Medicare Benefits Schedule - Item 2517

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View Associated Notes

Level B

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:

a)     taking a patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation


AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.

Completion Of A Cycle Of Care For Patients With Established Diabetes Mellitus

The minimum requirements of care to complete an annual Diabetes Cycle of Care for patients with established diabetes mellitus must be completed over a period of at least 11 months and up to 13 months, and must include:


-     Assess diabetes control by measuring HbA1c               At least once every  year

-     Ensure that a comprehensive eye examination is carried out*     At least once every two years

-     Measure weight and height and calculate BMI**               At least twice every cycle of care

-     Measure blood pressure                         At least twice every cycle of care

-     Examine feet***                              At least twice every cycle of care

-     Measure total cholesterol, triglycerides and HDL cholesterol     At least once every year

-     Test for microalbuminuria                         At least once  every year

-     Test for estimated Glomerular Filtration Rate (eGFR)                    At least once every year

-     Provide self-care education                         Patient education regarding diabetes management

-     Review diet                              Reinforce information about appropriate dietary                                                             choices

-     Review levels of physical activity                    Reinforce information about appropriate levels of                                                        physical activity

-     Check smoking status                         Encourage cessation of smoking (if relevant)

-     Review of medication                         Medication review


*     Not required if the patient is blind or does not have both eyes.

**     Initial visit: measure height and weight and calculate BMI as part of the initial patient assessment.

    Subsequent visits: measure weight.

***     Not required if the patient does not have both feet.

Category 1 - PROFESSIONAL ATTENDANCES

2517

2517 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Group
A18 - General Practitioner Attendance Associated With Pip Incentive Payments
Subgroup
2 - Completion Of A Cycle Of Care For Patients With Established Diabetes Mellitus
Subheading
1 - Level B

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

Fee: $37.05 Benefit: 100% = $37.05

(See para AN.0.9, AN.0.54 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $111.15


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.9

Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)

Items 3 to 51 and 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067 relate specifically to attendances rendered by medical practitioners who are either:

-                  listed on the Vocational Register of General Practitioners maintained by the Department of Human Services;

-                  holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or

-                  holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the Australian College of Rural and Remote Medicine (ACRRM) for continuing medical education and quality assurance as defined in ACRRM's Professional Development Program;

-                  undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or

-                  undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.

Only general practitioners are eligible to itemise the Group A1, items 597and 599 of Group A11 and Group A22 content-based items. (See the General Explanatory Notes for further details of eligibility and registration.)

To assist general practitioners in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

LEVEL A

A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner's records.  In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

LEVEL B

A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

LEVEL C

A Level C item will be used for a consultation lasting at least 20 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

LEVEL D

A Level D item will be used for a consultation lasting at least 40 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Creating and Updating a Personally Controlled Electronic Health Record (PCEHR)

The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:

· Reviewing a patient's clinical history, in the patient's file and/or the PCEHR, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or

· Preparing an Event Summary for the episode of care.

Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time.

MBS rebates are not available for creating or updating a Shared Health Summary as a stand alone service.

Counselling or Advice to Patients or Relatives

For items 23 to 51 and 5020 to 5067 'implementation of a management plan' includes counselling services.

Items 3 to 51 and 5000 to 5067 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Recording Clinical Notes

In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

Other Services at the Time of Attendance

Where, during the course of a single attendance by a general practitioner, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service. Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information on the interpretation of the Schedule).

The Department of Human Services (DHS) has developed an Health Practitioner Guideline for responding to a request to substantiate that a patient attended a service which is located on the DHS website.

Related Items: 3 4 20 23 24 35 36 37 43 44 47 51 193 195 197 199 597 599 2497 2501 2503 2504 2506 2507 2509 2517 2518 2521 2522 2525 2546 2547 2552 2558 2559 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.54

Completion of the Annual Diabetes Cycle of Care for Patients with Established Diabetes Mellitus - (Items 2517 - 2526 and 2620 - 2635)

The item numbers 2517, 2518, 2521, 2522, 2525, 2526, and 2620, 2622, 2624, 2631, 2633, 2635, should be used in place of the usual attendance item when a consultation completes the minimum requirements of the annual Diabetes Cycle of Care for a patient with established diabetes mellitus.

The annual Diabetes Cycle of Care must be completed over a period of 11 months and up to 13 months, and at a minimum must include:

Assess diabetes control by measuring HbA1c

At least once every year

Ensure that a comprehensive eye examination is carried out*

At least once every two years

Measure weight and height and calculate BMI**

At least twice every cycle of care

Measure blood pressure

At least twice every cycle of care

Examine feet***

At least twice every cycle of care

Measure total cholesterol, triglycerides and HDL cholesterol

At least once every year

Test for microalbuminuria

At least once every year

Test for estimated Glomerular Filtration Rate (eGFR)

At least once every year

Provide self-care education

Patient education regarding diabetes management

Review diet

Reinforce information about appropriate dietary choices

Review levels of physical activity

Reinforce information about appropriate levels of physical activity

Check smoking status

Encourage cessation of smoking (if relevant)

Review of Medication

Medication review

*    Not required if the patient is blind or does not have both eyes.

**  Initial visit: measure height and weight and calculate BMI as part of the initial assessment.

      Subsequent visits: measure weight.

*** Not required if the patient does not have both feet.

These requirements are generally based on the current general practice guidelines produced by Diabetes Australia and the Royal Australian College of General Practitioners (Diabetes Management in General Practice). Doctors using these items should familiarise themselves with these guidelines and with subsequent editions of these guidelines as they become available.

Use of these items certifies that the minimum requirements of the Diabetes Cycle of Care have been completed for a patient with established diabetes mellitus in accordance with the guidelines above.

These items should only be used once per cycle per patient of either A18 Subgroup 2 or A19 Subgroup 2. For example, if item 2517 is claimed for a patient then no other diabetes item in groups A18 or A19 can be used for this patient in the same cycle.

The requirements for claiming these items are the minimum needed to provide good care for a patient with diabetes.  Additional levels of care will be needed by insulin-dependent patients and those with abnormal review findings, complications and/or co-morbidities.

In addition to attracting a Medicare rebate, recording a completion of a Diabetes Cycle of Care through the use of these items will initiate a Diabetes Service Incentive Payment (SIP) through the Practice Incentives Program (PIP).

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Diabetes Cycle of Care.

A PIP Diabetes SIP is available for completing the minimum requirements of the Diabetes Cycle of Care for individual patients as specified above. The Diabetes SIP is only paid once every 11-13 month period per patient. The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Diabetes Incentive. A further PIP Diabetes Incentive payment is paid to practices which reach target levels of care for their patients with diabetes mellitus.  More detailed information on the PIP Diabetes Incentive is available from the Department of Human Services PIP enquiry line on 1800 222 032 or  the Department of Human Services website.

Related Items: 2517 2518 2521 2522 2525 2526 2620 2622 2624 2631 2633 2635


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