Medicare Benefits Schedule - Item 11716

Note: the service only applies if the patient meets one or more of the following and the requirements in Note: DR.1.1

Continuous ambulatory electrocardiogram recording for 12 or more hours, by a specialist or consultant physician, if the service:

(a) is indicated for the evaluation of any of the following:

(i) syncope;

(ii) pre‑syncopal episodes;

(iii) palpitations where episodes are occurring more than once a week;

(iv) another asymptomatic arrhythmia is suspected with an expected frequency of greater than once a week;

(v) surveillance following cardiac surgical procedures that have an established risk of causing dysrhythmia; and

(b) utilises a system capable of superimposition and full disclosure printout of at least 12 hours of recorded electrocardiogram data (including resting electrocardiogram and the recording of parameters) and microprocessor based scanning analysis; and

(c) includes interpretation and report; and

(d) is not provided in association with ambulatory blood pressure monitoring; and

(e) is not associated with a service to which item 11704, 11705, 11707, 11714, 11717, 11723, 11735, 12203, 12204, 12205, 12207, 12208, 12210, 12213, 12215, 12217 or 12250 applies

Applicable only once in any 4 week period

Note: this services does not apply if the patient is being provided with the service as part of an episode of:

1. hospital treatment; or
2. hospital‑substitute treatment.

Fee: $184.40 Benefit: 85% = $156.75

(See para DN.1.28, DR.1.1 of explanatory notes to this Category)

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Indications interpretation

The following indications would be considered appropriate even in patients who may not experience symptoms more often than once a week.

1. For the detection of asymptomatic atrial fibrillation (AF) following a transient ischaemic attack (TIA) or cryptogenic stroke.
2. For the surveillance of paediatric patients following cardiac surgeries that have an established risk of causing dysrhythmia.
3. For babies, young children and other patients where there is a demonstrable benefit for the documentation of heart rate or if a cardiac dysrhythmia is suspected, but due to the patient’s age, cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

Results

Discussions of the results, findings or interpretation of a study are reasonably expected to be part of a formal report. Discussion of these findings with a patient does not constitute a consult. Similarly, discussion(s) during the course of a study or to determine the safety or appropriateness of the study is part of the service and should not be claimed as a consult.

Related Items: 11716

Items 11716, 11717, 11723 or 11735 do not apply to a service unless:

(i)  the patient is referred to a specialist or consultant physician by a referring practitioner; or
(ii) the service is requested by a requesting practitioner.

Admitted patient

Item 11716, 11717, 11723 or 11735 do not apply to a service if the patient is an admitted patient.

An “admitted patient” includes an episode of hospital treatment and an episode of hospital-substitute treatment where a benefit is paid from a private health insurer.

Referred services

For referred services to which items 11716, 11717, 11723 or 11735 apply, the specialist or consultant physician who renders the service must:

(i)   manage the ongoing care of the patient; or
(ii)  perform an attendance to determine that testing is necessary, where the need for the test has not otherwise been scheduled; or
(iii) perform an attendance immediately after the test has been performed, at which clinical management decisions are discussed with the patient.

A service is taken to be referred if the specialist or consultant physician who renders the service to which items 11716, 11717, 11723 or 11735 applies is the patient’s treating practitioner, determines the need for a cardiac investigation that has not otherwise been scheduled, or performs a scheduled test but also provides an attendance where clinical management decisions are discussed with the patient.  Services in all other circumstances are considered to be requested.

Requested services

(i)   for requested services, items 11716, 11717, 11723 or 11735 do not apply to a service if the rendering specialist or consultant physician has performed a service to which an attendance applies for the same patient on the same day.

(ii)  definition of 'requesting practitioner' when applied to items 11716, 11717, 11723 or 11735 is as follows:

1. a medical practitioner (other than a specialist or consultant physician) requests that a specialist or consultant physician provide the service.
2. a specialist or consultant physician requests that a separate specialist or consultant physician provide the service.

Related Items: 11716 11717 11723 11735