Medicare Benefits Schedule - Item 42740

INTRAVITREAL INJECTION OF THERAPEUTIC SUBSTANCES, or the removal of vitreous humour for diagnostic purposes, 1 or more of, as a procedure associated with other intraocular surgery.

Multiple Operation Rule

(Anaes.)

Fee: $331.05 Benefit: 75% = $248.30 85% = $281.40

(See para TN.8.121 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $264.85

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Items 42738 and 42739 provide for paracentesis for the injection of therapeutic substances and/or the removal of aqueous or vitreous, when undertaken as an independent procedure. That is, not in conjunction with other intraocular surgery.

Item 42739 should be claimed for patients requiring the administration of anaesthetic by an anaesthetist for the procedure. The administration of oral sedation is not sufficient justification for the use of item 42739, and item 42738 is applicable in those circumstances. Advice from the Royal Australian and New Zealand College of Ophthalmologists is that independent injections require only topical anaesthesia, with or without subconjunctival anaesthesia, except in specific circumstances as outlined below where the administration of anaesthetic by an anaesthetist may be indicated:

- nystagmus or eye movement disorder;

- cognitive impairment precluding safe intravitreal injection without sedation;

- a patient under the age of 18 years;

- a patient unable to tolerate intravitreal injection under local anaesthetic without sedation; or

- endophthalmitis or other inflammation requiring more extensive anaesthesia (eg peribulbar).

GP anaesthetists are expected to meet the Joint Consultative Committee on Anaesthesia (JCCA) Continuing Professional Development (CPD) Standard which defines the minimum recommended requirements for all general practitioners providing anaesthesia services.

Practitioners billing item 42739 must keep clinical notes outlining the basis of the requirement for the administration of anaesthetic by an anaesthetist.

Item 42740 provides for intravitreal injection of therapeutic substances and/or the removal of vitreous for diagnostic purposes when performed in conjunction with other intraocular surgery including with a service to which Item 42809 (retinal photocoagulation) applies.

Related Items: 42738 42739 42740