Billing and medical-aid claims for psychiatry practices

Psychiatry is the exception to the pattern the rest of this site describes. Psychiatrists are medical specialists, so they bill the bare four-digit code the way a GP bills 0190 - the discipline number 22 identifies the practice, and it is never prefixed onto the procedure code. A psychiatrist who follows the allied-health convention and sends 22 in front of the code will have the claim come back unknown.

South African tariff codes come in more than one billed form, and which one applies depends on your discipline. Medical specialties bill the bare four-digit code — a GP bills 0190 as 0190, and a psychiatrist bills 2974 as 2974. Allied and paramedical disciplines bill their BHF discipline number followed by the procedure number. That procedure part is three digits for most disciplines and four for speech therapy and audiology, which is the exception people miss. Psychiatry is discipline 22:

Discipline	BHF number	Billed code form
Psychiatry	22	nnnn
Occupational therapy	66	66nnn
Podiatry	68	68nnn
Physiotherapy	72	72nnn
Counselling	81	81nnn
Audiology	82	82nnnn
Dietetics	84	84nnn
Psychology	86	86nnn
Nursing and home-based care	88	88nnn
Social work	89	89nnn
Biokinetics	91	91nnn

This is invisible on a tariff schedule, because the schedule prints the short procedure number and leaves the form to you. For a medical specialty the mistake runs the other way: following the allied convention and prefixing the discipline number produces a code the scheme has never heard of. It does not fail politely: codes come back unknown or priced at zero across the board rather than case by case. If that is what your rejections look like, check the form before you check anything else.

Each scheme’s own tariff schedule is the authority on its rates and codes. Where a scheme’s schedule disagrees with anything here, follow the schedule. Clinical technology is deliberately absent from the table above: its numbering is not consistent between schemes, so no single pattern would be correct.

Do psychiatrists bill a 22-prefixed tariff code?

No. Psychiatry is discipline 22 for the purposes of your practice number, but the billed code is the bare four-digit specialist code - a consultation printed as 2974 goes out as 2974, not 222974. Prefixing the discipline number is an allied-health convention and does not apply to medical specialties.

Why did my psychiatry claim pay the patient instead of the practice?

That usually means the scheme has decided to settle with the member rather than the provider, and the most common trigger is a submitted price above the scheme’s rate for the code. It is worth checking, because the line does not pay partially in that case - the whole amount goes to the member and the practice collects it from them.

Are mental-health admissions and consultations billed differently?

Yes, and the place of service is part of what the scheme is assessing. In-hospital and out-of-hospital work are treated as different events with different benefit rules, so the claim needs to say plainly which one it was.

Do psychiatry claims need an ICD-10 diagnosis code?

Yes. Every claim to a South African medical scheme needs a valid ICD-10 code, coded to the most specific level the record supports. For an injury the scheme also expects an external-cause code, and that cause code has to be a billable five-character code rather than a category heading.

What does billing software cost for a psychiatry practice?

On NetPractice it is R9.50 per claim with the first 10 claims each month free, and no monthly fee or contract. A practice submitting 200 claims a month pays R1,805.