Billing and medical-aid claims for social work practices

Social work in private practice bills a session, and the code says which kind of session it was. Because the codes sit close together and differ mainly by the length and nature of the contact, the wrong one is rarely obviously wrong - it pays a different amount, or it does not pay, and nothing about the claim looks like an error until the remittance arrives.

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. Social work is discipline 89:

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. It is the most common structural coding error in allied practices. 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.

Which tariff codes do social workers bill in South Africa?

Social work is BHF discipline 89, so the billed code is 89 followed by the three-digit procedure number - a session printed as 208 on your schedule goes out as 89208. The scheme’s own schedule is the authority on which procedure number applies to which kind of session.

Why are my social work claims rejected more often than colleagues in other disciplines?

Two causes account for most of it. The first is the code form: a bare three-digit or four-digit code instead of the 89-prefixed one fails across the board rather than case by case. The second is authorisation - sessions continuing past the authorised number are a rejection at the scheme even though the work was done and correctly coded.

Can I bill medical schemes and an employee-assistance programme from the same practice?

Yes, and most private social work practices do. They are different payers with different rules, so the practical need is to keep them apart in the record while still seeing one picture of what the practice is owed.

Do social work 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 social work 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.