Medicare Benefits Schedule - Item 16519

Search Results for Item 16519

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Category 3 - THERAPEUTIC PROCEDURES

16519

16519 - Additional Information

Item Start Date:
01-Nov-1995
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Nov-2012

Group
T4 - Obstetrics

Management of labour and birth by any means (including Caesarean section) including post-partum care for 5 days

(Anaes.)

Fee: $693.95 Benefit: 75% = $520.50 85% = $612.25

(See para TN.4.5, TN.4.6, TN.4.10 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $329.15


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.4.5

Labour and Birth - (Items 16515, 16518, 16519, 16530 and 16531)

Benefits for management of labour and birth covered by Items 16515, 16518, 16519, 16530  and 16531  includes the following (where indicated):-

-                  surgical and/or intravenous infusion induction of labour;

-                  forceps or vacuum extraction;

-                  evacuation of products of conception by manual removal (not being an independent procedure);

-                  episiotomy or repair of tears.

Item 16519 covers birth by any means including Caesarean section. If, however, a patient is referred, or her care is transferred to another medical practitioner for the specific purpose of birth by Caesarean section, whether because of an emergency situation or otherwise, then Item 16520 would be the appropriate item.

In some instances the obstetrician may not be able to be present at all stages of confinement. In these circumstances, Medicare benefits are payable under Item 16519 provided that the doctor attends the patient as soon as possible during the confinement and assumes full responsibility for the mother and baby.

Two items in Group T9 provide benefits for assistance by a medical practitioner at a Caesarean section. Item 51306 relates to those instances where the Caesarean section is the only procedure performed, while Item 51309 applies when other operative procedures are performed at the same time.

Where, during labour, a medical practitioner hands the patient over to another medical practitioner, benefits are payable under Item 16518 for the referring practitioner's services. The second practitioner's services would attract benefits under Item 16515 (i.e., management of vaginal birth) or Item 16520 (Caesarean section).  If another medical practitioner is called in for the management of the labour and birth, benefits for the referring practitioner's services should be assessed under Item 16500 for the routine antenatal attendances and on a consultation basis for the postnatal attendances, if performed.

At a high risk birth benefits will be payable for the attendance of any medical practitioner (called in by the doctor in charge of the birth) for the purposes of resuscitation and subsequent supervision of the neonate.  Examples of high risk births include cases of difficult vaginal birth, Caesarean section or the birth of babies with Rh problems and babies of toxaemic mothers.

Related Items: 16515 16518 16519 16530 16531

Category 3 - THERAPEUTIC PROCEDURES

TN.4.6

Caesarean Section - (Item 16520)

Benefits under this item are attracted only where the patient has been specifically referred to another medical practitioner for the management of the birth by Caesarean section and the practitioner carrying out the procedure has not rendered any antenatal care. Caesarean sections performed in any other circumstances attract benefits under Item 16519.

 

Related Items: 16519 16520

Category 3 - THERAPEUTIC PROCEDURES

TN.4.10

Post-Partum Care - (Items 16515 to 16520 and 16564 to 16573)

The Schedule fees and benefits payable for Items 16519 and 16520 cover all postnatal attendances on the mother and the baby, except in the following circumstances:‑

(i)               where the medical services rendered are outside those covered by a consultation, e.g., blood transfusion;

(ii)              where the condition of the mother and/or baby is such as to require the services of another practitioner (e.g., paediatrician, gynaecologist, etc);

(iii)             where the patient is transferred, at arms length, to another medical practitioner for routine post-partum, care (eg mother and/or baby returning from a larger centre to a country town or transferring between hospitals following confinement).  In such cases routine postnatal attendances attract benefits on an attendance basis. The transfer of a patient within a group practice would not qualify for benefits under this arrangement except in the case of Items 16515 and 16518. These items cover those occasions when a patient is handed over while in labour from the practitioner who under normal circumstances would have delivered the baby, but because of compelling circumstances decides to transfer the patient to another practitioner for the birth;

(iv)             where during the postnatal period a condition occurs which requires treatment outside the scope of normal postnatal care;

(v)              in the management of premature babies (i.e. babies born prior to the end of the 37th week of pregnancy or where the birth weight of the baby is less than 2500 grams) during the period that close supervision is necessary. 

Normal postnatal care by a medical practitioner would include:-

(i)               uncomplicated care and check of

-     lochia

-     fundus

-     perineum and vulva/episiotomy site

-     temperature

-     bladder/urination

-     bowels

(ii)              advice and support for establishment of breast feeding

(iii)             psychological assessment and support

(iv)             Rhesus status

(v)              Rubella status and immunisation

(vi)             contraception advice/management 

Examinations of apparently normal newborn infants by consultant or specialist paediatricians do not attract benefits 

Items 16564 to 16573 relate to postnatal complications and should not be itemised in respect of a normal birth. To qualify for benefits under these items, the patient is required to be transferred to theatre, or be administered general anaesthesia or epidural injection for the performance of the procedure. Utilisation of the items will be closely monitored to ensure appropriate usage.

 

Related Items: 16515 16518 16519 16520 16564 16567 16570 16571 16573


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