Circular no. 10 of 2025

1.1. The ICD-10 Implementation Task Team has adopted the ICD-10 reason and rejection codes as outlined in the ‘South African Council for Medical Schemes’ ICD-10 Compliance Statistics Guidelines (CmplncSttstcsGrdVrsn2_20150107 (1).xls). These codes represent a well-established and effective framework for ensuring ICD-10 coding compliance.

The reason and rejection codes will be enforced during the mandatory phase of ICD-10 implementation. The table below sets out the complete list of reasons and rejection codes. Administrators are required to accommodate the full range of alphanumeric codes.

1.2. For Phase 2.2 implementation, the following reasons and rejection codes will apply:

i. R101: Primary ICD-10 code invalid (Code does not exist on MIT or is not within the current active range date)
ii. R104: ICD-10 Code omitted
iii. R110: Cannot read the ICD-10 Code provided

In addition to the codes listed above, the remaining reason and rejection codes will be required for implementation during Phase 3.

1.3. For Phase 3 implementation, the following reasons and rejection codes will apply:

i. R102: Primary ICD-10 code invalid in the primary position
ii. R103: Primary ICD-10 code incomplete (not to the maximum level of specificity)
iii. R105: Secondary ICD-10 code invalid (code does not exist on MITor is not within the current active date range)
iv. R106: Secondary ICD-10 code incomplete (not to the maximum level of specificity)
v. R107: Dagger code omitted (supplier should amend future accounts)
vi. R108a: Age code Incorrect
vii. R108b: Gender code incorrect
viii. R111: ICD-10 external cause code omitted

1.4. The table below shows the breakdown of ICD-10 rejection code categories and warning messages.

Primary ICD-10 code invalid (code does not exist on MIT or is not within the current active date range) The primary ICD-10 code is invalid in the primary position Primary ICD-10 code incomplete (not to the maximum level of specificity) ICD-10 code omitted Secondary ICD-10 code invalid (code does not exist on MIT or is not within the current active date range) Secondary ICD-10 code incomplete (not to the maximum level of specificity) Dagger code omitted (supplier should amend future accounts) Age code incorrect Gender code incorrect Cannot read the ICD-10 provided ICD-10 external cause code omitted
R101 R102 R103 R104 R105 R106 R107 R108 a R108 b R110 R111

i. Medical aid funds and administrators are advised to refer to the updated ICD-10 Technical User Guide for guidance on interpreting and applying ICD-10 reason and rejection codes. Alternatively, they may contact NAMAF for further clarification.

ii. Healthcare providers must familiarise themselves with these codes during Phase 2.2 and Phase 3 of the ICD-10 implementation to properly understand the reasons for claim or claim-line rejections.

All healthcare stakeholders seeking support or additional information regarding the ICD-10 implementation must email NAMAF to Mrs. Lunza Maswahu at clinicalservices@namaf.org.na.