Discovery Health ER Casualty – New Codes

Item Description DH Rates KC Rates
  Emergency department    
7060 Emergency department visit for the evaluation and management of a patient, presenting problem(s) are self-limited or minor R 203.10 R 173.00
7061 Emergency department visit for the evaluation and management of a patient, presenting problem(s) are of low to moderate severity R 406.30 R 346.00
7062 Emergency department visit for the evaluation and management of a patient, presenting problem(s) are of moderate severity R 557.70 R 464.10
7063 Emergency department visit for the evaluation and management of a patient, the presenting problem(s) are of high severity, and require urgent evaluation by the medical practitioner but do not pose an immediate and significant threat to life or physiological function R 814.90 R 697.40
7064 Emergency department visit for the evaluation and management of a patient, the presenting problem(s) are of high severity, and require urgent evaluation by the medical practitioner and pose an immediate significant threat to life or physiological function R 1 377.10 R 1 177.10

 

 

Above is new rates for Discovery ER SAMA Codes that apply from 1st September 2017. Available for providers to use.
 
Dicovery only allows payment for the DHMS plans, including the KeyCare plans, if the GP is in the ER Casualty network 227.
 
For Key care claims the GP needs to be in the KeyCare Casualty network 353 and the ER Casualty network 227 to allow payment for the new ER SAMA codes.
 
Should you have questions around this, please do not hesitate to send an email to electronic@discovery.co.za for further support.
 
Regards,
ETM Team
Specialised Claims
Discovery Health

 

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