There are 4 different codes that are used in billing.  This article aims to clear up any confusion regarding the differences:


1.  Medical Aid codes.

  • Each medical aid has a standard code that is used for sending claims via EDI.  Even if you do not use EDI the code is a convenient one to use so we send out our software with all medical aids and their correct 3 digit numeric code eg Discovery = 125.  
  • Namibian codes are not numeric eg NAMM - Nammed.
  • If you need to add a medical aid that is not for EDI you can just make up any code.  It is best to use Alpha so that it remains clear that this in a non-EDI code. 
  • To add a medical aid that will be EDI'ed you will need to get the correct 3 digit numeric code from Datamax.
  • You can also use the medical aid code to group patients eg for classes where medical aid info is irrelevant.  eg Add a medical aid code PIL fro a Pilates class and ignore any other medical aid info.  
  • When Medical Aid is not applicable the account should be set to N/A code 0000

2. Tariff codes

  • Also called procedure codes / treatment codes / billing codes
  • These are the codes that describe the treatment eg 91925 - Hydrotherapy
  • For the allied disciplines eg physio, OT, Bio etc the code is 5 (or 6) digits and starts with the 2 digits that determine the practice type eg 72 = Physio, 86 = Psychology etc.  Every medical aid has a different rate that they will pay for each code based usually on its unit weighting and unit type.  This info was published in the last NHRPL Gazetted Tariffs 2009 together with full descriptions and rules regarding the codes.  For the Allied Disciplines there are few enough codes that we are able to provide them as an import from our website.
  • For doctors and specialists the codes are 4 digits and there are too many to provide as an import. You will be responsible for keeping your own codes up to date - we will provide you with the 2010 calculated NHRPL document .  Most doctors and specialists are anyway not charging standard medical aid rates ans they have special contractual relationships with the funds, or have noting to do with them and are charging their own private rates.

3.  ICD10 codes

  • International Codes for Diagnosis - these describe what is wrong with the patient.
  • Medical aids require that you provide at least 1 ICD10 code  to the highest level of specificity as a primary code
  • Our MTMCloud lookup to the ICD10 codes is available from within your program as well as this knowledgebase 
  • If the ICD10 code is a trauma code (S or T), an External Cause Code (ECC ) (U V W) is needed (See helpfiles for instructions)
  • If the ICD10 code is a cancer code (C or D), a Morphology Code (M ) is needed (See helpfiles for instructions)

4. Nappi codes

  • Nappi codes are required by medical aids when you are billing drugs and consumables
  • You will need an additional Nappi Code module to bill these codes
  • Nappi codes are 9 or 10 digits and describe the  product.
  • They are always billed with a tariff code for consumables.  For doctors this is 0201, physios 72939, OT 0009 etc.  the tariff code is specifies as a materials code in you tariff code list
  • Usually you will get the correct Nappi code from your supplier when you buy the product.  A Medikredit lookup for Nappi codes is available from the Knowledgebase