Supervision Rules

Can item 11714 (ECG) be co-claimed with item 17610 or 17615 (pre-anaesthetic consultations) prior to admission?

24 February 21

The question posed was: If an ECG is performed during a pre-admission consultation (MBS Item 17610 or 17615) and the criteria of item number 11714 is met, is it permissible to claim both?

How do I bill for a 3 day course of chemotherapy delivered via a pump?

18 December 20

This very common scenario is billed by oncologists and haematologists when delivering chemotherapy via an infuser pump such as a folfox. The typical scenario is that the patient comes in on day 1 to have the pump connected and loaded, is home on day 2 and returns for the disconnect on day 3. Usually the entire course of treatment is billed under supervision arrangements with the medical practitioners not usually attending the patient at all. Oncology nurses typically administer the entire regime. Here are some examples of reported confusion around the correct billing of this course of treatment using item 13950. 1. Doctor A had received advice that Item 13950 can be billed on all 3 days even when the patient was at home on day 2. 2. Doctor B had received advice that she could bill item 13950 on day 3 when the pump was disconnected, but could not bill item 14221 on that day. 3. Doctor C was advised he could bill item 13950 everyday while his patients were admitted and receiving a continuous chemotherapy infusion, even if he did not attend the patient (that this could be supervised). This was also not only legally incorrect, but alarming.

Can oncologists bill item 14206 and does it come under the supervision rules?

17 August 20

A practice manager for an oncology practice asked whether the oncologists can claim item 14206 even though it is in the assisted reproductive technology (ART) section of the MBS, because it accurately describes a service the oncologists provide, being “HORMONE OR LIVING TISSUE IMPLANTATION by cannula.”

Can a nephrologist bill item 13103 for supervising dialysis patients when unable to see the patients face to face?

1 August 20

I am a nephrologist working in both public and private hospitals, including a private dialysis facility. I have private patients on dialysis whom I am responsible for and I supervise their treatment. Dialysis patients are admitted for each treatment. I am frequently contacted by staff for ongoing issues, but I only get to physically see the patients about once in a month or so due to timing issues. Currently, I bulk bill private patients item number 116, but only when I see them face to face. I have recently learned about item 13103, which someone said I could bill even when I am not present. Can I legally claim item 13103 when these patients are having their dialysis treatment and I am not seeing them face to face, but am working in the background? I am in Australia.

If a patient is having chemotherapy at a hospital and the doctor goes on holiday, can we still bill for treatment under that doctor’s provider number because they created and approved the treatment regime?

1 August 20

Question: Wanting to confirm that if a patient is on a chemotherapy regime at a hospital and the doctor goes on holiday, can we still bill the treatment under the doctor’s provider number, as they created and approved the treatment pathway? For example: A patient has chemotherapy scheduled on Thursday, their doctor goes on holiday on the Wednesday, so the covering doctor sees the patient and bills for a consultation. The patient’s usual doctor (who is on holiday) is still allowed to bill for the treatment code though, as they created the pathway. Is that correct?