Dental Practices
Dental Practices
Xstrata Name Change to Glencore 2014-01-01
On 1 January 2014, the Xstrata Alloys Medical Aid Scheme name will change to Glencore Medical Scheme, and all our members will receive a new membership card (as shown on the right) with their existing membership number during the first quarter of 2014.
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The Scheme has also removed the 20% co-payment from certain benefits and introduced monetary limits for acute medicines, out-of-hospital pathology and additional medical services in hospital. Set out below are some of the Scheme’s benefit limits for 2014 including the new monetary limits: Benefit |
Monetary limits |
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Acute medicines |
Member: R4,000 Member +1 dependant: R7,000 Member +2 dependants: R9,000 Member +3 or more dependants: R10,000 |
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Medicine on discharge from hospital (TTOs) subject to the Acute medicine limit |
R392 per beneficiary per admission |
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Over the counter medicine subject to the Acute medicine limit |
R 1,300 per family with a maximum of R323 per script |
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GP and Specialist consultations out-of-hospital |
Member: R4,000 Member +1 dependant: R6,000 Member +2 dependants: R8,000 Member + 3 or more dependants: R10,000 |
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Related maternity services |
R6,466 per family |
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Additional medical services |
In-hospital: R10,000 per family Out-of-hospital: R3,578 per family |
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Rehab for substance abuse |
Included in the Mental Health limit |
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Pathology |
In hospital: Subject to the overall annual limit Out-of-hospital: R7,200 |
ICD 10 Codes For Dental Practice

ICD-10 Codes For Dental Practice
Date: 13 Jul 2012
Recommended Codes for Dental Billing and Claims

Z00-Z99 Factors influencing health status and contact with health Services
Z01.2= Routine Dental check – up.
Disorders of tooth development and eruption – K00
K00.0 Anodontia
K00.1 Supernumerary teeth
K00.2 Abnormalities of tooth size and form (macr/micro-dontia, dens in dente)
K00.3 Mottled teeth (Fluorosis)
K00.4 Disturbances in tooth formation
K00.5 Hereditary disturbances in tooth structure, not elsewhere classified ( Amylo/dentino-genisis imperfecta)
K00.6 Disturbances in tooth eruption (Natal/neonatal teeth, retained deciduous tooth)
K00.7 Teething syndrome
K00.8 Other disorders of tooth development (Colour changes due to blood incompatability, biliary malformation, porphyria)
K00.9 Disorders of tooth development, unspecified
Embedded and impacted teeth K01
K01.0 Embedded teeth
K01.1 Impacted teeth ( in contact with another tooth)
Dental caries K02
K02.0 Caries limited to enamel
K02.1 Caries of dentine
K02.2 Caries of cementum
K02.3 Arrested dental caries
K02.4 Odontoclasia (Infantile meladontia)
K02.8 Other dental caries
K02.9 Dental caries, unspecified
Other diseases of hard tissues of teeth – K03
- K03.0 Excessive attrition of teeth
- K03.1 Abrasion of teeth
- K03.2 Erosion of teeth
- K03.3 Pathological resorption of teeth
- K03.4 Hypercementosis
- K03.5 Ankylosis of teeth
- K03.6 Deposits [accretions] on teeth ( Diagnostic for S/P, root planning)
- K03.7 Posteruptive colour change of dental hard tissues (metal, pulp changes)
- K03.8 Other specified diseases of hard tissue of teeth (sensitive dentine)
- K03.9 Diseases of hard tissue or teeth, unspecified
Diseases of the pulp and periapical tissues – K04
K04.0 Pulpitis
K04.1 Necrosis of pulp
K04.2 Pulp degeneration ( pulp stones, sclerosis)
K04.3 Abnormal hard tissue formation in pulp (2ndary dentine)
K04.4 Acute apical periodontitis of pulpal origin
K04.5 Chronic apical periodontitis
K04.6 Periapical abscess with sinus
K04.7 Periapical abscess without sinus (dental abscess)
K04.8 Radicular cyst
K04.9 Other and unspecified diseases of the pulp and periapical tissues
Gingivitis and periodontal diseases K05
K05.0 Acute gingivitis
K05.1 Chronic gingivitis
K05.2 Acute Periodontitis ( includes acute pericoronitis)
K05.3 Chronic Periodontitis ( includes chronic pericoronitis)
K05.4 Periodontosis (juvenile)
K05.5 Other periodontal disease
K05.6 Periodontal disease, unspecified
Other diseases of the gingiva and edentulous alveolar ridges K06
K06.0 Gingival recession
K06.1 Gingival enlargement
K06.2 Gingiva and edentulous alveolar ridge lesions associated with trauma ( denture hyperplasia)
K06.8 Other specified disorders of the gingiva and edentulous alveolar ridge
K06.9 Disease of the gingiva and edentulous alveolar ridge, unspecified
Dento-facial anomalies including malocclusion – K07
K07.0 Major anomalies of jaw size (condylar hyperplasia,macro/micro gnathism)
K07.1 Anomalies of jaw-cranial base relationship (Asmetries, severe CL2 & CL3)
K07.2 Anomalies of dental arch relationship
K07.3 Anomalies of tooth position
K07.4 Malocclusion, unspecified
K07.5 Dento-facial functional abnormalities (retained infantile swallow, habits)
K07.6 Temporo-mandibular joint disorders (dislocations, clicks, pain)
K07.8 Other dento-facial anomalies
K07.9 Dento-facial anomaly, Unspecified
Other disorders of the teeth and supporting structures K08
K08.0 Exfoliation of teeth due to systemic disorders (Hypophosphatasia, scurvy)
K08.1 Loss of teeth due to extraction, accident or local periodontal disease (Use for dentures, bridges, implants)
K08.2 Atrophy of edentulous alveolar ridge (Use for grafts)
K08.3 Retained dental root
K08.8 Other specified disorders of teeth and supporting structures
K08.9 Disorders of teeth and supporting structures, unspecified
Cysts of oral origin, not elsewhere classified K09
K09.0 Developmental odontogenic cysts
K09.1 Developmental (non-odontogenic) cysts of oral origin (naso-palatine)
K09.2 Other cysts of jaws (aneurismal bone cyst)
K09.8 Other cysts of oral region, not elsewhere classified (dermoid)
K09.9 Cysts of oral region, unspecified
Other diseases of jaws K10
Developmental disorders of jaws K10.0 (Tori)
Giant cell granuloma, central K10.1
Inflammatory conditions of jaws K10.2 (Osteomyelitis, sequestra)
Alveolitis of jaws K10.3 (Dry socket)
Other specified diseases of jaws K10.8
Disease of jaws, unspecified K10.9
Diseases of the salivary glands K11
K11.0 Atrophy of salivary gland
K11.1 Hypertrophy of salivary gland
K11.2 Sialoadenitis
K11.3 Abscess of salivary gland
K11.4 Fistula of salivary gland
K11.5 Sialolithiasis (salivary calculus)
K11.6 Mucocoele of salivary gland
K11.7 Disturbances of salivary secretion (Xerostoma)
K11.8 Other diseases of salivary glands (Miculicz’)
K11.9 Disease of salivary gland, unspecified
Stomatitis and related lesions K12
K12.0 Recurrent oral aphthae
K12.1 Other forms of stomatitis
K12.2 Cellulitis and abscess of mouth
Other diseases of the lip and oral mucosa K13
K13.0 Diseases of lips (Angular chelitis)
K13.1 Cheek and lip biting
K13.2 Leukoplakia and other disturbances of the oral epithelium, including tongue
K13.3 Hairy Leukoplakia
K13.4 Granuloma and granuloma-like lesions of oral mucosa ( pyogenic granuloma)
K13.5 Oral submucous fibrosis
K13.6 Irritative hyperplasia of oral mucosa
K13.7 Other and unspecified lesions of oral mucosa
Diseases of the tongue K14
K14.0 Glossitis (ulcer, abscess)
K14.1 Geographic Tongue
K14.2 Median Rhomboid Glossitis
K14.3 Hypertrophy of papillae (black hairy tongue)
K14.4 Atrophy of papillae
K14.5 Plicated tongue (scrotal, fissured)
K14.6 Glossodynia
K14.8 Other diseases of the tongue
K14.9 Disease of the tongue, unspecified
Miscellaneous codes
Note that items in blue indicate changes or additions.
Administration of local anaesthetic: Use the primary code for the procedure being done e.g. if for caries removal, use K02.1
- Z01.2 Dental examination
- K03.6 Deposits (accretions) on teeth – use for scaling and polishing
- Z29.8 Other specified prophylactic measures – use for fluoride treatment , fissure sealants, mouth guard
- S02.51/Y34.99 Fracture of tooth (broken tooth) includes fracture of enamel, crown, root and for insertion of post in root of a fractured tooth(Note that for this diagnosis two 5-character codes must be used, separated by a forward slash)
- S02.6 Fracture of mandible (requires a 5th character:0 – closed or 1 – open)
- S03.21 Dislocation of tooth : luxation, extrusion or avulsion) (Note that this is a 5 character code plus an external cause code)
- T17 Foreign body in respiratory tract – (See 4 character codes in volume 1 or BHF disc for full list)
- T18 Foreign body in alimentary tract – (See 4 character codes in volume 1 or BHF disc for full list)
- Z46.3 Fitting and adjusting of dental prosthetic appliance (use for: recementation of crown/bridge, facing replacement/ Fractured repair/ease denture
- T81.0 Haemorrhage and haematoma complicating a procedure, not elsewhere specified
- Y48.3 (Reaction to) local anaesthetic
- Y61.0 Use for fractured endodontics instrument
- T88.8/Y88.29 Use for removal of fractured post, replacement of fractured filling in absence of caries
- T85.8 Use for implant insertion damaging inferior alveolar nerve
- Y60 Unintentional cut during surgical e.g.tongue/cheek laceration operation
- R20.8 Numbness of tongue or lip
- R20.2 Paraesthesia of tongue or lip
- Z53.2 Procedure not carried out because of patient’s decision for other and unspecified reasons Use for failed appointment
- Z48.0 Attention to surgical dressings and sutures (when original procedure done by other practitioner)
- Z46.4 Fitting + adjustment of orthodontic devices
- Z45.8 Adjustment + management of implanted devices
- § F45.8 Bruxism
- M25.58 Pain in TMJ
- J01.0 Acute Maxillary Sinusitis
- R20.2 Paraesthesia
- § K08.8 Toothache Use this only when diagnosis is not found elsewhere
- Y48.3 Complications from Local anaesthetic (must be preceded by a primary code
- T85.9 Unspecified complication of internal prosthetic device, implant and
- graft Use for surgical removal of failed implant
- Z29.2 Prophylactic antibiotic therapy
- Q38.0 Congenital malformation of lips NOS Use for lip frenectomy (not for cleft lip)
- Q38.1 Ankyloglossia Use for tongue frenectomy
- R06.5 for snoring device
- S03.22/W01.99 Avulsed tooth from fall
- Z41.8 Other procedures for purposes other than remedying health state Use e.g. for tooth whitening or patient requesting replacement of intact, non-carious amalgams with composite restorations.
- S03.21/Y04.28 Use for avulsed tooth resulting from fight at school. (In supplementary code: Y04 = assault by bodily force; .2 = at school;.-8 = during unspecified activity.
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Metropolitan Health MHG Administered Medical Schemes
Afrox
Alliance Midmed
Anglo Medical Scheme
Bankmed
BP
Engen
Fishmed
GEMS
IMPERIALMED
MEDiPOS
Metropolitan
Nampak SA Medical Scheme
Netcare Medical Scheme
NIMAS
PG Group Medical Scheme
Pick n Pay
POLMED
Sappi
South African Breweries Medical Aid Scheme
TopMed
Transmed
Wooltru
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TFG Medical Aid Scheme administered by Discovery Health
TFG Medical Aid Scheme to be administered by Discovery Health (Pty) Ltd from 1 January 2012
Discovery Health (Pty) Ltd administers 13 medical schemes at the moment. We’re pleased to let you know that from 1 January 2012, Discovery Health will also be administering TFG Medical Aid Scheme.
To ensure that healthcare providers and members of TFG Medical Aid Scheme experience a seamless transition in claiming under the new administrator, we include information about where you need to send claims for the members of TFG Medical Aid Scheme from 1 January 2012.
To identify themselves as valid members, members will carry membership cards issued by Discovery Health, branded with TFG Medical Aid Scheme logo. This is a typical example:
Submitting claims to TFG Medical Aid Scheme
Claims with a service date up to 31 December 2011
You can send claims with a service date up to 31 December to Metropolitan Health Group (MHG) as you have always done. You will have four months to send claims with a service date until the end of December 2011 to the Scheme. Any claims received after this will not be paid.
Claims with a service date from 1 January 2012
Please send claims for members of TFG Medical Aid Scheme to Discovery Health from 1 January 2012. You will need to use the member’s new membership number, which is printed on the newly issued membership cards.
Planned hospital admissions
Discovery Health will transfer all approved hospital admissions of members for 2012 to its administration database.
Reimbursement of claims for members of TFG Medical Aid Scheme
The Scheme will reimburse all GP’s in the GP network at the network rate, although TFGMAS benefits will apply. TFGMAS has also adopted the Premier Rate Payment Arrangement for 2012. TFG Medical Aid Scheme has also adopted the Discovery Health Rate as their rate of reimbursement of all claims with certain exceptions which will continue to be covered at the specific TFGMAS tariff.
Medical Aid Telephone Numbers
MEDICAL AID CONTACT TELEPHONE NUMBERS
Courtesy of Medinol Practice Management Software
| Medical Aid Name | Telephone Number |
| AFRISAM SA MEDICAL SCHEME | 011-767-7242 |
| AFROX MEDICAL AID SOCIETY | 0800-003-749 |
| ALLCARE | 011-290-6200 |
| ALLIANCE MIDMED MED SCHEME | 086-000-2101 |
| ALTRON MEDICAL AID SCHEME | 011-290-6200 |
| ANGLOAMERICAN | 0860-222-633 |
| ANGLOVAAL | 0860-100-456 |
| AUTOMED | 021-948-6400 |
| BANKMED | 0800-226-5633 |
| BARLOWORLD MEDICAL SCHEME | 086-111-2666 |
| BENMED | 011-293-1600 |
| BESTMED MEDICAL SCHEME | 086-000-2378 |
| BMW EMPLOYEES MEDICAL AID SOCIETY | 086-000-2107 |
| BONITAS MEDICAL FUND | 0860-002-147 |
| BP MEDICAL AID SOCIETY | 021-480-4610 |
| BUILDING & CONSTRUCTION INDUSTRY MEDICAL FUND | 011-208-1000 |
| BUILDINGMED | 021-950-7400 |
| BUILT ENVIRONMENT PROFESSIONAL ASSOC (BEPMED) | 031-5734000 |
| CAPE MEDICAL PLAN | 086-010-2930 |
| CARECROSS | 0860-101-159 |
| CARLTON PAPER | 021-423-2609 |
| CHARTERED ACCOUNTANTS MEDICAL AID FUND (CAMAF) | 086-170-0600 |
| CLICKS GROUP MEDICAL SCHEME | 021-4601202 |
| COMMED | 086-131-1911 |
| COMMUNITY MEDICAL AID SCHEME (COMMED) | 011-290-6338 |
| COMPCARE WELLNESS MEDICAL SCHEME | 011-2081000 |
| DE BEERS BENEFIT SOCIETY | 053-807-3111 |
| DENIS | 860033647 |
| DISCOVERY HEALTH MEDICAL SCHEME | 0860-445-566 |
| DRC | 086-111-5057 |
| EDCON MEDICAL AID SCHEME | 011-495-6707 |
| ENGEN MEDICAL BENEFIT FUND | 080-000-1615 |
| EYETHUMED MEDICAL SCHEME | 0860-502-502 |
| FEDHEALTH MEDICAL SCHEME | 0860-104-555 |
| FISHING INDUSTRY MEDICAL SCHEME (FISH-MED) | 086-010-4121 |
| FOOD WORKERS MEDICAL BENEFIT FUND | 021-9303550 |
| FOSCHINI GROUP MEDICAL AID SCHEME | 021-480-5064 |
| GEMS | 086-000-4367 |
| GEN-HEALTH MEDICAL SCHEME | 011-457-8700 |
| GENESIS MEDICAL SCHEME | 0860-102-010 |
| GOLD FIELDS MEDICAL SCHEME | 041-395-4400 |
| GOLDEN ARROWS EMPLOYEES MEDICAL BENEFIT FUND | 0860-104-122 |
| GOOD HOPE MEDICAL AID SOCIETY | 011-208-1000 |
| GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) | 012-362-6321 |
| GRINTEK ELECTRONICS MEDICAL AID SCHEME | 011-208-1000 |
| HOSMED MEDICAL AID SCHEME | 0860-000-048 |
| IBM (SA) MEDICAL SCHEME | 086-010-0418 |
| IMPALA MEDICAL PLAN | 014-5697597 |
| IMPERIAL GROUP MEDICAL SCHEME | 086-046-7374 |
| INGWE HEALTH PLAN | 086-010-2493 |
| KEYHEALTH | 086-067-1050 |
| KILOCARE | 021-931-7356 |
| LA-HEALTH MEDICAL SCHEME | 021-555-4727 |
| LAMAF | 021-402-8840 |
| LIBCARE MEDICAL SCHEME | 080-012-2273 |
| LIBERTY MEDICAL SCHEME | 086-000-2163 |
| LONMIN MEDICAL SCHEME | 086-010-4883 |
| MALCOR MEDICAL SCHEME | 011-372-1500 |
| MASSMART HEALTH PLAN | 086-000-2117 |
| MBMED MEDICAL AID FUND | 011-510-2000 |
| MEDCOR | 012-673-8733 |
| MEDICOVER | 086-000-2163 |
| MEDIHELP | 086-010-0678 |
| MEDIMED MEDICAL SCHEME | 041-395-4400 |
| MEDIPOS MEDICAL SCHEME | 086-010-0078 |
| MEDSHIELD MEDICAL SCHEME | 0860-002-147 |
| MEDSCHEME | 086-111-2666 |
| METHEALTH | 021-480-4411 |
| METROCARE | 086-000-2123 |
| METROPOLITAN MEDICAL SCHEME | 086-188-8104 |
| MIMED | 011-329-8800 |
| MINEMED MEDICAL SCHEME | 041-395-4400 |
| MOMENTUM HEALTH | 086-011-7859 |
| MOREMED MEDICAL SCHEME | 086-010-1103 |
| MOTO HEALTH CARE | 086-132-9800 / 0861 000 300 |
| MUNIMED | 0860-671-1050 |
| MX HEALTH | 012-673-8985 |
| NAMPAK (SA) MEDICAL SCHEME | 086-010-1047 |
| NASPERS MEDICAL FUND | 0860-445-5666 |
| NATIONAL INDEPENDENT MEDICAL AID SOCIETY (NIMAS) | 0860-100-670 |
| NBC MED | 011-290-6200 |
| NEDGROUP MEDICAL AID SCHEME | 086-111-2666 |
| NETCARE MEDICAL SCHEME | 086-010-3406 |
| NIMAS | 0860-100-671 |
| NMP (NATIONAL) | 031-573-4000 |
| OLD MUTUAL STAFF MEDICAL AID FUND | 0860-100-456 |
| OMNI-HEALTH | 0860-888-014 |
| OPMED | 012-427-5333 |
| ONE CARE | 011-234-3578 |
| OXYGEN MEDICAL SCHEME | 021-532-6800 or 0860 101 233 |
| PARMED MEDICAL AID SCHEME | 086-000-2126 |
| PG BISON MEDICAL AID SOCIETY | 086-010-9595 |
| PG GROUP MEDICAL SCHEME | 11-417-5800 |
| PHAROS MEDICAL PLAN | 031-267-5000 |
| PICK N PAY MEDICAL SCHEME | 080-000-4389 |
| POLMED | 086-076-5633 |
| PLATINUM HEALTH | 014-591-3069 |
| PRIMECURE | 086-166-5665 |
| PROFMED | 086-067-9200 |
| PROSANO MEDICAL SCHEME | 0860-002-035 |
| PROFMED | 011-628-8904 |
| PROTEA MEDICAL AID SOCIETY | 021-552-7111 |
| PROTECTOR | 012-421-2022 |
| PROVIA | 0860-102-472 |
| PROVIDENCE | 041-395-4545 |
| PUREHEALTH MEDICAL SCHEME | 086-010-9393 |
| QUANTUM MEDICAL AID SOCIETY | 086-010-2958 |
| RAND WATER MEDICAL SCHEME | 011-682-0560 |
| REMEDI MEDICAL AID SCHEME | 0860-102-472 |
| RESOLUTION HEALTH MEDICAL SCHEME | 0861-111-778 |
| RETAIL MEDICAL SCHEME | 021-980-4465 |
| RHODES UNIVERSITY MEDICAL SCHEME | 041-395-4476 |
| S A BREWERIES MEDICAL AID SOCIETY | 086-000-2133 |
| SABC MEDICAL AID SCHEME | 086-000-2136 |
| SAMWUMED | 086-010-4117 |
| SAPPI MEDICAL AID SCHEME | 086-010-1280 |
| SASOLMED | 086-000-2134 |
| SEDMED | 051-4478271 |
| SELFMED MEDICAL SCHEME | 086-010-5508 |
| SIEMENS MEDICAL SCHEME | 011-671-2000 |
| SIZWE MEDICAL FUND | 0860-100-871 |
| S.A. POLICE SERVICE MEDICAL SCHEME (POLMED) | 012-431-0239 |
| SOVEREIGN HEALTH | 031-367-6800 |
| SPECTRAMED | 0861-497-497 |
| STATUS – UNIVERSAL | 011-208-1000 |
| STOCKSMED | 086-000-2137 |
| SUREMED HEALTH | 086-008-0888 |
| TELEMED | 0860-119-553 |
| THEBEMED | 011-5448899 |
| TIGER BRANDS MEDICAL SCHEME | 011-2081000 |
| TOPMED MEDICAL SCHEME | 0860-002-158 |
| TRANSMED MEDICAL FUND | 080-011-0268 |
| TRAWLMED | 021-712-8775 |
| TSOGO SUN GROUP MEDICAL SCHEME | 086-010-0421 |
| UMED | 012-667-8008 |
| UMVUZO HEALTH MEDICAL SCHEME | 012-8450000 |
| UNIVERSITY OF KWAZULU NATAL MEDICAL SCHEME | 031-260-1007 |
| UNIVERSITY OF WITWATERSRAND STAFF MEDICAL AID | 086000-2140 |
| WITBANK COALFIELDS MEDICAL AID SCHEME | 013-6561407 |
| WOOLTRU HEALTHCARE FUND | 080-222-8922 |
| XPRESS CARE | 011-375-3000 |
| XSTRATA MEDICAL AID SCHEME | 086-000-2141 |
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