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Category 1 - PROFESSIONAL ATTENDANCES
6015 - Additional Information
Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to him or her-an attendance after the first in a single course of treatment, involving an exhaustive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 45 minutes in duration at consulting rooms or hospital
Fee: $155.60 Benefit: 75% = $116.70 85% = $132.30
(See para AN.0.64 of explanatory notes to this Category)
Category 1 - PROFESSIONAL ATTENDANCES
Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)
Referred consultations provided by specialist neurosurgeons will be covered under items 6007 to 6015. These new items replace the use of specialist items 104 and 105 for referred consultations by neurosurgeons.
The neurosurgical consultation structure comprises an initial consultation (item 6007) and four categories of subsequent consultations (items 6009-6015). These categories relate to the time AND level of complexity of the attendance i.e
(i) Level 1 - 6009
(ii) Level 2 - 6011
(iii) Level 3 - 6013
(iv) Level 4 - 6015
The following provides further guidance for neurosurgeons in utilising the appropriate items in common clinical situations:
(i) Initial consultation item 6007 will replace item 104.
(ii) Subsequent consultation items 6009-6015 will replace item 105
Item 6009 (subsequent consultation on a patient for 15 mins or less) covers a minor subsequent attendance which is straightforward in nature. Some examples of a minor attendance would include consulting with the patient for the purpose of issuing a repeat script for anticonvulsant medications or the routine review of a patient with a ventriculo-peritoneal shunt.
Item 6011 (subsequent consultation on a patient for a duration of between 16 to 30 mins) would involve an detailed and comprehensive examination of the patient which is greater in complexity than would be provided under item 6009, arranging or evaluating any necessary investigations and include detailed relevant patient notes. Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record included in the patient notes. Some examples of a detailed neurosurgical attendance would include:
· the reviewing of neuroimaging for the monitoring of a tumour or lesion and discussion of the results with the patient (e.g. meningiomaglioma, spinal cord tumour);
· consultation on a patient to review imaging for spinal cord/cauda equina/ nerve root compression from a disc prolapse and discussion of results; or
· consultation on a patient prior to insertion of a ventriculo-peritoneal shunt)
Item 6013 (subsequent consultation on a patient with complex neurological conditions for the duration of between 31 to 45 mins) should involve a extensive and comprehensive examination of the patient greater in complexity than under item 6011, arranging or evaluating any necessary investigations and include detailed relevant patient notes. Item 6013 would be expected to cover complications, adverse outcomes, or review of chronic conditions. Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record be included in the patient notes. Some examples of an extensive neurosurgical attendance would include:
· an attendance on a patient prior to a craniotomy for cerebral tumour;
· surgery for spinal tumour;
· revision of spinal surgery;
· epilepsy surgery; or
· for the treatment of cerebral aneurysm.
Examination of such patients would include full cranial nerve examination or examination of upper and lower limb nervous system.
Item 6015 (subsequent consultation on a patient with complex neurological conditions for a duration of more than 45 mins) should involve an exhaustive examination of the patient that is more comprehensive than 6013 and any ordering or evaluation of investigations and include detailed relevant patient notes. It would be expected to cover complications, adverse outcomes, or review of chronic conditions. Where a management plan is formulated it is expected that this plan is thoroughly discussed with the patient and a written record be included in the patient notes. An exhaustive neurosurgical consultation includes:
· managing adverse neurological outcomes;
· detailed discussion when multiple modalities are available for treatment (e.g. clipping versus coiling for management of a cerebral aneurysm, surgical resection versus radiosurgery for cerebral tumour); or
· discussion where surgical intervention is likely to result in a neurological deficit but surgery is critical to patient's life or to stop progressive neurologic decline (e.g. cranial nerve dysfunction, motor dysfunction secondary to a cerebral or spinal cord lesion).
Examination of such patients would include exhaustive neurosurgical examination includings full neurological examination (cranial nerves and limbs) or detailed 'focused examination' (e.g.: brachial plexus examination)
Complex neurosurgical problems referred to in items 6013 and 6015 include:
· deterioration in neurologic function following cranial or spinal surgery;
· presentation with new neurologic signs/symptoms; multifocal spinal and cranial disease (e.g. neurofibromatosis); or
· chronic pain states following spinal surgery (including discussion of other treatment options and referral to pain management)
NOTE: It is expected that informed financial consent be obtained from the patient where possible.
- 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