system V09AA Technetium (99mTc) compounds V09AA01 Technetium (99mTc) exametazime V09AA02 Technetium (99mTc) bicisate V09AB Iodine (123I) compounds V09AB01 Iodine iofetamine (123I) V09AB02 Iodine iolopride (123I) V09AB03 Iodine ioflupane (123I) V09AX Other central nervous system diagnostic radiopharmaceuticals V09AX01 Indium (111In) pentetic acid V09AX02 Fludeoxyglucose (18F) V09AX03 Iodine (124I) 2beta-carbomethoxy-3beta-(4 iodophenyl)-tropane V09AX04 Flutemetamol (18F) V09AX05 Florbetapir (18F) V09AX06 Florbetapen (18F) V09B Skeleton V09BA Technetium (99mTc) compounds V09BA01 Technetium (99mTc) oxidronic acid V09BA02 Technetium (99mTc) medronic acid V09BA03 Technetium (99mTc) pyrophosphate V09BA04 Technetium (99mTc) butedronic acid V09C Renal system V09CA Technetium (99mTc) compounds V09CA01 Technetium (99mTc) pentetic acid V09CA02 Technetium (99mTc) succimer V09CA03 Technetium (99mTc) mertiatide V09CA04 Technetium (99mTc) gluceptate V09CA05 Technetium (99mTc) gluconate V09CA06 Technetium (99mTc) ethylenedicysteine V09CX Other renal system diagnostic radiopharmaceuticals V09CX01 Sodium iodohippurate (123I) V09CX02 Sodium iodohippurate (131I) V09CX03 Sodium iothalamate (125I) V09CX04 Chromium (51Cr) edetate V09D Hepatic and reticulo endothelial system V09DA Technetium (99mTc) compounds V09DA01 Technetium (99mTc) disofenin V09DA02 Technetium (99mTc) etifenin V09DA03 Technetium (99mTc) lidofenin V09DA04 Technetium (99mTc) mebrofenin V09DA05 Technetium (99mTc) galtifenin V09DB Technetium (99mTc), particles and colloids V09DB01 Technetium (99mTc) nanocolloid V09DB02 Technetium (99mTc) microcolloid V09DB03 Technetium (99mTc) millimicrospheres V09DB04 Technetium (99mTc) tin colloid V09DB05 Technetium (99mTc) sulfur colloid V09DB06 Technetium (99mTc) rheniumsulfide colloid V09DB07 Technetium (99mTc) phytate V09DX Other hepatic and reticulo endothelial system diagnostic radiopharmaceuticals V09DX01 Selenium (75Se) tauroselcholic acid V09E Respiratory system V09EA Technetium (99mTc), inhalants V09EA01 Technetium (99mTc) pentetic acid V09EA02 Technetium (99mTc) technegas V09EA03 Technetium (99mTc) nanocolloid V09EB Technetium (99mTc), particles for injection V09EB01 Technetium (99mTc) macrosalb V09EB02 Technetium (99mTc) microspheres V09EX Other respiratory system diagnostic radiopharmaceuticals V09EX01 Krypton (81mKr) gas V09EX02 Xenon (127Xe) gas V09EX03 Xenon (133Xe) gas V09F Thyroid V09FX Various thyroid diagnostic radiopharmaceuticals V09FX01 Technetium (99mTc) pertechnetate V09FX02 Sodium iodide (123I) V09FX03 Sodium iodide (131I) V09FX04 Sodium iodide (124I) V09G Cardiovascular system V09GA Technetium (99mTc) compounds V09GA01 Technetium (99mTc) sestamibi V09GA02 Technetium (99mTc) tetrofosmin V09GA03 Technetium (99mTc) teboroxime V09GA04 Technetium (99mTc) human albumin V09GA05 Technetium (99mTc) furifosmin V09GA06 Technetium (99mTc) stannous agent labelled cells V09GA07 Technetium (99mTc) apcitide V09GB Iodine (125I) compounds V09GB01 Fibrinogen (125I) V09GB02 Iodine (125I) human albumin V09GX Other cardiovascular system diagnostic radiopharmaceuticals V09GX01 Thallium (201Tl) chloride V09GX02 Indium (111In) imciromab V09GX03 Chromium (51Cr) chromate labelled cells V09GX04 Rubidium (82RB) chloride V09H Inflammation and infection detection V09HA Technetium (99mTc) compounds V09HA01 Technetium (99mTc) human immunoglobulin V09HA02 Technetium (99mTc) exametazime labelled cells V09HA03 Technetium (99mTc) antigranulocyte antibody V09HA04 Technetium (99mTc) sulesomab V09HB Indium (111In) compounds V09HB01 Indium (111In) oxinate labelled cells V09HB02 Indium (111In) tropolonate labelled cells V09HX Other diagnostic radiopharmaceuticals for inflammation and infection detection V09HX01 Gallium (67Ga) citrate V09I Tumour detection V09IA Technetium (99mTc) compounds V09IA01 Technetium (99mTc) antiCarcinoEmbryonicAntigen antibody V09IA02 Technetium (99mTc) antimelanoma antibody V09IA03 Technetium (99mTc) pentavalent succimer V09IA04 Technetium (99mTc) votumumab V09IA05 Technetium (99mTc) depreotide V09IA06 Technetium (99mTc) arcitumomab V09IA07 Technetium (99mTc) hynic-octreotide V09IA08 Technetium (99m Tc) etarfolatide V09IA09 Technetium (99m Tc) tilmanocept V09IB Indium (111In) compounds V09IB01 Indium (111In) pentetreotide V09IB02 Indium (111In) satumomab pendetide V09IB03 Indium (111In) antiovariumcarcinoma antibody V09IB04 Indium (111In) capromab pendetide V09IX Other diagnostic radiopharmaceuticals for tumour detection V09IX01 Iobenguane (123I) V09IX02 Iobenguane (131I) V09IX03 Iodine (125I) CC49-monoclonal antibody V09IX04 Fludeoxyglucose [18F] V09IX05 Fluorodopa (18F) V09IX06 sodium fluoride (18F) V09IX07 Fluoromethylcholine (18F) V09IX08 Fluoroethylcholine (18F) V09IX09 Gallium (68Ga) edotreotide V09IX10 Fluoroethyl-L-tyrosine (18F) V09IX11 Fluoroestradiol (18F) V09IX12 Fluciclovine (18F) V09X Other diagnostic radiopharmaceuticals V09XA Iodine (131I) compounds V09XA01 Iodine (131I) norcholesterol V09XA02 Iodocholesterol (131I) V09XA03 Iodine (131I) human albumin V09XX Various diagnostic radiopharmaceuticals V09XX01 Cobalt (57Co) cyanocobalamine V09XX02 Cobalt (58Co) cyanocobalamine V09XX03 Selenium (75Se) norcholesterol V09XX04 Ferric (59Fe) citrate

V10 Therapeutic radiopharmaceuticals V10A Antiinflammatory agents V10AA Yttrium (90Y) compounds V10AA01 Yttrium (90Y) citrate colloid V10AA02 Yttrium (90Y) ferrihydroxide colloid V10AA03 Yttrium (90Y) silicate colloid V10AX Other antiinflammatory therapeutic radiopharmaceuticals V10AX01 Phosphorous (32P) chromicphosphate colloid V10AX02 Samarium (153Sm) hydroxyapatite colloid V10AX03 Dysprosium (165Dy) colloid V10AX04 Erbium (169Er) citrate colloid V10AX05 Rhenium (186Re) sulfide colloid V10AX06 Gold (198Au) colloidal V10B Pain palliation (bone seeking agents) V10BX Various pain palliation radiopharmaceuticals V10BX01 Strontium (89Sr) chloride V10BX02 Samarium (153Sm) lexidronam V10BX03 Rhenium (186Re) etidronic acid V10X Other therapeutic radiopharmaceuticals V10XA Iodine (131I) compounds V10XA01 Sodium iodide (131I) V10XA02 Iobenguane (131I) V10XA53 Tositumomab/iodine (131I) tositumomab V10XX Various therapeutic radiopharmaceuticals V10XX01 Sodium phosphate (32P) V10XX02 Ibritumomab tiuxetan[90Y] V10XX03 Radium (223 Ra) dichloride Discipline Sub-discipline Discipline-description Sub-Discipline description 002 000 Nutritionist 003 000 Accredited Blood and Blood Product Couriers 004 000 Chiropractors 008 000 Homoeopaths 009 001 Ambulance Service Basic Life Support Service 009 002 Ambulance Service Intermediate Life Support Service 009 003 Ambulance Service Advance Life Support Service 009 004 Ambulance Service Provincial Ambulance Service 010 000 Anaesthetists 012 000 Dermatology 014 000 General Medical Practice 015 000 Specialist Family Medicine 016 000 Independent Practice Specialist Obstetrics and Gynaecology 016 001 Independent Practice Sub Specialist Obstetrics and Gynaecology Critical Care 016 002 Independent Practice Sub Specialist Obstetrics and Gynaecology Gynaecological Oncology 016 003 Independent Practice Sub Specialist Obstetrics and Gynaecology Medical Genetics 016 004 Independent Practice Sub Specialist Obstetrics and Gynaecology Maternal and Foetal Medicine 016 005 Independent Practice Sub Specialist Obstetrics and Gynaecology Reproductive Medicine 016 006 Independent Practice Sub Specialist Obstetrics and Gynaecology Infectious Diseases 017 000 Pulmonology 018 000 Independent Practice Specialist Medicine 018 001 Independent Practice Subspecialist Medicine Clinical Haematology 018 002 Independent Practice Subspecialist Medicine Nephrology 018 003 Independent Practice Subspecialist Medicine Cardiology 018 004 Independent Practice Subspecialist Medicine Endocrinology 018 005 Independent Practice Subspecialist Medicine Pulmonology 018 006 Independent Practice Subspecialist Medicine Critical Care 018 007 Independent Practice Subspecialist Medicine Geriatric Medicine 018 008 Independent Practice Subspecialist Medicine Medical Genetics 018 009 Independent Practice Subspecialist Medicine Infectious Diseases 018 010 Independent Practice Subspecialist Medicine Gastroenterology 018 011 Independent Practice Subspecialist Medicine Medical Oncology 018 012 Independent Practice Subspecialist Medicine Rheumatology 019 000 Gastroenterology 020 000 Neurology 021 000 Cardiology 021 001 Cardiology Independent Practice Sub Specialist Medicine 021 002 Cardiology Independent Practice Sub Specialist Paediatrics 021 003 Cardiology Independent Practice Sub Specialist Special Merit 022 000 Psychiatry 023 000 Medical Oncology 024 000 Independent Practice Specialist Neurosurgery 024 001 Independent Practice Sub Specialist Neurosurgery Critical Care 025 000 Nuclear Medicine 026 000 Ophthalmology 027 000 Clinical Haemotology 027 001 Clinical Haematology Independent Practice Sub Specialist Pathology (Haematological) 027 002 Clinical Haematology Paediatrics 027 003 Clinical Haematology Medicine 028 000 Orthopaedics 029 000 Occupational Medicine Independent Practice Specialist 030 000 Otorhinolaryngology 031 000 Rheumatology 032 000 Paediatrics Independent Practice Specialist 032 001 Paediatrics Independent Practice Sub Specialist Neurology 032 002 Paediatrics Independent Practice Sub Specialist Developmental Paediatrics 032 003 Paediatrics Independent Practice Sub Specialist Medical Oncology 032 004 Paediatrics Independent Practice Sub Specialist Infectious Diseases 032 005 Paediatrics Independent Practice Sub Specialist Medical Genetics 032 006 Paediatrics Independent Practice Sub Specialist Endocrinology 032 007 Paediatrics Independent Practice Sub Specialist Gastroenterology 032 008 Paediatrics Independent Practice Sub Specialist Neonatology 032 009 Paediatrics Independent Practice Sub Specialist Pulmonology 032 010 Paediatrics Independent Practice Sub Specialist Rheumatology 032 011 Paediatrics Independent Practice Sub Specialist Nephrology 032 012 Paediatrics Independent Practice Sub Specialist Critical Care 032 013 Paediatrics Independent Practice Sub Specialist Cardiology 032 014 Paediatrics Independent Practice Sub Specialist Clinical Haematology 034 000 Physical Medicine 035 000 Emergency Medicine Independent Practice Specialist 036 000 Plastic and Reconstructive Surgery 037 000 Medical technology 037 001 Medical technology Blood Transfusion Technology 037 002 Medical technology Cardiology 037 003 Medical technology Chemical Pathology 037 004 Medical technology Clinical Pathology 037 005 Medical technology Cytotechnology 037 006 Medical technology Forensic Pathology 037 007 Medical technology Haematology 037 008 Medical technology Histopathological Technique 037 009 Medical technology Lung Function 037 010 Medical technology Microbiology 037 011 Medical technology Parasitology 037 012 Medical technology Pharmacology 037 013 Medical technology Virology 037 014 Medical technology Immunology 037 015 Medical technology Radio-Isotope Technology 038 000 Diagnostic Radiology 039 000 Radiography 039 001 Radiography Diagnosis 039 002 Radiography Therapy 039 003 Radiography Nuclear Medicine 039 004 Radiography Ultrasound 040 000 Independent Practice Specialist Radiation Oncology 042 000 Surgery Independent Practice Specialist 042 001 Surgery Independent Practice Sub Specialist Vascular Surgery 042 002 Surgery Independent Practice Sub Specialist Critical Care 042 003 Surgery Independent Practice Sub Specialist Gastroenterology 042 005 Surgery Independent Practice Sub Specialist Trauma Surgery 044 000 Cardio Thoracic Surgery 046 000 Urology 047 000 Drug & Alcohol Rehab (Department of Health) 047 001 Drug & Alcohol Rehab (Welfare) 048 000 Travel Clinic 049 001 Sub-Acute Facilities General Care 049 002 Sub-Acute Facilities Psychiatry 049 003 Sub-Acute Facilities Physical Rehab 049 004 Sub-Acute Facilities All Services 049 005 Sub-Acute Facilities Post Natal Unit 049 006 Sub-Acute Facilities Psychiatric/Post Natal 049 007 Sub-Acute Facilities Rehab/Post Natal 049 008 Sub-Acute Facilities Specialised Psychiatric Unit Only 050 000 Group practices 050 009 Group Practice Primary Care 050 010 Delayed Children Development Clinic WELFARE & DOH 051 000 Group practices/Hospitals 052 000 Pathology Independent Practice Specialist 052 001 Pathology Independent Practice Sub-Specialist Anatomy 052 002 Pathology Independent Practice Sub-Specialist Chemical 052 003 Pathology Independent Practice Sub-Specialist Clinical 052 004 Pathology Independent Practice Sub-Specialist Forensic 052 006 Pathology Independent Practice Sub-Specialist Medical Genetics 052 007 Pathology Independent Practice Sub-Specialist Microbiology 052 008 Pathology Independent Practice Sub-Specialist Infectious Diseases 052 009 Pathology Independent Practice Sub-Specialist Virology 054 000 General Dental Practice 055 000 Mental Health Institutions 056 000 Provincial Hospitals 056 001 Provincial Hospitals District Hospital 056 002 Provincial Hospitals Regional Hospital 056 003 Provincial Hospitals Tertiary/Academic Hospital 056 004 Provincial Hospitals DOH Oral healthcare Centre 056 009 Provincial Hospitals Primary Care 056 010 Provincial Hospitals DOH Orthotics & Prosthetics Centre 056 011 Provincial Hospitals Central Hospital 056 012 Provincial Hospitals Specialised Hospital 056 013 Provincial Hospitals Small District Hospital 056 014 Provincial Hospitals Medium District Hospital 056 015 Provincial Hospitals Large District Hospital 057 000 Private Hospitals ('A' - Status) 057 001 Private Hospitals ('A' - Status) +ICU +Theatre Less than 100 beds 057 002 Private Hospitals ('A' - Status) #NAME? 057 003 Private Hospitals ('A' - Status) #NAME? 057 004 Private Hospitals ('A' - Status) #NAME? 057 005 Private Hospitals ('A' - Status) #NAME? 057 006 Private Hospitals ('A' - Status) #NAME? 057 008 Private Hospital Lesotho #NAME? 057 100 Private Hospitals ('A' - Status) Mine Hospilals 057 200 Private Hospitals ('A' - Status) State subsidised 058 000 Private Hospitals ('B' - Status) 059 000 Private Rehab Hospital (Acute) 060 000 Pharmacies 060 001 Pharmacies Consultant Pharmacy 061 000 Pharmacotherapist 062 000 Maxillo-facial and Oral Surgery 064 000 Orthodontics 066 000 Occupational Therapy 067 000 Art Therapists 068 000 Podiatry 069 000 Medical Scientist Clinical Biochemist 069 001 Medical Scientist Genetic Councillor 069 002 Medical Scientist Medical Biological Scientist 069 003 Medical Scientist Medical Physicist 070 000 Optometrists 070 001 Supplementary Optometrists Visual Science,Ocular Pathology & Dispensing of Spectacles 071 000 Optical dispensers 071 001 Supplementary Optical dispensers No limitations 072 000 Physiotherapists 073 000 Masseurs 074 000 Orthoptists 075 000 Clinical technology 075 001 Clinical technology Cardio-Vascular Perfusion 075 002 Clinical technology Pulmonology 075 003 Clinical technology Nephrology 075 004 Clinical technology Reproductive biology 075 006 Clinical technology Neurophysiology 075 007 Clinical technology Critical Care 075 008 Clinical technology Cardiology 076 000 Unattached operating theatres / Day clinics 077 000 Approved U O T U / Day clinics 078 000 Blood transfusion services 079 000 Hospices 079 001 Hospices SA Cancer Associations 080 000 Nursing Agencies/Home Care Services 081 000 Registered Counsellors 082 000 Speech therapy and Audiology 082 001 Speech Therapy Only 082 002 Audiology Only 083 000 Hearing Aid Acoustician 084 000 Dieticians 085 000 Psychometry 086 000 Psychologists 086 001 Psychologists Clinical 086 002 Psychologists Counselling 086 003 Psychologists Educational 086 004 Psychologists Industrial 086 005 Psychologists Neuropsychologists 087 000 Orthotists & Prosthetists 088 000 Registered nurses 088 001 Registered nurses Midwife only 088 002 Registered nurses Psychiatric only 088 009 Registered nurses Primary Care 089 000 Social workers 090 000 Clinical services 090 001 Clinical services Oxygen Supplier 090 002 Clinical services Wheelchairs Supplier 090 003 Clinical services Ear & Voice Prosthetic Supplier 090 004 Clinical services Eye Prosthetic Supplier 090 005 Clinical services Breast Prosthetic Supplier 090 006 Clinical services Cardiac Prosthetic Supplier 090 007 Clinical services Stomal/appliances Supplier 090 008 Clinical services Medical General Supplier 090 009 Clinical services FAMSA (family and marriage counselling) 090 011 Clinical services Oncology units (not owned by hospital) 090 013 Clinical services Diabetes Appliances 090 014 Clinical Services Compression Bandaging & Bone Healing System 090 015 Clinical Services Parenteral Nutrition (TPN) - homecare 091 000 Biokinetics 092 000 Periodontics 093 000 Dental Technician 094 000 Prosthodontic 095 000 Dental therapy 096 000 Community dentistry 097 000 Independent Practice Specialist Public Health Medicine 098 000 Oral pathology 101 000 Naturopathy 102 000 Osteopathy 103 000 Phytotherapy 104 000 Ayurveda Ayurveda Practitioner 104 001 Ayurveda Primary Healthcare Advisor 104 002 Ayurveda Yoga Therapist 105 000 Acupuncturist 106 000 Therapeutic Aromatherapist 107 000 Therapeutic Massage Therapist 108 000 Therapeutic Reflexologist 109 000 Unani-Tibb 110 000 Clinical Pharmacokineticist 111 000 Radiopharmacist 112 000 Independent Practice Specialist Clinical Pharmacology 113 000 Oral Hygiene 114 000 Paediatric Surgery Independent Practice Specialist 115 000 Medical Genetics Haemophilia Related Complications Respiratory Haemorrhage from respiratory passages R04.0 Epistaxis Haemorrhage from respiratory passages R04.1 Haemorrhage from throat Haemorrhage from respiratory passages R04.2 Haemoptysis Haemorrhage from respiratory passages R04.8 Haemorrhage from other sites in respiratory passages Haemorrhage from respiratory passages R04.9 Haemorrhage from respiratory passages, unspecified

Joint M25.0 Haemarthrosis M25.00 Haemarthrosis, multiple sites M25.01 Haemarthrosis, shoulder region M25.02 Haemarthrosis, upper arm M25.03 Haemarthrosis, forearm M25.04 Haemarthrosis, hand M25.05 Haemarthrosis, pelvic region and thigh M25.06 Haemarthrosis, lower leg M25.07 Haemarthrosis, ankle and foot M25.08 Haemarthrosis, other site M25.09 Haemarthrosis, site unspecified

Dental Gingivitis and periodontal diseases K05 Gingivitis and periodontal diseases Gingivitis and periodontal diseases K05.0 Acute gingivitis Gingivitis and periodontal diseases K05.1 Chronic gingivitis Gingivitis and periodontal diseases K05 Gingivitis and periodontal diseases Gingivitis and periodontal diseases K05.0 Acute gingivitis Gingivitis and periodontal diseases K05.1 Chronic gingivitis Dental caries K02 Dental caries Dental caries K02.0 Caries limited to enamel Dental caries K02.1 Caries of dentine Dental caries K02.2 Caries of cementum Dental caries K02.3 Arrested dental caries Dental caries K02.4 Odontoclasia Dental caries K02.5 Caries with pulp exposure Dental caries K02.8 Other dental caries Dental caries K02.9 Dental caries, unspecified

GIT Vascular disorders of intestine K55.2 Angiodysplasia of colon Peptic ulcer, site unspecified K27.0 Peptic ulcer, site unspecified, acute with haemorrhage Peptic ulcer, site unspecified K27.2 Peptic ulcer, site unspecified, acute with both haemorrhage and perforation Peptic ulcer, site unspecified K27.4 Peptic ulcer, site unspecified, chronic or unspecified with haemorrhage Peptic ulcer, site unspecified K27.6 Peptic ulcer, site unspecified, chronic or unspecified with both haemorrhage and perforation Other diseases of digestive system K92.1 Melaena Other diseases of digestive system K92.0 Haematemesis

Genitourinary Recurrent and persistent haematuria N02 Recurrent and persistent haematuria Recurrent and persistent haematuria N02.0 Recurrent and persistent haematuria, minor glomerular abnormality Recurrent and persistent haematuria N02.1 Recurrent and persistent haematuria, focal and segmental glomerular lesions Recurrent and persistent haematuria N02.2 Recurrent and persistent haematuria, diffuse membranous glomerulonephritis Recurrent and persistent haematuria N02.3 Recurrent and persistent haematuria, diffuse mesangial proliferative glomerulonephritis Recurrent and persistent haematuria N02.4 Recurrent and persistent haematuria, diffuse endocapillary proliferative glomerulonephritis Recurrent and persistent haematuria N02.5 Recurrent and persistent haematuria, diffuse mesangiocapillary glomerulonephritis Recurrent and persistent haematuria N02.6 Recurrent and persistent haematuria, dense deposit disease Recurrent and persistent haematuria N02.7 Recurrent and persistent haematuria, diffuse crescentic glomerulonephritis Recurrent and persistent haematuria N02.8 Recurrent and persistent haematuria, other Recurrent and persistent haematuria N02.9 Recurrent and persistent haematuria, unspecified

Pregnancy Antenatal screening Z36.2 Other antenatal screening based on amniocentesis 5026 Ultrasound guided amniocentesis 2611 Chorion villus sampling (excluding after-care)

Pain Systemic disorders of connective tissue in diseasesM36.2 classifiedHaemophilic elsewhere arthropathy (D66-D68+) ABBREVIATIONS aPCC Activated prothrombin complex concentrate aPTT Activated partial thromboplastin time BA Bethesda Assay BC Buffered Citrol 1® Coagulation Control Level 1 BDDRFVIII B-domain-deleted recombinant factor VIII BNPP Buffered Normal Pooled Plasma BU/mL Bethesda unit per millilitre CFC Clotting factor concentrate Citrol 1 Dade® Citrol 1® Coagulation Control Level 1 CI Confidence interval CV Coefficient of variation ECAT External quality Control of diagnostic Assays and Tests Foundation FEIBA Factor Eight Inhibitor Bypassing Activity FLRFVIII Full-length recombinant factor VIII FVIII Factor VIII FIX Factor IX HCCC Haemophilia Comprehensive Care Centre ITI Immune tolerance induction LTA Low-titre FVIII inhibitor assay NA Nijmegen modification of the Bethesda Assay NBU/mL Nijmegen-Bethesda unit per millilitre NPP Normal Pooled Plasma pdFVIII Plasma-derived factor VIII PPP Platelet poor plasma PTP Previously treated patients PUP Previously untreated patients QC Quality control RCF Relative centrifugal force rFVIIa Recombinant activated Factor VII rFVIII Recombinant factor VIII