Pathology

Can item 38248 (selective coronary angiography) be performed to exclude serious pathology for a patient who recently attended ED with tachycardia, has a family history of heart attack, has been on statins for a long time and is anxious about their condition?

23 October 26

My 60 year-old patient has been on cholesterol lowering drugs for many years and said they recently had a racing heart and went to a private ED. The ED said there was nothing to worry about an…

Can a pathologist split a request for 4 or more MBS pathology services, bulk billing some and charging a fee for the rest?

11 September 26

If a pathology provider bills more than 3 items do the coning rules mean that every item from number 3 onwards becomes a single professional service? And therefore, does that mean you can’t …

Can a public outpatient use a private pathology or imaging provider if a staff specialist has written a request? Or do they have to use the non-Medicare public service?

1 March 26

Staff specialist physician in a public hospital with a Right of Private Practice (RoPP). This is a public outpatients question. Our department refers to these as “hospital patients” i.e…

We have been told to tell public patients that without a named referral they won’t be able to access bulk billed private imaging and pathology outside of the hospital. Is this legal?

1 March 26

Staff specialist physician in a NSW public hospital with a Right of Private Practice (RoPP). Our dept is under pressure to increase Medicare billings.I understand that Clause G17(b) of the NHR…

Can Medicare be charged by a pathology company if the request was signed by a doctor who did not see the patient and is not going to view or interpret the results?

26 January 26

Can Medicare be charged by a pathology provider if the pathology request came from a doctor who has no intention of viewing the results. An online vendor issues the request and charges a fee f…

Can low testosterone be continually monitored through Medicare funded blood tests when it’s not clinically necessary?

31 August 25

I understand that if a patient is under the care of an endocrinologist for low testosterone, Tx would qualify the patient for a repeat MBS funded pathology testing as a formal hypogonadism dia…

There are telehealth wellness companies sending patients to 3rd party telehealth companies for Medicare funded pathology tests. Who is responsible?

19 May 25

There are telehealth wellness and “optimisation” clinics sending patients for Medicare funded tests to a 3rd party telehealth company that has agreed to provide Medicare funded testing automat…

Can a telehealth company sell MBS funded pathology tests if the patient has not had a consultation with a doctor or nurse practitioner?

12 May 25

There are telehealth companies using the sexual and reproductive health exemption to offer MBS funded pathology tests but some of them don’t do a consult beforehand. They basically just sell a…

If a pathology company fits a BP monitoring device but a GP does the treatment plan, who can claim the item 11607?

2 December 24

I am a GP. I have come across an issue with item number 11607. Our pathology company is billing 11607. They fit the patient with an ambulatory bp monitor and send a report to me from a cardiol…

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