Medicare Benefits Schedule - Item 11820

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Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

11820

11820 - Additional Information

Item Start Date:
01-May-2004
Description Updated:
01-Nov-2017
Schedule Fee Updated:
01-Jul-2022

Group
D1 - Miscellaneous Diagnostic Procedures And Investigations
Subgroup
7 - Gastroenterology & Colorectal

Capsule endoscopy to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device (including administration of the capsule, associated endoscopy procedure if required for placement, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered) if:

(a) the service is provided to a patient who:

(i) has overt gastrointestinal bleeding; or

(ii) has gastrointestinal bleeding that is recurrent or persistent, and iron deficiency anaemia that is not due to coeliac disease, and, if the patient also has menorrhagia, has had the menorrhagia considered and managed; and

(b)    an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the
   bleeding; and

(c)  the service has not been provided to the same patient on more than 2 occasions in the preceding 12 months; and

(d)  the service is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and

(e)   the service is not associated with a service to which item 30680, 30682, 30684 or 30686 applies

 

Fee: $1,299.60 Benefit: 75% = $974.70 85% = $1,211.70

(See para DN.1.15 of explanatory notes to this Category)


Associated Notes

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

DN.1.15

Capsule Endoscopy - (Item 11820 and 11823)

Capsule endoscopy is primarily used to view the small bowel, which cannot be viewed by upper gastrointestinal endoscopy and colonoscopy.  

Capsule endoscopy imaging must be kept in a manner that facilitates retrieval on the basis of the patient's name and date of service. Records must be retained for a period of 2 years commencing on the day on which the service was rendered.

 Conjoint committee

The Conjoint Committee comprises representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). For the purposes of Items 11820 and 11823, specialists or consultant physicians performing this procedure must have endoscopic training recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy, and the Department of Human Services notified of that recognition. 

Related Items: 11820 11823


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change