3 March 25

If Doctor A writes a named referral to Doctor B from Doctor A’s private rooms to a public hospital outpatient clinic and through the triage process Doctor A is assigned the patient to treat in the public hospital outpatient clinic can MBS be claimed? Would the referral from the private rooms be able to be utilised in billing as the referring Doctor and treating Doctor are the same but have different provider numbers.

24 February 25

As an anaesthetist who is not rostered in the intensive care unit (ICU), I am sometimes asked to go to ICU and take a ventilated and sedated patient to radiology for various imaging procedures such as CT scans and MRIs. Can I bill a pre-anaesthetic consultation when I go and see the patient? I don’t talk to them obviously. The initiation item I bill is 21922.

10 February 25

If 92210 is the telehealth equivalent of item 599, does this mean the doctor would also have to visit the patient, or open the consulting rooms? I am very confused by this. I asked AskMBS and their answer left me with more questions. Here is the answer I received. “Generally, MBS telehealth (video) and phone items have the same requirements as their face-to-face counterpart items. However, in relation to item 599 and 92210, the advice in explanatory note AN.0.19–i.e. ‘If the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open the consulting rooms for the attendance’ (and the advice in note AN.0.19 generally)–applies to face-to-face services only. Where the service is provided via telehealth, this requirement does not apply.”

3 February 25

What happens to billing of a private patient in a public hospital who undergoes solid organ (other than kidney) transplantation? There is no MBS item billable for this so it can’t be billed to the patient’s private insurance, so can the hospital just change them back to public or does the patient have to be involved in that decision? Follow-up question asked. This updated context was provided. I think the situation is a bit more complex because it is not correct that patients are aware at the time of admission that they require a solid organ transplant, unless they are admitted to hospital from a transplant waiting list. A significant proportion of liver, heart, lung transplant patients are admitted to hospital with an infection, poisoning or trauma, that eventually leads to irrecoverable organ failure and a requirement for transplantation – sometimes months into the admission. If we follow the logic in your answer, anyone who has any chance of developing end stage organ failure that could be then eligible for a transplant should be admitted by default as public, which would be counterintuitive. So to be more specific, the question would be this: How should a hospital and clinicians approach a situation when a patient admitted with an acute condition (NOT previously on a transplant list) develops end stage organ failure and requires liver, heart, lung, etc transplantation during the course of their hospital admission (a good example would be a community acquired pneumonia or chest trauma leading into complicated...

27 January 25

The questioner had received this advice which was wrong. “Thank you for your enquiry regarding the revised item descriptor for item 45518, that will come into effect from 1 July 2023.The rationale of the Plastic and Reconstructive Surgery Clinical Committee to amend items 45515 and 45518 was that they were potentially subject to inappropriate use for the revision of cosmetic breast implants. Specifying recording of photographic evidence and the explicit wording around the exclusion of insertion of breast implants concurrent with scar revision adds clarity to the descriptors and assist in preventing cosmetic misuse. To answer your question, if the proposed scar revision does not involve the insertion of breast implants, and all of the other requirements of the items are met, items 45515 and 45518 can be claimed, regardless of whether the original surgery was for cosmetic purposes.”

27 January 25

Can a medical practice registered as a Unit Trust charge a user fee to patients along with the doctors’ fees, if the doctor does not bulk bill that visit. e.g. For an initial visit with an Obstetrician, the Obstetrician charges $200, and the patient can claim about $78 from Medicare as rebate. Can the practice under its own name, charge $70 as user fee, i.e. Issue 2 invoices: 1 doctor’s invoice for $200 with the correct Medicare Item number, and another invoice of $70 under the practice’s name?

12 January 25

We have a scenario where Medicare reject claims submitted by the physician for an item 38417 because it states fluoroscopy can only be claimed by one provider once for that occasion of service. The physician performs the bronchial biopsy and a radiologist performs the fluoroscopic imaging to guide the physician when taking the biopsy. In this case the doctor physician claimed a 38417. The radiologist claimed a category 5 diagnostic item group 13 MBS item and the radiologist claim was submitted prior to the physician lodging their claim. As stated by the physician, “38417 is the most correct item number for the procedure. The item description does say “with or without associated fluoroscopic imaging”. I performed the procedure described as MBS 38417 for an ultrasound biopsy and the radiologist performed and billed the fluoroscopy. “It does not seem right that the physician cannot claim the 38417 when by description the procedure fits exactly with this item.” When two providers need to partake in the provision of a service due to the particular areas of specialty (i.e. medical procedure v diagnostic imaging), what is the best approach when dealing with Medicare and the claim?

12 January 25

I occasionally have patients who come into hospital for a pulmonary vein isolation (item numbers 38290, 38212, 38206, 55118) but at the time of the procedure we find an intracardiac thrombus which means the case has to be abandoned. Is there a way to bill for abandoned pulmonary vein isolations? The same occasionally happens where a patient comes into hospital for a pacemaker implant (item numbers 38356, 38353, 61109) and I find that the veins are blocked or abnormal and not suitable for passing pacemaker wires into the heart. In these cases I have to abandon the procedure and rebook them for another time after further assessment and discussion with the patient. Is there a way to bill for abandoned pacemaker procedures as well?

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