Medicare Benefits Schedule - Item 2526

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View Associated Notes

Level D

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:

a)     taking an extensive 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

2526

2526 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
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
3 - Level D

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive 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 that completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus

The fee for item 2525, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for 2525 plus $2.00 per patient.
Ready Reckoner

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

Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500, whichever is the lesser amount


Associated Notes

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