Emergency Medicine

Can Medicare benefits be claimed when a FACEM does a virtual consult in an accredited private emergency department?

4 October 24

The emergency specialists (FACEMs) are all accredited and licensed and practicing in public emergency departments (ED) across the country. The hypothetical scenario given was that a patient presents in the usual way to the private ED and is triaged and assessed by onsite nursing staff. If there are no onsite doctors available or they are too busy can the nurse and patient onsite engage in a video consultation with a virtual FACEM and is that claimable to Medicare? The FACEM would assess the patient, make a management plan and either discharge as appropriate or admit to a relevant specialty within the hospital. The clinical record would be produced as per normal and uploaded into the patient record. The Virtual FACEMs would also be accredited by the private ED in the normal way.

Can a fellow of the Australasian College for Emergency Medicine (FACEM) bill MBS codes outside of a private emergency department?

24 September 24

This FACEM was planning to open a walk-in emergency clinic similar to a GP urgent care centre. Importantly, this would not be an approved private emergency department (ED). The following scenarios were posed as part of the question. Scenario 1: A 68-year-old female presents to the treatment centre (FACEM lead) post fall and sustains a right wrist fracture & a laceration to her forehead. The patient is assessed by the FACEM which includes history, examination and organising investigations – some blood tests, ECG and X ray. As a part of treatment, the patient requires interpretation of an ECG, reduction of the fracture and application of plaster under a local block, and suturing of forehead laceration under local. Which code applies for the consult, is it 104 or 107? Which code applies for the fracture reduction and plaster application? Which code applies for the local block? Scenario 2: A patient presents with abdominal pain on a Sunday. The patient requires assessment by a FACEM, which includes, history, examination and organising investigations followed by treatment. Is seeing this patient on a Sunday considered an afterhours presentation? If yes, which code applies for the consult?

What constitutes a referral from the Emergency Department to an inpatient medical unit?

20 January 21

This is a common question. Who should the referrer be in these circumstances?

If a specialist sees a non-admitted patient in an approved private emergency department, can they bill to Medicare and is the patient entitled to a rebate?

10 July 20

Billing to Medicare for non-admitted patients in public hospital emergency departments is strictly prohibited, even if patients have private health insurance and are happy to use it. This is provided for in various provisions of both the Health Insurance Act 1973 and its intersection with the National Health Reform Agreement. However, in this scenario, Dr A was a haematologist who worked at a private hospital with an approved private emergency department (ED). Dr A wanted to know whether non-admitted patients in the ED could be billed to Medicare and whether the patient would be entitled to a Medicare rebate. Further, Dr A wanted to know at what point a patient is considered an inpatient after a decision to admit has been made, so that the patient’s private health insurer (PHI) could be billed. Was it: 1. When the patient is physically out of the ED and on the ward, or 2. When a decision has been made to admit the patient, but the patient is still in the ED, or 3. When the patient’s admission status has been changed in the hospital administration system indicating the patient is an inpatient.