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Annex 1: List of Medical Case Rates

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Annex 1: List of Medical Case Rates ANNEX 1. LIST OF MEDICAL CASE RATES FIRST CASE RATE ICD CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee P91.3 Neonatal cerebral irritability ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 P91.4 Neonatal cerebral depression ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 P91.6 Hypoxic ischemic encephalopathy of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 P91.8 Other specified disturbances of cerebral status of newborn ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 P91.9 Disturbance of cerebral status of newborn, unspecified ABNORMAL SENSORIUM IN THE NEWBORN 12,000 3,600 8,400 Peritonsillar abscess; Abscess of tonsil; Peritonsillar J36 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 cellulitis; Quinsy Other diseases of larynx; Abscess of larynx; Cellulitis of larynx; Disease NOS of larynx; Necrosis of larynx; J38.7 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Pachyderma of larynx; Perichondritis of larynx; Ulcer of larynx Retropharyngeal and parapharyngeal abscess; J39.0 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Peripharyngeal abscess Other abscess of pharynx; Cellulitis of pharynx; J39.1 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Nasopharyngeal abscess Other diseases of pharynx; Cyst of pharynx or nasopharynx; J39.2 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Oedema of pharynx or nasopharynx J85.1 Abscess of lung with pneumonia ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 J85.2 Abscess of lung without pneumonia; Abscess of lung NOS ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 J85.3 Abscess of mediastinum ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 J86.0 Pyothorax with fistula ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 Pyothorax without fistula; Abscess of pleura; Abscess of J86.9 ABSCESS OF RESPIRATORY TRACT 10,000 3,000 7,000 thorax; Empyema; Pyopneumothorax A00.0 Cholera due to Vibrio cholerae 01, biovar cholerae ACUTE GASTROENTERITIS 6,000 1,800 4,200 A00.1 Cholera due to Vibrio cholerae 01, biovar eltor ACUTE GASTROENTERITIS 6,000 1,800 4,200 A00.9 Cholera, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200 Shigellosis due to Shigella dysenteriae; Group A shigellosis A03.0 ACUTE GASTROENTERITIS 6,000 1,800 4,200 [Shiga-Kruse dysentery] A03.1 Shigellosis due to Shigella flexneri;Group B shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.2 Shigellosis due to Shigella boydii; Group C shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.3 Shigellosis due to Shigella sonnei; Group D shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.8 Other shigellosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A03.9 Shigellosis, unspecified; ; Bacillary dysentery NOS ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.0 Enteropathogenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.1 Enterotoxigenic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.2 Enteroinvasive Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.3 Enterohaemorrhagic Escherichia coli infection ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.4 Other intestinal Escherichia coli infections ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.5 Campylobacter enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A04.6 Enteritis due to Yersinia enterocolitica ACUTE GASTROENTERITIS 6,000 1,800 4,200 Enterocolitis due to Clostridium difficile; Foodborne A04.7 intoxication by Clostridium difficile; Pseudomembranous ACUTE GASTROENTERITIS 6,000 1,800 4,200 colitis A04.8 Other specified bacterial intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200 Bacterial intestinal infection, unspecified. Bacterial enteritis A04.9 ACUTE GASTROENTERITIS 6,000 1,800 4,200 NOS A05.0 Foodborne staphylococcal intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200 Foodborne Clostridium perfringens [Clostridium welchii] A05.2 intoxication. Enteritis necroticans. ACUTE GASTROENTERITIS 6,000 1,800 4,200 Pig-bel A05.3 Foodborne Vibrio parahaemolyticus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200 A05.4 Foodborne Bacillus cereus intoxication ACUTE GASTROENTERITIS 6,000 1,800 4,200 A05.8 Other specified bacterial foodborne intoxications ACUTE GASTROENTERITIS 6,000 1,800 4,200 A05.9 Bacterial foodborne intoxication, unspecified ACUTE GASTROENTERITIS 6,000 1,800 4,200 A07.0 Balantidiasis; Balantidial dysentery ACUTE GASTROENTERITIS 6,000 1,800 4,200 A07.1 Giardiasis [lambliasis] ACUTE GASTROENTERITIS 6,000 1,800 4,200 A07.2 Cryptosporidiosis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Isosporiasis; Infection due to Isospora belli and Isospora A07.3 ACUTE GASTROENTERITIS 6,000 1,800 4,200 hominis; Intestinal coccidiosis; Isosporosis Other specified protozoal intestinal diseases; Intestinal A07.8 ACUTE GASTROENTERITIS 6,000 1,800 4,200 trichomoniasis; Sarcocystosis; Sarcosporidiosis Protozoal intestinal disease, unspecified;Flagellate A07.9 diarrhoea; Protozoal colitis; Protozoal diarrhoea; Protozoal ACUTE GASTROENTERITIS 6,000 1,800 4,200 dysentery A08.0 Rotaviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Acute gastroenteropathy due to Norwalk agent; Small A08.1 ACUTE GASTROENTERITIS 6,000 1,800 4,200 round structured virus enteritis A08.2 Adenoviral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 A08.3 Other viral enteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Viral intestinal infection, unspecified; Viral enteritis NOS; A08.4 ACUTE GASTROENTERITIS 6,000 1,800 4,200 Viral gastroenteritis NOS; Viral gastroenteropathy NOS A08.5 Other specified intestinal infections ACUTE GASTROENTERITIS 6,000 1,800 4,200 A09.0 Infectious diarrhea ACUTE GASTROENTERITIS 6,000 1,800 4,200 A09.9 Acute gastroenteritis ACUTE GASTROENTERITIS 6,000 1,800 4,200 K52.0 Gastroenteritis and colitis due to radiation ACUTE GASTROENTERITIS 6,000 1,800 4,200 K52.1 Toxic gastroenteritis and colitis ACUTE GASTROENTERITIS 6,000 1,800 4,200 Page 1 of 111 ANNEX 1. LIST OF MEDICAL CASE RATES FIRST CASE RATE ICD CODE DESCRIPTION GROUP Professional Health Care Case Rate Fee Institution Fee Allergic and dietetic gastroenteritis and colitis; Food K52.2 ACUTE GASTROENTERITIS 6,000 1,800 4,200 hypersensitivity gastroenteritis or colitis Other specified noninfective gastroenteritis and colitis; K52.8 ACUTE GASTROENTERITIS 6,000 1,800 4,200 Eosinophilic gastritis or gastroenteritis Noninfective gastroenteritis and colitis, unspecified; Diarrhoea specified as noninfective, or NOS in countries K52.9 where the conditions can be presumed to be of ACUTE GASTROENTERITIS 6,000 1,800 4,200 noninfectious origin; Enteritis specified as noninfective, or NOS in countries where the conditio K58.0 Irritable bowel syndrome with diarrhoea ACUTE GASTROENTERITIS 6,000 1,800 4,200 Acute renal failure with tubular necrosis; Tubular necrosis N17.0 ACUTE RENAL FAILURE 19,300 5,790 13,510 NOS; Acute Tubular necrosis ; Renal Tubular necrosis Acute renal failure with acute cortical necrosis; Cortical N17.1 necrosis NOS; Acute Cortical necrosis ; Renal Cortical ACUTE RENAL FAILURE 19,300 5,790 13,510 necrosis Acute renal failure with medullary necrosis; Medullary N17.2 papillary necrosis, NOS; Acute medullary papillary necrosis; ACUTE RENAL FAILURE 19,300 5,790 13,510 Renal medullary papillary necrosis N17.8 Other acute renal failure ACUTE RENAL FAILURE 19,300 5,790 13,510 N17.9 Acute renal failure, unspecified; ACUTE RENAL FAILURE 19,300 5,790 13,510 Renal failure following abortion and ectopic and molar O08.4 pregnancy; Oliguria Acute renal failure; Oliguria renal ACUTE RENAL FAILURE 19,300 5,790 13,510 shutdown; Oliguria renal tubular necrosis; Oliguria Uraemia Adult respiratory distress syndrome; Adult hyaline J80 ADULT RESPIRATORY DISTRESS SYNDROME 32,000 9,600 22,400 membrane disease T78.1 Other adverse food reactions, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340 T78.3 Angioneurotic oedema; Giant urticaria; Quinke's oedema ALLERGIC REACTIONS 6,200 1,860 4,340 Allergy, unspecified; Allergic reaction NOS; Hypersensitivity T78.4 ALLERGIC REACTIONS 6,200 1,860 4,340 NOS; Idiosyncracy NOS T78.8 Other adverse effects, not elsewhere classified ALLERGIC REACTIONS 6,200 1,860 4,340 T78.9 Adverse effect, unspecified ALLERGIC REACTIONS 6,200 1,860 4,340 Unspecified adverse effect of drug or medicament; Adverse effect of correct drug or medicament properly T88.7 administered; Allergic reactiion to correct drug or ALLERGIC REACTIONS 6,200 1,860 4,340 medicament properly administered; Hypersensitivity to correct drug or medicament properly administe A06.4 Amoebic liver abscess; Hepatic amoebiasis AMOEBIASIS, HEPATIC 10,000 3,000 7,000 Acute amoebic dysentery; Acute amoebiasis; Intestinal A06.0 AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 amoebiasis NOS A06.1 Chronic intestinal amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.2 Amoebic nondysenteric colitis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.3 Amoeboma of intestine; Amoeboma NOS AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.7 Cutaneous amoebiasis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 A06.8 Amoebic Appendicitis AMOEBIASIS, NONHEPATIC 6,000 1,800 4,200 E85.8 Other amyloidosis; Localized amyloidosis AMYLOIDOSIS 11,100 3,330 7,770 T78.0 Anaphylactic shock due to adverse food reaction ANAPHYLACTIC SHOCK 7,600 2,280 5,320 Anaphylactic shock, unspecified; Allergic shock NOS; T78.2 ANAPHYLACTIC SHOCK 7,600 2,280 5,320 Anaphylactic reaction NOS; Anaphylaxis NOS Anaphylactic shock due to adverse effect of correct drug or T88.6 ANAPHYLACTIC SHOCK 7,600 2,280 5,320 medicament properly administered Iron deficiency anaemia secondary to blood loss (chronic);
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