Medicare Benefits Schedule - Item 11729

Multi channel electrocardiogram monitoring and recording during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, if:

(a) the patient is 17 years or more; and

(b) the patient:

(i) has symptoms consistent with cardiac ischemia; or

(ii) has other cardiac disease which may be exacerbated by exercise; or

(iii) has a first degree relative with suspected heritable arrhythmia; and

(c) the monitoring and recording:

(i) is not less than 20 minutes; and

(ii) includes resting electrocardiogram; and

(d) a written report is produced by a medical practitioner that includes interpretation of the monitoring and recording data, commenting on the significance of the data, and the relationship of the data to clinical decision making for the patient in the clinical context; and

(e) the service is not a service:

(i) provided on the same occasion as a service to which item 11704, 11705, 11707 or 11714 applies; or

(ii) performed within 24 months of a service to which item 55141, 55143, 55145, 55146, 61324, 61329, 61345, 61349, 61357, 61394, 61398, 61406, 61410 or 61414 applies

 Applicable only once in any 24 month period

Fee: $167.55 Benefit: 75% = $125.70 85% = $142.45

(See para DN.1.29, DR.1.2 of explanatory notes to this Category)

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Indication interpretation

Heritable arrhythmias include those defined in the CSANZ guidelines for the diagnosis and management of catecholaminergic polymorphic ventricular tachycardia, familial long QT syndrome and genetic investigation of young sudden unexplained death and resuscitated out of hospital cardiac arrest.

A calcium score of zero is normal and clinician judgement should be applied for scores of 0–10.

Results

Discussions of the results, findings or interpretation of a study are reasonably expected to be part of a formal report. Discussion of these findings with a patient does not constitute a consult. Similarly, discussion(s) during the course of a study or to determine the safety or appropriateness of the study is part of the service and should not be claimed as a consult.

Related Items: 11729

This service can be performed as an out-of-hospital service or for admitted hospital patients. 

Item 11729 does not apply to a service unless:

1. the patient is referred to a specialist or consultant physician by a referring practitioner; or
2. the service is requested by a requesting practitioner.

Referred services

For referred services to which item 11729 applies, the specialist or consultant physician who renders the service must:

1. manage the ongoing care of the patient; or
2. perform an attendance to determine that testing is necessary, where the need for the test has not otherwise been scheduled; or
3. perform an attendance immediately after the test has been performed, at which clinical management decisions are discussed with the patient.

A service is taken to be referred if the specialist or consultant physician who renders the service to which item 11729 applies is the patient’s treating practitioner, determines the need for a cardiac investigation that has not otherwise been scheduled, or performs a scheduled test but also provides an attendance where clinical management decisions are discussed with the patient.  Services in all other circumstances are considered to be requested.

Requested services

For requested services, item 11729 does not apply to a service if the rendering medical practitioner has performed a service to which an attendance applies for the same patient on the same day unless both of the following apply:

1. another medical practitioner has requested the electrocardiogram service; and
2. the attendance service is provided at the same time as, or after, the electrocardiogram service and is required because there is an urgent clinical need to make decisions about the patient’s care as a result of the electrocardiogram service.

Definition of 'requesting practitioner' when applied to item 11729 is as follows:

1. a medical practitioner (other than a specialist or consultant physician) requests that a specialist or consultant physician provide the diagnostic service; or
2. a specialist or consultant physician requests that a separate specialist or consultant physician provide the diagnostic service; or
3. a medical practitioner (other than a specialist or consultant physician) requests that a medical practitioner (other than a specialist or consultant physician) provide the diagnostic service; or
4. a specialist or consultant physician requests that a medical practitioner (other than a specialist or consultant physician) provide the diagnostic service.

Patient requirements

1. Item 11729 does not apply to a service unless:
   the patient’s body habitus, or other physical condition, is suitable for exercise stress testing or pharmacological induced stress testing; and
2. the patient can complete the exercise sufficiently or respond adequately to pharmacological induced stress, to take the required measurements.

Item 11729 does not apply to a service performed on a patient who:
   (i)   is asymptomatic and has a normal cardiac examination; or
  (ii)  has a known cardiac disease but the absence of symptom evolution suggests the disease has not progressed and the service is used for monitoring; or
 (iii) has an abnormal resting electrocardiography result which would prevent the interpretation of results.

Exercise testing and cardiopulmonary resuscitation

The Taskforce recommended changes to the performance of exercise or pharmacological electrocardiogram stress testing for optimal patient safety. For a service to be performed, the person performing the monitoring and recording must be:

1. in continuous attendance; and
2. trained in “exercise testing”  and cardiopulmonary resuscitation; and
3. a second person trained in cardiopulmonary resuscitation must be located at the premise and available to attend the electrocardiogram stress testing in an emergency.

Please refer to the Cardiac Society of Australia and New Zealand position statement on clinical exercise stress testing: https://www.csanz.edu.au/wp-content/uploads/2014/12/Clinical_Exercise_Stress_Testing_2014-December.pdf

Related Items: 11729