Subject: Urgent Request for Correction of ICD-10 Code (N31.1) for PMB Claim

Subject: Urgent Request for Correction of ICD-10 Code (N31.1) for PMB Claim

Dear Discovery Health Claims Department,

I hope this message finds you well.

I am writing to urgently request the correction and resubmission of a Prescribed Minimum Benefit (PMB) claim relating to the medications Urton and Microdentin. The correct ICD-10 code is N31.1, which refers to neuropathic bladder due to intermittent catheterisation—a PMB condition confirmed by the treating physician, Dr. Adam. It's not possible to undertake blood and urine tests every month as we fully aware the patient has been diagnosed with a neurological bladder Fwd: Dispite/Appeal Unresolved Re CMS87542/ Fwd: Decision Letter -MailRef#***#-authorisation number *** neourological..

In the previous month, Dis-Chem Killarney correctly submitted the claim using ICD-10 code N31.1, and it was successfully processed. However, the current claim has been submitted using an incorrect code, leading to delays in both processing and medication delivery.

This issue has occurred repeatedly across different pharmacies, including:

Lancet (previous error with ICD code),

Logan Pharmacy (used incorrect ICD code for Urton),

And now again with Microdentin.

Additionally, the delivery was unsuccessful as the medication from Mevrou Theresa Nel at lorgan avenue dispensary for my chronic (Urton and Microdentin) was grouped into a single delivery unit, which could not be separated due to the claim issue. The driver, Mr Joshua Victor Chabata, was unable to proceed with delivery and we were unable to get hold of the pharmacy on their listed number *** .This continues to place an unnecessary burden on a patient who has already submitted all relevant authorisations and supporting documentation for this PMB condition.

Please urgently:

Resubmit the current claim using ICD-10 code N31.1,

Ensure future claims reflect this correct and authorised code, and

Confirm that this matter has been resolved and that the medication delivery can now proceed without further delay.

This issue has been discussed previously with Ms Ashley Sivak and Nokuphiwa from Discovery. I trust that appropriate action will be taken promptly to avoid any further compromise of the patient's care.

Thank you for your urgent attention to this matter. Please confirm receipt and resolution at your earliest convenience.

Kind regards, Very concerned patient