Gastroenterology

Do I need a specific referral to admit the patient privately for every episode requiring admission?

27 September 24

No additional context was provided.

If a patient presents at a public hospital outpatient clinic with a named referral from their GP and needs admission but wants to go to a private hospital, is a new referral required?

27 September 24

If I see patients referred to me in the public clinic, and they are unwell and require admission to hospital at presentation to the clinic as patients with chronic disease sometimes are, do I need a separate referral from the referring GP or other senior doctor to admit them to the private hospital?

Do you get one item 132 and two item 133’s every 12 months?

31 August 20

Doctor A worked in a public hospital outpatient department where they exercised a right of private practice. They thought that they were not automatically permitted to bill item 132 every 12 months but had received contrary advice. Further, they were unclear about whether item 133 applies twice in the first year only or twice every year. They had been further advised that 133 can be billed twice during a 12 month period and therefore, for a patient of 20 calendar years that would mean they could bill item 133 40 times.

Can I bulk bill a Medicare service and charge for a related non-Medicare service simultaneously?

1 August 20

A gastroenterology practice asked whether a service provider providing two services to a patient on the same day, one for which there is an MBS item number, and the other for which there is not, can bulk bill the MBS service and simultaneously collect private payment for the non-MBS service. The question related to an outpatient context and both services were clinically relevant for the treatment of the patient, meaning neither would be considered cosmetic. NB: The scenario presented in this question is distinct from the common scenario of bulk billing a consultation and charging a private fee for a cosmetic botox injection, which is permitted, because Medicare specifically excludes rebates for cosmetic procedures, which are not clinically relevant. In this scenario, both services are clinically relevant. It is an important distinction and often a point of confusion.

When I am covering another physician’s inpatients and it’s the first time I see the patient, can I bill an initial consultation?

27 July 20

When one physician covers anothers’ inpatients who have already been admitted, but are new to the doctor covering for the weekend, Dr A wanted to know if it is acceptable to bill a 110? Dr A’s instincts were that all encounters should be billed as 116 since they are generally part of the same episode of care, (even if provided by a different physician) but she had received conflicting advice.

Can we co-claim a consultation every time we do a bone marrow biopsy?

3 July 20

A haematologist said that he and some colleagues were considering personally performing bone marrow aspirates and trephines (items 30084 and 30087) and explained that the MBS rebates for these procedures barely covered the cost of consumables, let alone the time taken, so they would have to charge gaps. However, he had heard that they could also claim an item 110 or 116 consultation item number at the same time as every aspirate procedure, because they review the patient’s appropriateness for the procedure, and obtain their consent.