The column on the left is your treatment date. The next column is details of your surgery,
the surgeon as well as your anaesthetic bill. This part of the bill contains the ICD Diagnostic
codes provided by your surgeon (the referring doctor), the anaesthetic codes used for your
bill (the codes on the left), the cost of the anaesthetic provided, as well as any payments
made either by yourself as well as your medical aid
These relate to anaesthetic bill and risk of anaesthesia:
• The anaesthetsist will charge a consultation fee
• An additional “emergency consult fee” may be charged if your procedure is either un-booked
prior to the start of the list or an emergency, irrespective of the time of the day.
• Emergency travel fee may be charged for the attending anaesthesiologist to make an unscheduled trip to the venue where your procedure takes place.
• The anaesthetist charges for all procedures done or carried out by the anaesthetist
• Epidurals, nerve blocks, postoperative drug infusions and ‘patient controlled analgesia’ (PCA)
devices for pain relief.
• Arterial and central venous lines for careful monitoring of your condition during and after the procedure.
• Should the patient have systemic illnesses causing functional impairment.
• Should the patient be ventilated or admitted to intensive care.
• The next part of the bill is for the anaesthetic for your procedure. This code is provided by your
surgeon to the anaesthetist
• The anaesthetic risk codes then follow
• Patients in non-typical positions during the procedure.
• Patients less than a year old, or older than 70 years of age.
• Body mass index (BMI) if greater than or equal to 35kg/m2.
• Orthopaedic modifiers depending on the site of surgery.
• Operations on the head/neck.
• Insertion of a nasogastric tube.
• All the time and risk modifier codes are allocated specific unit values and each unit is then allocated a Rand value determined by your medical fund or the anaesthetist private bill rates. These
values are added together to determine the final anaesthetic cost.
• Previously the HPCSA determined the guidelines for reasonable professional fees, and the
Council for Medical Schemes the “Reference Price List”, effectively the lowest tariff medical
funders would pay. The Competition board and Courts have however stopped all setting of prices and at this stage each medical aid and doctor set their own prices. (Competition Commission
ruling 2006) The rates that medical aids pay depends on the individual funder and the plans they
offer.
• To enable us to provide the quality service the patients deserve, the anaesthetists have linked
their fees to the cost of delivering the service and benchmarked this to other professional services.
The rate is based on training, expertise, experience and practice costs.
• Each anaesthetist sets their own rates yearly.
• Some anaesthetists have payment arrangements with some of the medical funders with no
co-payments on these plans. Please talk to the anaesthetist about these before you undergo your
surgical procedure.
• Your medical aid pays out at the rate they unilaterally determine according to the plan you take
with them which may be vastly different to the rate determined by the anaesthesiologist. Be aware
that your medical aid/funder may call this “the 100% rate” but this refers ONLY to their rates.
• Additionally, every anaesthetic account has to include VAT as the government has legislated that
healthcare is a value added item and they have added 15% to each account