CODE:

906A

DIAGNOSIS:

ACUTE GENERALISED PARALYSIS, INCLUDING POLIO AND GUILLAIN-BARRE

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION AND PLASMAPHERESIS

CODE:

341A

DIAGNOSIS:

BASAL GANGLIA, EXTRA-PYRAMIDAL DISORDERS; OTHER DYSTONIAS NOS

TREATMENT:

INITIAL DIAGNOSIS; INITIATION OF MEDICAL MANAGEMENT

CODE:

950A

DIAGNOSIS:

BENIGN AND MALIGNANT BRAIN TUMOURS, TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY AND CHEMOTHERAPY

CODE:

49A

DIAGNOSIS:

COMPOUND/DEPRESSED FRACTURES OF SKULL

TREATMENT:

CRANIOTOMY/CRANIECTOMY

CODE:

213A

DIAGNOSIS:

DIFFICULTY IN BREATHING, EATING, SWALLOWING, BOWEL, OR BLADDER CONTROL DUE TO NON-PROGRESSIVE NEUROLOGICAL (INCLUDING SPINAL) CONDITION OR INJURY

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT; VENTILATION

CODE:

83A

DIAGNOSIS:

ENCEPHALOCELE; CONGENITAL HYDROCEPHALUS

TREATMENT:

SHUNT; SURGERY

CODE:

902A

DIAGNOSIS:

EPILEPSY (STATUS EPILEPTICUS, INITIAL DIAGNOSIS, CANDIDATE FOR NEUROSURGERY)

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION; NEUROSURGERY

CODE:

211A

DIAGNOSIS:

INTRASP1NAL AND INTRACRANIAL ABSCESS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

905A

DIAGNOSIS:

MENINGITIS - ACUTE AND SUBACUTE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

513A

DIAGNOSIS:

MYASTHENIA GRAVIS; MUSCULAR DYSTROPHY; NEURO-MYOPATHIES NOS

TREATMENT:

INITIAL DIAGNOSIS; INITIATION OF MEDICAL MANAGEMENT; THERAPY FOR ACUTE COMPLICATIONS AND EXACERBATIONS

CODE:

510A

DIAGNOSIS:

PERIPHERAL NERVE INJURY WITH OPEN WOUND

TREATMENT:

NEUROPLASTY

CODE:

940A

DIAGNOSIS:

REVERSIBLE CNS ABNORMALITIES DUE TO OTHER SYSTEMIC DISEASE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

1A

DIAGNOSIS:

SEVERE/MODERATE HEAD INJURY: HEMATOMA/EDEMA WiTH LOSS OF CONSCIOUSNESS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT; VENTILATION

CODE:

MA

DIAGNOSIS:

SPINA BIFIDA

TREATMENT:

SURGICAL MANAGEMENT

CODE:

941A

DIAGNOSIS:

SPINAL CORD COMPRESSION, ISHAEMIA OR DEGENERATIVE DISEASE NOS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

901A

DIAGNOSIS:

STROKE - DUE TO HAEMORRHAGE, OR ISCHAEMIA

TREATMENT:

MEDICAL MANAGEMENT; SURGERY

CODE:

28A

DIAGNOSIS:

SUBARACHNOID AND INTRACRANIAL HEMORRHAGE/HEMATOMA; COMPRESSION OF BRAIN

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

305A

DIAGNOSIS:

TETANUS

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION

CODE:

265A

DIAGNOSIS:

TRANSIENT CEREBRAL ISCHEMIA; LIFE-THREATENING CEREBROVASCULAR CONDITIONS NOS

TREATMENT:

EVALUATION; MEDICAL MANAGEMENT; SURGERY

CODE:

109A

DAGNOSIS:

VERTEBRAL DISLOCATIONS/FRACTURES, OPEN OR CLOSED WITH INJURY TO SPINAL CORD

TREATMENT:

REPAIR/RECONSTRUCTION; MEDICAL MANAGEMENT; INPATIENT REHABILITATION UP TO 2 MONTHS

CODE:

684A

DIAGNOSIS:

VIRAL MENINGITIS, ENCEPHAUTIS, MYELITIS AND ENCEPHALOMYELITIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

47B

DIAGNOSIS:

ACUTE ORBITAL CELLULITIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

394B

DIAGNOSIS:

ANGLE-CLOSURE GLAUCOMA

TREATMENT:

IRIDECTOMY; LASER SURGERY; MEDICAL AND SURGICAL MANAGEMENT

CODE:

586B

DIAGNOSIS:

BELL'S PALSY; EXPOSURE KERATOCONJUNCTIVITIS

TREATMENT:

TARSORRHAPHY; MEDICAL AND SURGICAL MANAGEMENT

CODE:

950B

DIAGNOSIS:

CANCER OF EYE & ORBIT - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY AND CHEMOTHERAPY

CODE:

901 B

DIAGNOSIS:

CATARACT; APHAKIA

TREATMENT:

EXTRACTION OF CATARACT; LENS IMPLANT

CODE:

911B

DIAGNOSIS:

CORNEAL ULCER; SUPERFICIAL INJURY OF EYE AND ADNEXA

TREATMENT:

CONJUNCTIVAL FLAP; MEDICAL MANAGEMENT

CODE:

4058

DIAGNOSIS:

GLAUCOMA ASSOCIATED WITH DISORDERS OF THE LENS

TREATMENT:

SURGICAL MANAGEMENT

CODE:

386B

DIAGNOSIS:

HERPES ZOSTER & HERPES SIMPLEX WITH OPHTHALMIC COMPLICATIONS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

389B

DIAGNOSIS:

HYPHEMA

TREATMENT:

REMOVAL OF BLOOD CLOT; OBSERVATION

CODE:

4858

DIAGNOSIS:

INFLAMMATION OF LACRIMAL PASSAGES

TREATMENT:

INCISION; MEDICAL MANAGEMENT

CODE:

909B

DIAGNOSIS:

OPEN WOUND OF EYEBALL AND OTHER EYE STRUCTURES

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

407B

DIAGNOSIS:

PRIMARY AND OPEN ANGLE GLAUCOMA WITH FAILED MEDICAL MANAGEMENT

TREATMENT:

TRABECULECTOMY; OTHER SURGERY

CODE:

4198

DIAGNOSIS:

PURULENT ENDOPHTHALMITIS

TREATMENT:

VITRECTOMY

CODE:

922B

DIAGNOSIS:

RETAINED INTRAOCULAR FOREIGN BODY

TREATMENT:

SURGICAL MANAGEMENT

CODE:

904B

DIAGNOSIS:

RETINAL DETACHMENT, TEAR AND OTHER RETINAL DISORDERS

TREATMENT:

VITRECTOMY; LASER TREATMENT; OTHER SURGERY

CODE:

906B

DIAGNOSIS:

RETINAL VASCULAR OCCLUSION; CENTRAL RETINAL VEIN OCCLUSION

TREATMENT:

LASER SURGERY

CODE:

4098

DIAGNOSIS:

SYMPATHETIC UVEITIS AND DEGENERATIVE DISORDERS AND CONDITIONS OF GLOBE; SIGHT THREATENING THYROID OPTOPATHY

TREATMENT:

ENUCLEATION; MEDICAL MANAGEMENT; SURGERY

CODE:

33C

DIAGNOSIS:

ACUTE AND CHRONIC MASTOIDITIS

TREATMENT:

MASTOIDECTOMY; MEDICAL MANAGEMENT

CODE:

482C

DIAGNOSIS:

ACUTE OTITIS MEDIA

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, INCLUDING MYRINGOTOMY

CODE:

900C

DIAGNOSIS:

ACUTE UPPER AIRWAY OBSTRUCTION, INCLUDING CROUP, EPIGLOTTITIS AND ACUTE LARYNGOTRACHEITIS

TREATMENT:

MEDICAL MANAGEMENT; INTUBATION; TRACHEOSTOMY

CODE:

950C

DIAGNOSIS:

CANCER OF ORAL CAVITY, PHARYNX, NOSE, EAR, AND LARYNX - TREATABLE.

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

241C

DIAGNOSIS:

CANCRUM ORIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

38C

DIAGNOSIS:

CHOANAL ATRESIA

TREATMENT:

REPAIR OF CHOANAL ATRESIA

CODE:

133C

DIAGNOSIS:

CHOLESTEATOMA

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

910C

DIAGNOSIS:

CHRONIC UPPER AIRWAY OBSTRUCTION, RESULTING IN CORPULMONALE

TREATMENT:

SURGICAL AND MEDICAL MANAGEMENT

CODE:

901C

DIAGNOSIS:

CLEFT PALATE AND/OR CLEFT LIP WITHOUT AIRWAY OBSTRUCTION

TREATMENT:

REPAIR

CODE:

12C

DIAGNOSIS:

DEEP OPEN WOUND OF NECK, INCLUDING LARYNX; FRACTURE OF LARYNX OR TRACHEA, OPEN

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT; VENTILATION

CODE:

346C

DIAGNOSIS:

EPISTAXIS - NOT RESPONSIVE TO ANTERIOR PACKING

TREATMENT:

CAUIERY / REPAIR / CONTROL HEMORRHAGE

CODE:

521C

DIAGNOSIS:

FOREIGN BODY IN EAR & NOSE

TREATMENT:

REMOVAL OF FOREIGN BODY; AND MEDICAL AND SURGICAL MANAGEMENT

CODE:

29C

DIAGNOSIS:

FOREIGN BODY IN PHARYNX, LARYNX, TRACHEA, BRONCHUS & ESOPHAGUS

TREATMENT:

REMOVAL OF FOREIGN BODY

CODE:

339C

DIAGNOSIS:

FRACTURE OF FACE BONES, ORBIT, JAW; INJURY TO OPTIC AND OTHER CRANIAL NERVES

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

219C

DIAGNOSIS:

LEUKOPLAKIA OF ORAL MUCOSA, INCLUDING TONGUE

TREATMENT:

INCISION/EXCISION; MEDICAL MANAGEMENT.

CODE:

132C

DIAGNOSIS:

LIFE-THREATENING DISEASES OF PHARYNX NOS, INCLUDING RETROPHARYNGEAL ABSCESS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

457C

DIAGNOSIS:

OPEN WOUND OF EAR-DRUM

TREATMENT:

TYMPANOPLASTY; MEDICAL MANAGEMENT

CODE:

240C

DIAGNOSIS:

PERITONSILLAR ABSCESS

TREATMENT:

INCISION AND DRAINAGE OF ABSCESS; TONSILLECTOMY; MEDICAL MANAGEMENT

CODE:

347C

DIAGNOSIS:

SIALOADENITIS; ABSCESS / FISTULA OF SALIVARY GLANDS

TREATMENT:

SURGERY

CODE:

543C

DIAGNOSIS:

STOMATITIS, CELLULITIS AND ABSCESS OF ORAL SOFT TISSUE; VINCENTS ANGINA

TREATMENT:

INCISION AND DRAINAGE; MEDICAL MANAGEMENT

CODE:

903D

DIAGNOSIS:

BACTERIAL, VIRAL, FUNGAL PNEUMONIA

TREATMENT:

MEDICAL MANAGEMENT, VENTILATION.

CODE:

158D

DIAGNOSIS:

# RESPIRATORY FAILURE, REGARDLESS OF CAUSE

TREATMENT:

# MEDICAL MANAGEMENT; OXYGEN; VENTILATION

CODE:

157D

DIAGNOSIS:

ACUTE ASTHMATIC AUACK; PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3

TREATMENT:

MEDICAL MANAGEMENT

CODE:

125D

DIAGNOSIS:

ADULT RESPIRATORY DISTRESS SYNDROME; INHALATION AND ASPIRATION PNEUMONIAS

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION

CODE:

315D

DIAGNOSIS:

ATELECTASIS (COLLAPSE OF LUNG)

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT; VENTILATION

CODE:

MOD

DIAGNOSIS:

BENIGN NEOPLASM OF RESPIRATORY AND INTRATHORACIC ORGANS

TREATMENT:

BIOPSY; LOBECTOMY; MEDICAL MANAGEMENT; RADIATION THERAPY

CODE:

950D

DIAGNOSIS:

CANCER OF LUNG, BRONCHUS, PLEURA, TRACHEA, MEDIASTINUM & OTHER RESPIRATORY ORGANS -TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

1 7OD

DIAGNOSIS:

EMPYEMA AND ABSCESS OF LUNG

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

934D

DIAGNOSIS:

FRANK HAEMOPTYISIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

2O3D

DIAGNOSIS:

HYPOPLASIA AND DYSPLASIA OF LUNG

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

900D

DIAGNOSIS:

OPEN FRACTURE OF RIBS AND STERNUM; MULTIPLE RIB FRACTURES; FLAIL CHEST

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, VENTILATION

CODE:

SD

DIAGNOSIS:

PNEUMOTHORAX AND HAEMOTHORAX.

TREATMENT:

TUBE THORACOSTOMY / THORACOTOMY

CODE:

155E

DIAGNOSIS:

MYOCARDITIS; CARDIOMYOPATHY; TRANSPOSITION OF GREAT VESSELS; HYPOPLASTIC LEFT HEART SYNDROME.

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT; CARDIAC TRANSPLANT

CODE:

108E

DIAGNOSIS:

PERICARDITIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

907E

DIAGNOSIS:

ACUTE AND SUBACUTE ISCHEMIC HEART DISEASE, INCLUDING MYOCARDIAL INFARCTION AND UNSTABLE ANGINA

TREATMENT:

MEDICAL MANAGEMENT; SURGERY; PERCUTANEOUS PROCEDURES

CODE:

284E

DIAGNOSIS:

ACUTE PULMONARY HEART DISEASE AND PULMONARY EMBOLI

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

35E

DIAGNOSIS:

ACUTE RHEUMATIC FEVER

TREATMENT:

MEDICAL MANAGEMENT

CODE:

908E

DIAGNOSIS:

ANEURYSM OF MAJOR ARTERY OF CHEST, ABDOMENI NECK, -UNRUPTURED OR RUPTURED NOS

TREATMENT:

SURGICAL MANAGEMENT

CODE:

26E

DIAGNOSIS:

ARTERIAL EMBOLISM/THROMBOSIS: ABDOMINAL AORTA, THORAC1C AORTA

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

204E

DIAGNOSIS:

CARDIAC FAILURE: ACUTE OR RECENT DETERIORATION OF CHRONIC CARDIAC FAILURE

TREATMENT:

MEDICALTREATMENT

CODE:

98E

DIAGNOSIS:

COMPLETE, CORRECTED AND OTHER TRANSPOSTION OF GREAT VESSELS

TREATMENT:

REPAIR

CODE:

97E

DIAGNOSIS:

CORONARY ARTERY ANOMALY

TREATMENT:

ANOMALOUS CORONARY ARTERY LIGATION

CODE:

309E

DIAGNOSIS:

DISEASES AND DISORDERS OF AORTIC VALVE NOS

TREATMENT:

AORTIC VALVE REPLACEMENT

CODE:

210E

DIAGNOSIS:

DISEASES OF ENDOCARDIUM; ENDOCARDITIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

314E

DIAGNOSIS:

DISEASES OF MITRAL VALVE

TREATMENT:

VALVULOPLASTY; VALVE REPLACEMENT; MEDICAL MANAGEMENT

CODE:

902E

DIAGNOSIS:

DISORDERS OF ARTERIES: VISCERAL

TREATMENT:

BYPASS GRAFT; SURGICAL MANAGEMENT

CODE:

18E

DIAGNOSIS:

DISSECTING OR RUPTURED AORTIC ANEURYSM

TREATMENT:

SURGICAL MANAGEMENT

CODE:

915E

DIAGNOSIS:

GANGRENE; SEVERE ATHEROSCLEROSIS OF ARTERIES OF EXTREMITIES; DIABETES MELLITUS WITH PERIPHERAL CIRCULATORY DISEASE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT INCLUDING AMPUTATION

CODE:

294E

DIAGNOSIS:

GIANT CELL ARTERITIS, KAWASAKI DISEASE, HYPERSENSITIVITY ANGIITIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

450E

DIAGNOSIS:

HEREDITARY HEMORRHAGIC TELANGIECTASIA

TREATMENT:

EXCISION

CODE:

901E

DIAGNOSIS:

HYPERTENSION - ACUTE LIFE-THREATENING COMPLICATIONS AND MALIGNANT HYPERTENSION; RENAL ARTERY STENOSIS AND OTHER CURABLE HYPERTENSION

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

111E

DIAGNOSIS:

INJURY TO MAJOR BLOOD VESSELS - TRUNK, HEAD AND NECK, AND UPPER LIMBS

TREATMENT:

REPAIR

CODE:

19E

DIAGNOSIS:

INJURY TO MAJOR BLOOD VESSELS OF EXTREMITIES

TREATMENT:

LIGATION

CODE:

903E

DIAGNOSIS:

LIFE-THREATENING CARDIAC ARRHYTHMIAS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, PACEMAKERS, CARDIOVERSION

CODE:

900E

DIAGNOSIS:

LIFE-THREATENING COMPLICATIONS OF ELECTIVE CARDIAC AND MAJOR VASCULAR PROCEDURES

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

497E

DIAGNOSIS:

MULTIPLE VALVULAR DISEASE

TREATMENT:

SURGICAL MANAGEMENT

CODE:

355E

DIAGNOSIS:

OTHER ANEURYSM OF ARTERY - PERIPHERAL

TREATMENT:

SURGICAL MANAGEMENT

CODE:

905E

DIAGNOSIS:

OTHER CORRECTABLE CONGENITAL CARDIAC CONDITIONS

TREATMENT:

SURGICAL REPA!R; MEDICAL MANAGEMENT

CODE:

100E

DIAGNOSIS:

PATENT DUCTUS ARTERIOSUS; AORTIC PULMONARY FISTULA - PERSISTENT

TREATMENT:

LIGATION

CODE:

209E

DIAGNOSIS:

PHLEBITIS & THROMBOPHLEBITIS, DEEP

TREATMENT:

LIGATION AND DIVISION; MEDICAL MANAGEMENT

CODE:

914E

DIAGNOSIS:

RHEUMATIC PERICARDITIS; RHEUMATIC MYOCARDITIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

16E

DIAGNOSIS:

RUPTURE OF PAP1LLARY MUSCLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

627E

DIAGNOSIS:

SHOCK / HYPOTENSION - LIFE THREATENING

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION

CODE:

99E

DIAGNOSIS:

TETRALOGY OF FALLOT (TOF)

TREATMENT:

TOTAL REPAIR TETRALOGY

CODE:

93E

DIAGNOSIS:

VENTRICULAR SEPTAL DEFECT - PERSISTENT

TREATMENT:

CLOSURE

CODE:

920F

DIAGNOSIS:

ANAL FISSURE; ANAL FISTULA

TREATMENT:

FISSURECTOMY; FISTULECTOMY; MEDICAL MANAGEMENT

CODE:

41F

DIAGNOSIS:

ABSCESS OF INTESTINE

TREATMENT:

DRAIN ABSCESS; MEDICAL MANAGEMENT

CODE:

489F

DIAGNOSIS:

ACQUIRED HYPERTROPHIC PYLORIC STENOSIS AND OTHER DISORDERS OF THE STOMACH AND DUODENUM

TREATMENT:

SURGICAL MANAGEMENT

CODE:

254F

DIAGNOSIS:

ACUTE DIVERTICULITIS OF COLON

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, INCLUDING COLON RESECTION

CODE:

124F

DIAGNOSIS:

ACUTE VASCULAR INSUFFICIENCY OF INTESTINE

TREATMENT:

COLECTOMY

CODE:

337F

DIAGNOSIS:

AMOEBIASIS; TYPHOID

TREATMENT:

MEDICAL MANAGEMENT

CODE:

264F

DIAGNOSIS:

ANAL AND RECTAL POLYP

TREATMENT:

EXCISION OF POLYP

CODE:

9F

DIAGNOSIS:

APPENDICITIS

TREATMENT:

APPENDECTOMY

CODE:

952F

DIAGNOSIS:

CANCER OF RETROPERITONEUM, PERITONEUM, OMENTUM & MESENTERY - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

950C

DIAGNOSIS:

CANCER OF THE GASTRO-INTESTINAL TRACT INCLUDING OESOPHAGUS, STOMACH, BOWEL, RECTUM, ANUS - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY AND CHEMOTHERAPY

CODE:

9SF

DIAGNOSIS:

CONGENITAL ANOMALIES OF UPPER ALIMENTARY TRACT - EXCLUDING TONGUE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

214F

DIAGNOSIS:

OESOPHAGEAL STRICTURE

TREATMENT:

DILATION; SURGERY

CODE:

S16F

DIAGNOSIS:

ESOPHAGEAL VARICES

TREATMENT:

MEDICAL MANAGEMENT; SURGICAL SHUNT; SCLEROTHERAPY

CODE:

9O2F

DIAGNOSIS:

GASTRIC OR INTESTINAL ULCERS WITH HEMORRHAGE OR PERFORATION

TREATMENT:

SURGERY; ENDOSCOPIC DIAGNOSIS; MEDICAL MANAGEMENT

CODE:

901F

DIAGNOSIS:

GASTROENTERITIS AND COLITIS WITH LIFE-THREATENING HAEMORRHAGE OR DEHYDRATION, REGARDLESS OF CAUSE

TREATMENT:

MEDICAL MANAGEMENT

CODE:

6F

DIAGNOSIS:

HERNIA WITH OBSTRUCTION AND/OR GANGRENE; UNCOMPLICATED HERNIAS UNDER AGE 18

TREATMENT:

REPAIR; BOWEL RESECTION

CODE:

20F

DIAGNOSIS:

INTESTINAL OBSTRUCTION WITHOUT MENTION OF HERNIA; SYMPTOMATIC FOREIGN BODY IN STOMACH, INTESTINES, COLON & RECTUM

TREATMENT:

EXCISION; SURGERY; MEDICAL MANAGEMENT

CODE:

232F

DIAGNOSIS:

PARALYTIC 1LEUS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

498F

DIAGNOSIS:

PERITONEAL ADHESION

TREATMENT:

SURGICAL MANAGEMENT

CODE:

3F

DIAGNOSIS:

PERITONITIS, REGARDLESS OF CAUSE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

555F

DIAGNOSIS:

RECTAL PROLAPSE

TREATMENT:

PARTIAL COLECTOMY

CODE:

292F

DIAGNOSIS:

REGIONAL ENTERITIS; IDIOPATHIC PROCTOCOLITIS - ACUTE EXACCERBATIONS AND COMPLICATIONS ONLY

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

900F

DIAGNOSIS:

RUPURE OF INTRA-ABDOMINAL ORGAN

TREATMENT:

REPAIR; SPLENECTOMY; RESECTION

CODE:

5OYF

DIAGNOSIS:

THROMBOSED AND COMPLICATED HEMORRHOIDS

TREATMENT:

HEMORRHOIDECTOMY; INCISION

CODE:

32SG

DIAGNOSIS:

ACUTE NECROSIS OF LIVER

TREATMENT:

MEDICAL MANAGEMENT

CODE:

327G

DIAGNOSIS:

ACUTE PANCREATITIS

TREATMENT:

MEDICAL MANAGEMENT, AND WHERE APPROPRIATE, SURGICAL MANAGEMENT

CODE:

36G

DIAGNOSIS:

BUDD-CHIARI SYNDROME, AND OTHER VENOUS EMBOLISM AND THROMBOSIS

TREATMENT:

THROMBECTOMY/LIGATION

CODE:

910G

DIAGNOSIS:

CALCULUS OF BILE DUCT WITH CHOLECYSTITIS

TREATMENT:

MEDICAL MANAGEMENT; CHOLECYSTECTOMY; OTHER OPEN OR CLOSED SURGERY

CODE:

950G

DIAGNOSIS:

CANCER OF LIVER, BILIARY SYSTEM AND PANCREAS - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

255G

DIAGNOSIS:

CYST AND PSEUDOCYST OF PANCREAS

TREATMENT:

DRAINAGE OF PANCREATIC CYST

CODE:

156G

DIAGNOSIS:

DISORDERS OF BILE DUCT

TREATMENT:

EXCISION; REPAIR

CODE:

910G

DIAGNOSIS:

GALLSTONE WITH CHOLECYSTITIS AND/OR JAUNDICE

TREATMENT:

MEDICAL MANAGEMENT; CHOLECYSTECTOMY; OTHER OPEN OR CLOSED SURGERY

CODE:

743G

DIAGNOSIS:

HEPATORENAL SYNDROME

TREATMENT:

MEDICAL MANAGEMENTS

CODE:

27G

DIAGNOSIS:

LIVER ABSCESS; PANCREATIC ABSCESS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

911G

DIAGNOSIS:

LIVER FAILURE; HEPATIC VASCULAR OBSTRUCTION; INBORN ERRORS OF LIVER METABOLISM; BILIARY ATRESIA

TREATMENT:

LIVER TRANSPLANT, OTHER SURGERY, MEDICAL MANAGEMENT

CODE:

231G

DIAGNOSIS:

PORTAL VEIN THROMBOSIS

TREATMENT:

SHUNT

CODE:

353H

DIAGNOSIS:

ABSCESS OF BURSA OR TENDON

TREATMENT:

INCISION AND DRAINAGE

CODE:

32H

DIAGNOSIS:

ACUTE OSTEOMYELITIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

950H

DIAGNOSIS:

CANCER OF BONES - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

206H

DIAGNOSIS:

CHRONIC OSTEOMYELITIS

TREATMENT:

INCISION & DRAINAGE

CODE:

902H

DIAGNOSIS:

CLOSED FRACTURES/DISLOCATIONS OF LIMB BONES / EPIPHYSES - EXCLUDING FINGERS AND TOES

TREATMENT:

REDUCTION/RELOCATION

CODE:

85H

DIAGNOSIS:

CONGENITAL DISLOCATION OF HIP; COXA VARA & VALGA; CONGENITAL CLUBFOOT

TREATMENT:

REPAIR/RECONSTRUCTION

CODE:

147H

DIAGNOSIS:

CRUSH INJURIES OF TRUNK, UPPER LIMBS, LOWER LIMB, INCLUDING BLOOD VESSELS

TREATMENT:

SURGICAL MANAGEMENT; VENTILATION; ACUTE RENAL DIALYSIS

CODE:

491H

DIAGNOSIS:

DISLOCATIONS/FRACTURES OF VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY

TREATMENT:

MEDICAL MANAGEMENT; SURGICAL STABILISATION

CODE:

500H

DIAGNOSIS:

DISRUPTIONS OF THE ACHILLES / QUADRICEPS TENDONS

TREATMENT:

REPAIR

CODE:

178H

DIAGNOSIS:

FRACTURE OF HIP

TREATMENT:

REDUCTION; HIP REPLACEMENT

CODE:

445H

DIAGNOSIS:

INJURY TO INTERNAL ORGANS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

900H

DIAGNOSIS:

OPEN FRACTURE/DISLOCATION OF BONES OR JOINTS

TREATMENT:

REDUCTION/RELOCATION; MEDICAL AND SURGICAL MANAGEMENT

CODE:

34H

DIAGNOSIS:

PYOGENIC ARTHRITIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

901H

DIAGNOSIS:

TRAUMATIC AMPUTATION OF LIMBS, HANDS, FEET, AND DIGITS

TREATMENT:

REPLANTATION/AMPUTATION

CODE:

465J

DIAGNOSIS:

ACUTE LYMPHADENITIS

TREATMENT:

INCISION AND DRAINAGE; MEDICAL MANAGEMENT

CODE:

900J

DIAGNOSIS:

BURNS, GREATER THAN 10% OF BODY SURFACE, OR MORE THAN 5% INVOLVING HEAD, NECK, HANDS, PERINEUM

TREATMENT:

DEBRIDEMENT; FREE SKIN GRAFT; MEDICAL MANAGEMENT

CODE:

950J

DIAGNOSIS:

CANCER OF BREAST - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

954J

DIAGNOSIS:

CANCER OF SKIN, EXCLUDING MALIGNANT MELANOMA - TREATABLE

TREATMENT:

IF HISTOLOGICALLY CONFIRMED, MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY.

CODE:

952J

DIAGNOSIS:

CANCER OF SOFT TISSUE, INCLUDING SARCOMAS AND MALIGNANCIES OF THE ADNEXA -TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

349J

DIAGNOSIS:

CELLULITIS AND ABSCESSES WITH RISK OF ORGAN OR LIMB DAMAGE OR SEPTICEMIA IF UNTREATED; NECROTISING FASCIITIS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

901J

DIAGNOSIS:

DISSEMINATED BULLOUS SKIN DISEASE, INCLUDING PEMPHIGUS, PEMPHIGOID, EPIDERMOLYSIS BULLOSA, EPIDERMOLYTIC HYPERKERATOSIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

951J

DIAGNOSIS:

LETHAL MIDLINE GRANULOMA

TREATMENT:

MEDICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY

CODE:

953J

DIAGNOSIS:

MALIGNANT MELANOMA OF SKIN TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY.

CODE:

373J

DIAGNOSIS:

NON-SUPERFICIAL OPEN WOUNDS - NON LIFE-THREATENING

TREATMENT:

REPAIR

CODE:

356J

DIAGNOSIS:

PYODERMA; BODY, DEEP-SEATED FUNGAL INFECTIONS

TREATMENT:

MEDICAL MANAGEMENT~

CODE:

112J

DIAGNOSIS:

TOXIC EPIDERMAL NECROLYSIS AND STAPHYLOCOCCAL SCALDED SKIN SYNDROME; STEVENS-JOHNSON SYNDROME

TREATMENT:

MEDICAL MANAGEMENT

CODE:

331K

DIAGNOSIS:

ACUTE THYROIDITIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

951K

DIAGNOSIS:

BENIGN AND MALIGNANT TUMOURS OF PITUITARY GLAND WITH/WITHOUT HYPERSECRETION SYNDROMES

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT; RADIATION THERAPY

CODE:

30K

DIAGNOSIS:

BENIGN NEOPLASM OF ISLETS OF LANGERHANS

TREATMENT:

EXCISION OF TUMOR; MEDICAL MANAGEMENT

CODE:

950K

DIAGNOSIS:

CANCER OF ENDOCRINE SYSTEM, EXCLUDING THYROID - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

952K

DIAGNOSIS:

CANCER OF THYROID- TREATABLE; CARCINOID SYNDROME

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INLCUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

61K

DIAGNOSIS:

CONGENITAL HYPOTHYROIDISM

TREATMENT:

MEDICAL MANAGEMENT

CODE:

902K

DIAGNOSIS:

DISORDERS OF:..ADRENAL SECRETION NOS

TREATMENT:

MEDICAL MANAGEMENT; ADRENALECTOMY

CODE:

447K

DIAGNOSIS:

DISORDERS OF PARATHYROID GLAND; BENIGN NEOPLASM OF PARATHYROID GLAND

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

904K

DIAGNOSIS:

HYPER AND HYPOTHYROIDISM WITH LIFE-THREATENING COMPLICATIONS OR REQUIRING SURGERY

TREATMENT:

MEDICAL MANAGEMENT; SURGERY

CODE:

31K

DIAGNOSIS:

HYPOGLYCEMIC COMA; HYPERGLYCEMIA; DIABETIC KETOACIDOSIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

236K

DIAGNOSIS:

IRON DEFICIENCY; VITAMIN AND OTHER NUTRITIONAL DEFICIENCIES - LIFETHREATENING

TREATMENT:

MEDICAL MANAGEMENT

CODE:

901K

DIAGNOSIS:

LIFE-THREATENING CONGENITAL ABNORMALITIES OF CARBOHYDRATE, LIPID, PROTEIN AND AMINO ACID METABOLISM

TREATMENT:

MEDICAL MANAGEMENT

CODE:

903K

DIAGNOSIS:

LIFE-THREATENING DISORDERS OF FLUID AND ELECTROLYTE BALANCE, NOS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

354L

DIAGNOSIS:

ABSCESS OF PROSTATE

TREATMENT:

TURP; DRAIN ABSCESS

CODE:

904L

DIAGNOSIS:

ACUTE AND CHRONIC PYELONEPHRITIS; RENAL & PERINEPHRIC ABSCESS

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

903L

DIAGNOSIS:

ACUTE GLOMERULONEPHRITIS AND NEPHROTIC SYNDROME

TREATMENT:

MEDICAL MANAGEMENT

CODE:

954L

DIAGNOSIS:

CANCER OF PENIS AND OTHER MALE GENITAL ORGAN - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

953L

DIAGNOSIS:

CANCER OF PROSTATE GLAND - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

950L

DIAGNOSIS:

CANCER OF TESTIS - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

952L

DIAGNOSIS:

CANCER OF URINARY SYSTEM INCLUDING KIDNEY AND BLADDER - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

906L

DIAGNOSIS:

CONGENITAL ANOMALIES OF URINARY SYSTEM - SYMPTOMATIC AND LIFE-THREATENING

TREATMENT:

NEPHRECTOMY/REPAIR

CODE:

901L

DIAGNOSIS:

END STAGE RENAL DISEASE REGARDLESS OF CAUSE

TREATMENT:

DIALYSIS & RENAL TRANSPLANT WHERE DEPARTMENT OF HEALTH CRITERIA ARE MET ONLY (SEE CRITERIA PUBLISHED IN GPS 004-9001)

CODE:

900L

DIAGNOSIS:

HYPERPLAS1A OF THE PROSTATE, WITH ACUTE UR1NARY RETENTION OR OBSTRUCTIVE RENAL FAILURE

TREATMENT:

TRANSURETHRAL RESECTION; MEDICAL MANAGEMENT

CODE:

905L

DIAGNOSIS:

OBSTRUCTION OF THE UROGENITAL TRACT, REGARDLESS OF CAUSE

TREATMENT:

CATHETERIZATION; SURGERY; ENDOSCOPIC REMOVAL OF OBSTRUCTING

AGENT:

LITHOTRIPSY

CODE:

436L

DIAGNOSIS:

TORSION OF TESTIS

TREATMENT:

ORCHIDECTOMY; REPAIR

CODE:

43L

DIAGNOSIS:

TRAUMA TO THE URINARY SYSTEM INCLUDING RUPTURED BLADDER

TREATMENT:

CYSTORRHAPHY;SUTURE; REPAIR

CODE:

289L

DIAGNOSIS:

URETERAL FISTULA (INTESTINAL)

TREATMENT:

NEPHROSTOMY

CODE:

359L

DIAGNOSIS:

VESICOURETERAL REFLUX

TREATMENT:

MEDICAL MANAGEMENT; REPLANTATION

CODE:

539M

DIAGNOSIS:

ABSCESSES OF BARTHOLIN'S GLAND AND VULVA

TREATMENT:

INCISION AND DRAINAGE; MEDICAL MANAGEMENT

CODE:

288M

DIAGNOSIS:

ACUTE PELVIC INFLAMMATORY DISEASE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

954M

DIAGNOSIS:

CANCER OF CERVIX - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY AND CHEMOTHERAPY

CODE:

952M

DIAGNOSIS:

CANCER OF OVARY - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

950M

DIAGNOSIS:

CANCER OF UTERUS - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

953M

DIAGNOSIS:

CANCER OF VAGINA, VULVA AND OTHER FEMALE GENITAL ORGANS NOS - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY AND CHEMOTHERAPY

CODE:

960M

DIAGNOSIS:

CERVICAL AND BREAST CANCER SCREENING

TREATMENT:

CERVICAL SMEARS; PERIODIC BREAST EXAMINATION

CODE:

645M

DIAGNOSIS:

CANCER OF CERVIX - TREATABLE

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY AND CHEMOTHERAPY

CODE:

266M

DIAGNOSIS:

DYSPLASIA OF CERVIX AND CERVICAL CARCINOMA-IN-SITU; CERVICAL CONDYLOMATA

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

53M

DIAGNOSIS:

ECTOPIC PREGNANCY

TREATMENT:

SURGERY

CODE:

460M

DIAGNOSIS:

FISTULA INVOLVING FEMALE GENITAL TRACT

TREATMENT:

CLOSURE OF FISTULA

CODE:

951M

DIAGNOSIS:

HYDATIDIFORM MOLE; CHORIOCARCINOMA

TREATMENT:

D & C; HYSTERECTOMY; CHEMOTHERAPY

CODE:

902M

DIAGNOSIS:

INFERTILITY

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

528M

DIAGNOSIS:

MENOPAUSAL MANAGEMENT, ANOMALIES OF OVARIES, PRIMARY AND SECONDARY AMENORRHOEA, FEMALE SEX HORMONES ABNORMALITIES NOS, INCLUDING HIRSUTISM.

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT,INCLUDING HORMONE REPLACEMENT THERAPY

CODE:

4MM

DIAGNOSIS:

NON-INFLAMMATORY DISORDERS AND BENIGN NEOPLASMS OF OVARY, FALLOPIAN TUBES AND UTERUS

TREATMENT:

SALPINGECTOMY; OOPHORECTOMY; HYSTERECTOMY; MEDICAL AND SURGICAL MANAGEMENT

CODE:

237M

DIAGNOSIS:

SEXUAL ABUSE, INCLUDING RAPE

TREATMENT:

MEDICAL MANAGEMENT; PSYCHOTHERAPY

CODE:

903M

DIAGNOSIS:

SPONTANEOUS ABORTION

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

435M

DIAGNOSIS:

TORSION OF OVARY

TREATMENT:

OOPHORECTOMY; OVARIAN CYSTECTOMY

CODE:

530M

DIAGNOSIS:

UTERINE PROLAPSE; CYSTOCELE

TREATMENT:

SURGICAL REPAIR

CODE:

296M

DIAGNOSIS:

VOLUNTARY TERMINATION OF PREGNANCY

TREATMENT:

INDUCED ABORTION; MEDICAL AND SURGICAL MANAGEMENT

CODE:

67N

DIAGNOSIS:

# LOW BIRTH WEIGHT (UNDER 1000g) WITH RESPIRATORY DIFFICULTIES

TREATMENT:

# MEDICAL MANAGEMENT NOT INCLUDING VENTILATION

CODE:

967N

DIAGNOSIS:

# LOW BIRTH WEIGHT (UNDER 2500 GRAMS &> 1000g) WITH RESPIRATORY DIFFICULTIES

TREATMENT:

MEDICAL MANAGEMENT, INCLUDING VENTILATION; INTENSIVE CARE THERAPY

CODE:

71N

DIAGNOSIS:

BIRTH TRAUMA FOR BABY

TREATMENT:

MEDICAL MANAGEMENT; SURGERY

CODE:

901N

DIAGNOSIS:

CONGENITAL SYSTEMIC INFECTIONS AFFECTING THE NEWBORN

TREATMENT:

MEDICAL MANAGEMENT, VENTILATION

CODE:

904N

DIAGNOSIS:

HAEMATOLOGICAL DISORDERS OF THE NEWBORN

TREATMENT:

MEDICAL MANAGEMENT

CODE:

54N

DIAGNOSIS:

NECROTIZ1NG ENTEROCOLITIS IN NEWBORN

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

74N

DIAGNOSIS:

NEONATAL AND INFANT GIT ABNORMALITIES AND DISORDERS, INCLUDING MALROTATION AND ATRESIA

TREATMENT:

MEDICAL AND SURGICAL MANAGEMENT

CODE:

902N

DIAGNOSIS:

NEONATAL ENDOCRINE, METABLIC AND TOXIN-INDUCED CONDITIONS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

903N

DIAGNOSIS:

NEUROLOGICAL ABNORMALITIES IN THE NEWBORN

TREATMENT:

MEDICAL MANAGEMENT

CODE:

52N

DIAGNOSIS:

PREGNANCY

TREATMENT:

ANTENATAL AND OBSTETRIC CARE NECESSITATING HOSPITALISATION, INCLUDING DELIVERY

CODE:

56N

DIAGNOSIS:

RESPIRATORY CONDITIONS OF NEWBORN

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION

CODE:

505

DIAGNOSIS:

SYPHILIS - CQNGENITAL, SECONDARY AND TERTIARY

TREATMENT:

MEDICAL MANAGEMENT

CODE:

168S

DIAGNOSIS:

# HIV-INFECTION

TREATMENT:

# HIV VOLUNTARY COUNSELLING AND TESTING CO-TRIMOXAZOLE AS PREVENTIVE THERAPY SCREENING AND PREVENTIVE THERAPY FOR TB.

DIAGNOSIS AND TREATMENT OF SEXUALLY TRANSMITTED INFECTIONS.

PAIN MANAGEMENT IN PALLIATIVE CARE.

TREATMENT OF COMMON OPPORTUNISTIC INFECTIONS.

PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV.

POST-EXPOSURE PROPHYLAXIS FOLLOWING SEXUAL ASSAULT.

MEDICAL MANAGEMENT AND MEDICATION, INCLUDING THE PROVISION OF ANTI-RETROVIRAL THERAPY, TO THE EXTENT THAT THIS IS PROVIDED FOR IN ESTABLISHED NATIONAL GUIDELINES APPLICABLE IN THE PUBLIC SECTOR (THE NATIONAL GUIDELINES ARE SET OUT IN THE OPERATIONAL PLAN FOR COMPREHENSIVE HIV AND AIDS CARE, MANAGEMENT AND TREATMENT FOR SOUTH AFRICA; AND THE NATIONAL ANTIRETROVIRAL TREATMENT GUIDELINES. BOTH DOCUMENTS ARE AVAILABLE AT THE OFFICE OF THE DIRECTOR-GENERAL: NATIONAL DEPARTMENT OF HEALTH).

CODE:

260S

DIAGNOSIS:

# IMMINENT DEATH REGARDLESS OF DIAGNOSIS

TREATMENT:

# COMFORT CARE; PAIN RELIEF; HYDRATION

CODE:

113S

DIAGNOSIS:

ACQUIRED HAEMOLYT1C ANAEMIAS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

901S

DIAGNOSIS:

MULTIPLE MYELOMA AND CHRONIC LEUKEMIAS

TREATMENT:

TREATMENT: MEDICAL MANAGEMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

2778

DIAGNOSIS:

ANAEROBIC INFECTIONS - LIFE THREATENING

TREATMENT:

MEDICAL MANAGEMENT; HYPERBARIC OXYGEN

CODE:

488

DIAGNOSIS:

ANAPHYLACTIC SHOCK

TREATMENT:

MEDICAL MANAGEMENT; VENTILATION

CODE:

9008

DIAGNOSIS:

APLASTIC ANEMIA; AGRANULOCYTOSIS; OTHER LIFE-THREATENING HERIDITARY IMMUNE DEFICIENCIES

TREATMENT:

BONE MARROW TRANSPLANTATION; MEDICAL MANAGEMENT

CODE:

197S

DIAGNOSIS:

BOTULISM

TREATMENT:

MEDICAL MANAGEMENT

CODE:

338S

DIAGNOSIS:

CHOLERA; RAT-BITE FEVER

TREATMENT:

MEDICAL MANAGEMENT

CODE:

1968

DIAGNOSIS:

CHRONIC GRANULOMATOUS DISEASE

TREATMENT:

MEDICAL MANAGEMENT, WHICH INCLUDES RADIATION THERAPY

CODE:

9168

DIAGNOSIS:

COAGULATION DEFECTS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

2468

DIAGNOSIS:

CYSTICERCOSIS; OTHER SYSTEMIC CESTODE INFECTION

TREATMENT:

MEDICAL MANAGEMENT

CODE:

903S

DIAGNOSIS:

DEEP-SEATED (EXCLUDING NAIL INFECTIONS), DISSEMINATED AND SYSTEMIC FUNGAL INFECTIONS

TREATMENT:

MEDICAL MANAGEMENT; SURGERY

CODE:

44S

DIAGNOSIS:

ERYSIPELAS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

179S

DIAGNOSIS:

HEREDITARY ANGIOEDEMA; ANGIONEUROTIC ADEMA

TREATMENT:

MEDICAL AND SURGICAL THERAPY

CODE:

174S

DIAGNOSIS:

HEREDITARY HAEMOLYTIC ANAEMIAS (EG. SICKLE CELL); DYSERYTHROPOIETIC ANEMIA (CONGENITAL)

TREATMENT:

MEDICAL MANAGEMENT

CODE:

201S

DIAGNOSIS:

HERPETIC ENCEPHALITIS; REYE'S SYNDROME

TREATMENT:

MEDICAL MANAGEMENT

CODE:

913S

DIAGNOSIS:

IMMUNE COMPROMISE NOS AND ASSOCIATED LIFE-THREATENING INFECTIONS NOS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

9128

DIAGNOSIS:

LEPROSY AND OTHER SYSTEMIC MYCOBACTERIAL INFECTIONS, EXCLUDING TUBERCULOSIS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

336S

DIAGNOSIS:

LEPTOSPIROSIS; SPIROCHAETAL INFECTIONS NOS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

252S

DIAGNOSIS:

LIFE-THREATENING ANAEMIA NOS

TREATMENT:

MEDICAL MANAGEMENT; TRANSFUSION

CODE:

908S

DIAGNOSIS:

LIFE-THREATENING CONDITIONS DUE TO EXPOSURE TO THE ELEMENTS, INCLUDING HYPO AND HYPERTHERMIA; LIGHTNING STRIKES]

TREATMENT:

MEDICAL MANAGEMENT

CODE:

9078

DIAGNOSIS:

LIFE-THREATENING RICKETTSIAL AND OTHER ARTHROPOD-BORNE DISEASES

TREATMENT:

MEDICAL MANAGEMENT

CODE:

1728

DIAGNOSIS:

MALARIA; TRYPANOSOMIASIS; OTHER LIFE-THREATENING PARASITIC DISEASE

TREATMENT:

MEDICAL MANAGEMENT

CODE:

9048

DIAGNOSIS:

METASTATIC INFECTIONS; SEPTICEMIA

TREATMENT:

MEDICAL MANAGEMENT

CODE:

910S

DIAGNOSIS:

MULTIPLE MYELOMA AND CHRONIC LEUKAEMIAS

TREATMENT:

MEDICAL MANAGEMENT; WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY

CODE:

2478

DIAGNOSIS:

POISONING BY INGESTION, INJECTION, AND NON-MEDICINAL AGENTS

TREATMENT:

MEDICAL MANAGEMENT

CODE:

9118

DIAGNOSIS:

SEXUALLY TRANSMITTED DISEASES WITH SYSTEMIC INVOLVEMENT NOT ELSWHERE SPECIFIED

TREATMENT:

MEDICAL MANAGEMENT

CODE:

1288

DIAGNOSIS:

TETANUS; ANTHRAX; WHIPPLES DISEASE

TREATMENT:

MEDICAL MANAGEMENT

CODE:

122S

DIAGNOSIS:

THALASSEMIA AND OTHER HEMOGLOBINOPATHIES - TREATABLE

TREATMENT:

MEDICAL MANAGEMENT; BONE MARROW TRANSPLANT

CODE:

316S

DIAGNOSIS:

TOXIC EFFECT OF GASES, FUMES, AND VAPORS

TREATMENT:

MEDICAL THERAPY

CODE:

11S

DIAGNOSIS:

TUBERCULOSIS

TREATMENT:

DIAGNOSIS AND ACUTE MEDICAL MANAGEMENT; SUCCESSFUL TRANSFER TO MAINTENANCE THERAPY IN ACCORDANCE WITH DOH GUIDELINES

CODE:

937S

DIAGNOSIS:

TUMOUR OF INTERNAL ORGAN (EXCLUDES SKIN): UNKNOWN WHETHER BENIGN OR MALIGNANT

TREATMENT:

BIOPSY

CODE:

15S

DIAGNOSIS:

WHOOPING COUGH, DIPTHERIA

TREATMENT:

MEDICAL MANAGEMENT

CODE:

182T

DIAGNOSIS:

ABUSE OR DEPENDENCE ON PSYCHOACTIVE SUBSTANCE, INCLUDING ALCOHOL

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 WEEKS/YEAR

CODE:

901T

DIAGNOSIS:

ACUTE DELUSIONAL MOOD, ANXIETY, PERSONALITY, PERCEPTION DISORDERS AND ORGANIC MENTAL DISORDER CAUSED BY DRUGS;

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 DAYS

CODE:

910T

DIAGNOSIS:

ACUTE STRESS DISORDER ACCOMPANIED BY RECENT SIGNIFICANT TRAUMA, INCLUDING PHYSICAL OR SEXUAL ABUSE

TREATMENT:

HOSPITAL ADMISSION FOR PSYCHOTHERAPY COUNSELLING UP TO 3 DAYS, OR UP TO 12 OUTPATIENT PSYCHOTHERAPY / COUNSELLING CONTACTS

CODE:

910T

DIAGNOSIS:

ALCOHOL WITHDRAWAL DELIRIUM; ALCOHOL INTOXICATION DELIRIUM

TREATMENT:

HOSPITAL BASED MANAGEMENT UP TO 3 DAYS LEADING TO REHABILITATION

CODE:

908T

DIAGNOSIS:

ANOREXIA NERVOSA AND BULIMIA NERVOSA

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 WEEKS/YEAR OR MINIMUM OF 15 OUTPATIENT CONTACTS PER YEAR

CODE:

903T

DIAGNOSIS:

ATTEMPTED SUICIDE, IRRESPECTIVE OF CAUSE

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 DAYS OR UP TO 6 OUTPATIENT CONTACTS

CODE:

184T

DIAGNOSIS:

BRIEF REACTIVE PSYCHOSIS

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 WEEKS/YEAR

CODE:

910T

DIAGNOSIS:

DELIRIUM: AMPHETAMINE, COCAINE, OR OTHER PSYCHOACTIVE SUBSTANCE

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 DAYS

CODE:

902T

DIAGNOSIS:

MAJOR AFFECTIVE DISORDERS, INCLUDING UNIPOLAR AND BIPOLAR DEPRESSION

TREATMENT:

HOSPITAL-BASED MANAGEMENT UP TO 3 WEEKSLYEAR (INCLUDING INPATIENT ELECTRO-CONVULSIVE THERAPY AND INPATIENT PSYCHOTHERAPY) OR OUTPATIENT PSYCHOTHERAPY OF UP TO 15 CONTACTS

CODE:

907T

DIAGNOSIS:

SCHIZOPHRENIC AND PARANOID DELUSIONAL DISORDERS

TREATMENT:

HOSPITAL-BASED MEDICAL MANAGEMENT UP TO 3 WEEKS/YEAR

CODE:

909T

DIAGNOSIS:

TREATABLE DEMENTIA

TREATMENT:

ADMISSION FOR INITIAL DIAGNOSIS; MANAGEMENT OF ACUTE PSYCHOTIC SYMPTOMS - UP TO I WEEK