Intensive Care

Can an intensivist use a separate provider number for medical imaging services and their main provider number for usual ICU services to avoid rejected claims that should be paid?

30 September 24

The context for this question involves co-claiming diagnostic ultrasound and vascular access items. After the last MBS review, vascular access items 13815, 13842 and the newly introduced ECMO item number 13837/13838 and 13834/13835 definitions included a new clause to stipulate that no ultrasound item numbers can be claimed in association with these procedures. Traditionally 55054 was co-claimed when ultrasound was used, however the review taskforce stipulated that this was now standard of care and these procedures should attract no further ultrasound benefit. That is all fine, except the way this was implemented at a processing level, is that the above vascular access item numbers restrict with ALL diagnostic ultrasound item numbers. It is sometimes necessary to provide diagnostic imaging services to ICU patients (either referred or self-deemed). This is most often echocardiography, but it can be general abdominal, soft tissue, etc. These diagnostic imaging item numbers are not related to vascular access, but unfortunately even if it is clearly indicated in the service text that they are unrelated, a large majority of the time they get rejected and require manual processing. Someone suggested we could overcome this by obtaining a separate provider number that would be used for medical imaging services only and then the items would not conflict at processing. For example, the same intensivist would claim all intensive care item numbers including vascular access under their “ICU” provider number and then claim any medical imaging services they provide under a different provider number. I am not sure this...

Are there any legal restrictions to claiming more than one blood transfusion on the same day for the same patient?

26 September 24

There is nothing in the MBS to preclude multiple transfusions (item 13706) being provided on the same calendar day and the item number covers three different types of regularly provided transfusions (blood, platelets, IVIg). There are ample examples in ICU when a patient legitimately requires multiple appropriate transfusion episodes during a 24 hour period and these are due to changing clinical circumstances, not part of a pre-defined transfusion plan (e.g. blood transfusion at 4am with 2 units of packed cells, subsequent transfusion of platelets and another unit of blood at 2 pm and another transfusion with a unit of blood at 10pm – for ongoing surgical bleeding). In my interpretation these would account for three distinct, time separated transfusion episodes and item 13706 should be claimed three times. However, Medicare seems to reject claims with more than two 13706 items on it. The error message is usually that the service has already been paid or maximum number reached. This is in spite of times and NDS override documented on the submission. Also, how does one reconcile a massive transfusion episode in billing (sometimes dozens of units of blood and platelets are given) – clearly this is a very different level of clinical workload and involvement compared to a single unit transfusion.

Is there a legal restriction to claiming a new initial day of ICU when the patient was discharged from ICU and readmitted within 3 days?

25 September 24

If a patient is discharged from ICU and readmitted within 3 days and we claim a new initial day of ICU management (13870), the claims reject. We find that if we resubmit the claim as item 13873 (subsequent day of ICU management), it is paid. However, this is not strictly a correct claim because the service provided best matches the initial day item 13870. Is there a legal barrier? The practitioner was also experiencing the same problems in relation to a number of other first and subsequent day services such as dialysis, haemofiltration and extracorporeal life support.