This question came to us from a private health insurer as follows:

30-year male member undergoes procedures 49578 & 49580 as a same day patient in a private hospital, all claims paid at the fund agreement rate with no member out of pocket. Discharged with follow up appointment made for 8 weeks post op. Member had an uncomplicated recovery. Member needed to reschedule appointment for 1 week later so in total 9 weeks post op. Member attended post op consultation, consultation would have been less than 5 mins but slightly extended to a max of 10 mins as member had questions regarding return to sport and confirmation of details of surgery performed. Overall, the member was satisfied with consultation. Member was billed $150 MBS 00105 for the consultation with a rebate of $43.35 leaving an OOP of $106.65.

It is my understanding that all Group T8 – Surgical operations include standard aftercare as part of the surgical item MBS fee, therefore billing separately for a routine post op consult is not allowable.  Of course, I recognised that there could be exceptions to that in relation to consults for an unrelated condition, complications or any other non-standard services. It appears to me that there is a deliberate extension of the usual 6 week follow up period to 8 weeks so that it appears to be outside the standard aftercare period.

Do you consider the above case study appropriate billing?

Do you have any suggestions or tactics as to the best way to confront the surgeon regarding this?