Circular no. 7 2025
- Published by NAMAF
1. ICD10 Coding Implementation Update
Background
In December 2024, Namaf announced that Phase 2.1 of the ICD-10 implementation will take effect from 1 April 2025 to 30 June 2025. During this phase, all healthcare providers will be required to submit ICD-10 codes selected from the ICD-10 Master Industry Table (MIT). While claim rejections will not be enforced during this period, scheme administrators must notify providers regarding their level of compliance.
Circular 6 stated that Phase 2.2 will commence on 1 July 2025 and run until 30 September 2025. This phase will mandate the submission of at least one valid 3-character ICD-10 code per claim by all healthcare providers. Although multiple ICD-10 codes are encouraged, any claim submitted without an ICD-10 code will not be paid—following the “no ICD-10 code, no pay” principle. All ICD-10 codes used must be selected from the ICD-10 MIT.
Administrators are expected to validate claims against the ICD-10 MIT to ensure coding accuracy. Non-diagnosing providers are encouraged to submit either a referral diagnosis from the diagnosing provider, a sign or symptom code, or a Chapter XXI (Z-code) where appropriate.
Preparation for the Phased Implementation of ICD-10
Namaf has initiated several measures to support healthcare stakeholders in meeting the phased ICD-10 requirements. Stakeholders are encouraged to take note of the following initiatives:
2.1. Software Enhancement and Upgrade
Namaf has actively engaged with software vendors and administrators regarding the upcoming ICD-10 implementation. Encouragingly, the majority have provided written confirmation that their software and IT systems are compliant with the requirements for Phase
2.2. Namaf is continuing to liaise with those vendors and administrators who have not yet achieved full compliance.
Healthcare stakeholders are reminded to consult the ICD-10 Technical User Guide and ensure adherence to the ICD-10 requirements at the claim level, as follows:
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Practice Management Software Systems (PMS) must support ICD-10 coding at the line-item level, allowing for one primary code and up to nine secondary codes per line.
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Hospital Systems must support ICD-10 coding at the claim header level, allowing for one primary code and up to 19 secondary codes.
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Administrator Systems must accommodate both formats to ensure compatibility across all provider types.
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Switching companies are required to cater for both the PMS and hospital ICD-10 formats, if switiching claims for both parties.
2.2. ICD-10 Task Team
An ICD-10 Task Team has been established, with two meetings held to date. The first meeting, convened on 13 February 2025, focused on discussing the task team’s structure, terms of reference, core functions, and member representation. During the second meeting, held on 10 March 2025, these foundational elements were revisited to accommodate the inclusion of new members.
At the second meeting, Mr. Stephen Tjiuoro was formally introduced as the Chairperson of the main task team. Additionally, chairpersons and co-chairpersons were elected for two sub-committees: the ICD-10 Morbidity Sub-Committee and the Privacy and Confidentiality Sub-Committee. Each sub-committee was assigned specific responsibilities, which will be addressed in upcoming sessions.
The full composition of the main task team, along with future meeting dates, will be announced at the next scheduled meeting in May 2025.
2.3. ICD-10 Webinars, Workshops and Training
To promote awareness and understanding of ICD-10, a series of webinars and workshops were conducted during February and March 2025. These educational sessions will continue through April, May and June 2025. All healthcare stakeholders are strongly encouraged to attend these sessions to ensure readiness and compliance with the ICD-10 implementation requirements.
2.3.1. ICD-10 Webinars
Webinars provide general information on the implementation of ICD-10 at no cost to attendees.
2.3.2. ICD-10 Workshops
Workshops are designed to focus more specifically on the ICD-10 requirements relevant to each provider discipline at no cost to attendees. They also introduce healthcare stakeholders to the structure, and basic coding rules of the ICD-10 system. The ICD-10 workshops do not replace ICD-10 training.
2.3.3. ICD-10 Training
ICD-10 training sessions cover the application of ICD-10 rules, the accurate assignment of codes, and the use of the ICD-10 Coding Standards Document. To ensure the correct interpretation and use of ICD-10 codes, healthcare stakeholders are encouraged to attend the one-day training sessions at a cost that is payable by the attendee.
Conclusion
Stakeholders requiring assistance with ICD-10 implementation are advised to contact Namaf directly.
Action Required:
Complete the questions in Annexure 1 of the below.
Circular 7 ICD-10 Coding_ Implementataion Update_22April 2025_V1
