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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
100E Patent ductus arteriosus; aortic pulmonary fistula - persistent Ligation
108E Pericarditis Medical and surgical management
111E Injury to major blood vessels - trunk, head and neck, and upper limbs Repair
155E Myocarditis; cardiomyopathy; transposition of great vessels; hypoplastic left heart syndrome Medical and surgical management; cardiac transplant
16E Rupture of papillary muscle Medical and surgical management
18E Dissecting or ruptured aortic aneurysm Surgical management
19E Injury to major blood vessels of extremities Ligation
204E Cardiac failure: acute or recent deterioration of chronic cardiac failure Medical treatment
209E Phlebitis & thrombophlebitis, deep Ligation and division; medical management
210E Diseases of endocardium; endocarditis Medical management
26E Arterial embolism/thrombosis: abdominal aorta, thoracic aorta Medical and surgical management
284E Acute pulmonary heart disease and pulmonary emboli Medical and surgical management
294E Giant cell arteritis, Kawasaki disease, hypersensitivity angiitis Medical management
309E Diseases and disorders of aortic valve NOS Aortic valve replacement
314E Diseases of mitral valve Valvuloplasty; valve replacement; medical management
355E Other aneurysm of artery – peripheral Surgical management
35E Acute rheumatic fever Medical management
450E Hereditary hemorrhagic telangiectasia Excision
497E Multiple valvular disease Surgical management
627E Shock / hypotension – life-threatening Medical management; ventilation
900E Life-threatening complications of elective cardiac and major vascular procedures Medical and surgical management
901E Hypertension – acute life-threatening complications and malignant hypertension; renal artery stenosis and other curable hypertension Medical and surgical management
902E Disorders of arteries: visceral Bypass graft; surgical management
903E Life-threatening cardiac arrhythmias Medical and surgical management, pacemakers, cardioversion
905E Other correctable congenital cardiac conditions Surgical repair; medical management
907E Acute and subacute ischemic heart disease, including myocardial infarction and unstable angina Medical management; surgery; percutaneous procedures
908E Aneurysm of major artery of chest, abdomen, neck, - Unruptured or ruptured NOS Surgical management
914E Rheumatic pericarditis; rheumatic myocarditis Medical management
915E Gangrene; severe atherosclerosis of arteries of extremities; diabetes mellitus with peripheral circulatory disease Medical and surgical management including amputation
93E Ventricular septal defect - persistent Closure
97E Coronary artery anomaly Anomalous coronary artery ligation
98E Complete, corrected and other transposition of great vessels Repair
99E Tetralogy of Fallot (TOF) Total repair tetralogy

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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