Medicare Benefits Schedule - Item 91827

Search Results for Item 91827

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Category 1 - PROFESSIONAL ATTENDANCES

91827

91827 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
01-Mar-2024
Schedule Fee Updated:
01-Nov-2023

Group
A40 - Telehealth and phone attendance services
Subgroup
6 - Consultant psychiatrist telehealth services

Telehealth attendance for a person by a consultant psychiatrist; if:

(a)     the attendance follows a referral of the patient to the consultant psychiatrist by a referring practitioner; and

(b)     the attendance was not more than 15 minutes in duration;

if that attendance and another attendance to which item 296, 297, 299 or any of items 300, 302, 304, 306, 308, 91828 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year

Fee: $48.40 Benefit: 85% = $41.15

(See para AN.0.30, AN.0.31, AN.0.75 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $145.20


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.30

Consultant Psychiatrist - Referred Patient Assessment and Management Plan - Items 291 or 92435 and 293 or 92436

Intention of Item 291 and 92435:

It is expected that item 291 or 92435 will be a single attendance. The intention of this item is to provide access to psychiatry expertise and the provision of a detailed written report to the referrer, so that the medical practitioner in general practice (including a general practitioner, but not a specialist or consultant physician) or participating nurse practitioner can provide the ongoing management of the patient. The detailed report is a fundamental component of this item and must address not only a comprehensive diagnostic assessment but also the recommended management of the patient in both the immediate and longer term.

Where a patient’s clinical needs are complex and the psychiatrist assesses it is not appropriate for the referrer to provide the ongoing management of the patient, the psychiatrist should use item 296, 297 or 299 (for a new patient) or 300, 302, 304, 306 or 308 (for subsequent attendance) or telehealth equivalent items 92437, 91827 to 91831, 91837 to 91839 (refer to Note AN.0.75).

The referrer can seek a revision of this management plan once in a 12 month period, through item 293 or 92436.

Referral:

Referral for items 291 or 92435 and 293 or 92436 are required from a medical practitioner in general practice or participating nurse practitioner for the assessment and development of a management plan of a patient with mental health condition.

Note: If a specialist of a discipline outside of psychiatry, wishes to refer a patient for this item the referral should take place through the medical practitioner in general practice or participating nurse practitioner.

Claiming other psychiatry items in association with 291 or 92435:

Whilst it is not expected that additional attendance items would be routinely used prior to item 291 or 92435, there may be circumstances where a patient has been referred (by a medical practitioner in general practice or participating nurse practitioner) for an assessment or management plan, but it is not possible for the psychiatrist to determine in the initial consultation whether the patient is suitable for management under such a plan.

In those circumstances, where the psychiatrist undertakes a consultation prior to the 291 or 92435 consultation, time based consultation items can be claimed, according to the item requirements. In these cases, where clinically appropriate, items 296, 297 or 299 (for a new patient) or 300, 302, 304, 306 or 308 (for subsequent attendance) or telehealth equivalent items (92437, 91827 to 91831, 91837 to 91839) may be used. Non-patient interview items 341, 343, 345, 347 or 349 or telehealth equivalent items 91874 to 91878, 91882 to 91884 may be used, where clinically appropriate, to assist with diagnosis assessment and preparation of treatment plans.

Claiming other psychiatry items following item 291 or 92435:

Whilst it is not expected that psychiatry time-based attendance items, such as items 300 to 308, would be used following the billing of item 291 or 92435, there may be clinical circumstances where limited follow up is required to provide short term assistance to enable the medical practitioner in general practice or participating nurse practitioner to provide the ongoing management of the patient. For example, one or two consultations monitoring the titration of a Schedule 8 medication prior to transfer of care back to a medical practitioner in general practice.  As the intention of this item is to provide detailed recommendations to the referrer to manage the patient’s ongoing care, only short-term non-ongoing management which enables this intent would be considered appropriate.  

Item 293 or 92436 provides opportunity for a comprehensive review of the management plan initiated by the referrer and can be claimed once in a 12 month period following use of item 291 or 92435.

Requirements of item 291 or 92435 - Use of outcome tools:

In order to contribute to the diagnostic assessment and monitor response to therapy, where clinically appropriate, an assessment and/or outcome tool should be utilised during the assessment and review stage of treatment. The choice of the evidence-based tool/s to be used is at the clinical discretion of the practitioner, however the following outcome tools are recommended:

  • Kessler Psychological Distress Scale (K10)
  • Short Form Health Survey (SF12)
  • Health of the Nation Outcome Scales (HoNOS)
  • DASS 21 (Depression, Anxiety and Stress)
  • BDI (Depression)
  • BAI (Anxiety)
  • BDRS (Bipolar Disorder)
  • YBOCS (OCD)
  • GRS (Older adults)
  • EPDS (Postnatal Depression)

Requirements of item 291 or 92435 - Management Plan Report:

A written copy of the detailed management plan in consultation with the patient, must be provided to the referring GP or participating nurse practitioner within a maximum of two weeks of the assessment.

It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the referring GP or participating nurse practitioner may be appropriate.

The detailed Management Plan should contain:

  • The findings of the comprehensive diagnostic assessment and the formulation that contributed to this assessment (including the finding of the outcome tools where clinically appropriate)
  • Relevant history and Mental Status Examination
  • Identification of any risks to the patient or others
  • Detailed management plan which includes, as clinically appropriate, not limited to one or more of the following recommendations:

o   Biopsychosocial management

o   Non-medication recommendations including (where relevant): psychoeducation; recommendations for psychological treatment (and who should provide this); social prescribing

o   Indications for review or episode and escalation of treatment strategies

o   Longer term management goals

Review of Management Plan - Item 293 or 92436:

Item 293 or 92436 is available in instances where the referring medical practitioner in general practice or participating nurse practitioner initiates a review of the plan provided under item 291 or 92435, usually where the current plan is not achieving the anticipated outcome or there has been a change in the clinical circumstances. It is expected that when a plan is reviewed, any modifications necessary will be made. Item 293 or 92436 can only be claimed once in a 12 month period, following the provision of a service under 291 or 92435.

Related Items: 291 293 296 297 299 300 302 304 306 308 91166 91167 91169 91170 91172 91173 91175 91176 91827 91831 91837 91839 92435 92436 92437

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.31

Psychiatric Attendances (Items 319 and 91873)

Item 319 or 91873 provides for an attendance, by a psychiatrist, to provide intensive psychotherapy where the patient’s clinical condition requires intensive treatment. Clinical appropriateness and indications for intensive psychotherapy are determined following a comprehensive assessment and formulation of a diagnosis and should be documented in the patient’s notes. It is also expected that other appropriate psychiatric treatment has been used for a suitable period and the patient has shown little or no response to such treatment. Such treatment would include, but not be limited to: shorter term psychotherapy; less frequent but long-term psychotherapy; pharmacological therapy; and cognitive behaviour therapy. 

Once a patient is identified as meeting the criteria of item 319 or 91873, eligibility continues under that item for the duration of that course of treatment (provided that attendances under items 296, 297, 299, 300, 302, 304, 306, 308, 319, 91827 to 91831, 91837 to 91839, 91873 and 92437 do not exceed 160 in a calendar year). If the patient requires more than 160 services in a calendar year for intensive psychotherapy, then such attendances would be covered by items 310, 312, 314, 316, 318, 91868 to 91872 or 91879 to 91881. 

Related Items: 296 297 299 300 302 304 306 308 310 312 314 316 318 319 91827 91831 91837 91839 91873 92437

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.75

Initial Consultation for a new patient (item 296 in rooms, item 297 at hospital, item 299 for home visits or telehealth equivalent item 92437)

Referral for items 296, 297 and 299 or item 92437 may be from a participating nurse practitioner, medical practitioner practising in general practice, a specialist or another consultant physician.

It is intended that either item 296, 297, 299 or 92437 will be claimed once on the first occasion that the patient is seen by a consultant psychiatrist.

If the patient is referred by a medical practitioner in general practice or participating nurse practitioner for an assessment or management plan, item 291 or 92435 should be utilised (refer to note AN.0.30). It is not expected that 296, 297, 299 or 92437 items would be routinely used prior to item 291 or 92435.

Use of items 296, 297, 299 or 92435 by one consultant psychiatrist does not preclude them being used by another consultant psychiatrist for the same patient. The use of items 296, 297, 299 or 92437 are identical except for the location of where the service is rendered. That is: item 296 is only available for consultations rendered in consulting rooms, item 297 is only available for consultations rendered at a hospital, and item 299 is only available for consultations rendered at a place other than consulting rooms or a hospital (such as in a patient’s home) and item 92437 is available for telehealth consultations delivered by videoconference.

For patients who have already been seen by the consultant psychiatrist in the preceding 24 months the psychiatrist can use time-tiered attendance items 300, 302, 304, 306 and 308 or telehealth equivalent consultation items 91827 to 91831 and 91837 to 91839.

Related Items: 291 296 297 299 300 302 304 306 308 91827 91831 91837 91839 92435 92437


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