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← Medical schemes & PMBs

Diagnosis Treatment Pairs (DTPs)

PMB conditions linking diagnosis to mandated treatment — from CMS Annexure A / coded list.

Browse by system

CodeDiagnosisTreatment
109A Vertebral dislocations/ fractures, open or closed with injury to spinal cord Repair /reconstruction; medical management; inpatient rehabilitation up to 2 months
1A Severe / moderate head injury: hematoma / oedema with loss of consciousness Medical and surgical management; ventilation
211A Intraspinal and Intracranial abscess Medical and surgical management
213A Difficulty in breathing, eating, swallowing, bowel, or bladder control due to non-progressive neurological (including spinal) condition or injury Medical and surgical management; ventilation
265A Transient cerebral ischaemia; life-threatening cerebrovascular conditions NOS Evaluation; medical management; surgery
28A Subarachnoid and intracranial hemorrhage / hematoma; compression of brain Medical and surgical management
305A Tetanus Medical management; ventilation
341A Basal ganglia, extra-pyramidal disorders; other dystonias NOS Initial diagnosis; initiation of medical management
386B Herpes zoster & herpes simplex with ophthalmic complications Medical management
389B Hyphaema Removal of blood clot; observation
394B Angle-closure glaucoma Iridectomy; laser surgery; medical and surgical management
405B Glaucoma associated with disorders of the lens Surgical management
407B Primary and open angle glaucoma with failed medical management Trabeculectomy; other surgery
409B Sympathetic uveitis and degenerative disorders and conditions of globe; sight threatening thyroid optopathy Enucleation; medical management; surgery
419B Purulent endophthalmitis Vitrectomy
47B Acute orbital cellulitis Medical and surgical management
485B Inflammation of lacrimal passages Incision; medical management
49A Compound/ depressed fractures of skull Craniotomy/ craniectomy
510A Peripheral nerve injury with open wound Neuroplasty
513A Myasthenia gravis; muscular dystrophy; neuro-myopathies NOS Initial diagnosis; initiation of medical management; therapy for acute complications and exacerbations
586B Bell’s palsy; exposure keratoconjunctivitis Tarsorrhaphy; medical and surgical management
684A Viral meningitis, encephalitis, myelitis and encephalomyelitis Medical management
83A Encephalocele; congenital hydrocephalus Shunt; surgery
84A Spina Bifida Surgical management
901A Stroke – due to hemorrhage, or ischaemia Medical management; surgery
901B Cataract; aphakia Extraction of cataract; lens implant
902A Epilepsy (status epilepticus, initial diagnosis, candidate for neurosurgery) Medical management; ventilation; neurosurgery
904B Retinal detachment, tear and other retinal disorders Vitrectomy; laser treatment; other surgery
905A Meningitis – acute and subacute Medical and surgical management
906A Acute generalised paralysis, including polio and Guillain-Barre Medical management; ventilation and plasmapheresis
906B Retinal vascular occlusion; central retinal vein occlusion Laser surgery
909B Open wound of eyeball and other eye structures Medical and surgical management
911B Corneal ulcer; Superficial injury of eye and adnexa Conjunctival flap; medical management
922B Retained intraocular foreign body Surgical management
940A Reversible CNS abnormalities due to other systemic disease Medical and surgical management
941A Spinal cord compression, ischaemia or degenerative disease NOS Medical and surgical management
950A Benign and malignant brain tumours, treatable Medical and surgical management which includes radiation therapy and chemotherapy
950B Cancer of the eye and orbit - treatable Medical and surgical management, which includes radiation therapy and chemotherapy

Data quality & linkage

Core ingest — feeds Library, Clinical Atlas, compiler
Domain Records Completeness Accuracy Cross-refs Linkage Notes
CMS registered schemes 71 2023 Industry Report Manual PDF extract ClinicalAtlas schemes dir Open/restricted typed Diff job pending on new CMS report
DTP diagnosis–treatment pairs 266 CMS XLS ingest CMS Annexure A CDL heuristic + body system 266 coded pairs Scheduled diff on CMS publish
CDL chronic conditions 26 CMS + Gazette algorithms Curated from CMS PMB ICD atlas_slug 26/26 100% Mapping workbench in Core

Official sources & ingest

Authority feeds — master ingest in Core ZA (coreza.riskatlas.co.za)
Domain Official source Feed type API / access Refresh Synced to Status
Medical Schemes & PMB Council for Medical Schemes — PMB HTML / portal www.medicalschemes.co.za/resources/pmb/ Daily cache Library · Clinical Atlas Ingested
Medical Schemes & PMB CMS Industry Report 2023 HTML / portal www.medicalschemes.co.za/media-centre/the… Annual Library · Clinical Atlas Ingested
Medical Schemes & PMB PMB conditions spreadsheet (CMS) XLSX download www.medicalschemes.co.za/download/2032/pr… When CMS updates Library · Clinical Atlas Ingested
Medical Schemes & PMB CDL treatment algorithms HTML / portal www.medicalschemes.co.za/publications/#20… When CDL revised Library · Clinical Atlas Ingested
Clinical Atlas WHO ICD-10 HTML / portal icd.who.int/browse10/2019/en Per atlas release Library · Clinical Atlas Curated / partial API
Clinical Atlas SAHPRA HTML / portal www.sahpra.org.za/ Per atlas release Library · Clinical Atlas Curated / partial API
Clinical Atlas MIMS / SA package inserts Reference www.mims.co.za/ Per atlas release Library · Clinical Atlas Curated / partial API
Clinical Atlas SA Essential Medicines List (EML) Reference www.health.gov.za/ Per atlas release Library · Clinical Atlas Curated / partial API
Clinical Atlas ClaimBuddy curated Reference Internal Per atlas release Library · Clinical Atlas Curated / partial API
Social security (shared) ISSA Country Profiles HTML database www.issa.int/databases/country-profiles Two-year regional cycle Core · Compass ZA Primary — structure
News & conduct NFOSA press releases WordPress REST + RSS nfosa.co.za/wp-json/wp/v2/posts Hourly cache Library · compiler Live — master in Core
News & conduct FSCA media releases RSS / HTML www.fsca.co.za/ Daily Library news Planned structured ingest
Practitioners HPCSA i-register Live HTTP iregister.hpcsa.co.za/ 5-min cache Clinical Atlas · compiler HPCSA lookup Live proxy
Life insurers NFO Life Insurance Division participants HTML register www.nfosa.co.za/participants/life-insuran… When NFO updates the participant list Library life-insurers directory · intake autocomplete Curated — Library directory live
Conduct & complaints NFO Life Insurance Division case reports HTML case reports nfosa.co.za/category/case-reports/ When NFO publishes (curated holdings in Library) Library language map · wiki · precedent pages Curated — CR403, CR356, CR351, CR276, CR72, CR259 live in Library

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