Medicare Benefits Schedule - Item 13870

Search Results for Item 13870

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

13870

13870 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

Group
T1 - Miscellaneous Therapeutic Procedures
Subgroup
10 - Management And Procedures Undertaken In An Intensive Care Unit

(Note: See para T1.8 of Explanatory Notes to this

Category for definition of an Intensive Care Unit)


    

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on the first day (H)

Fee: $367.90 Benefit: 75% = $275.95

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.1.9

Intensive Care Units - (Items 13870 to 13888)

'Intensive Care Unit' means a separate hospital area that:

(a)              is equipped and staffed so as to be capable of providing to a patient:

(i)      mechanical ventilation for a period of several days; and

(ii)     invasive cardiovascular monitoring; and

(b)              is supported by:

(i)      at least one specialist or consultant physician in the specialty of intensive care who is immediately available and exclusively rostered to the ICU during normal working hours; and

(ii)     a registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and

(iii)    a registered nurse for at least 18 hours in each day; and

(c)              has defined admission and discharge policies. 

"immediately available" means that the intensivist must be predominantly present in the ICU during normal working hours. Reasonable absences from the ICU would be acceptable to attend conferences, meetings and other commitments which might involve absences of up to 2 hours during the working day. 

"exclusively rostered" means that the specialist's sole clinical commitment is to intensive care associated activities and is not involved in any other duties that may preclude immediate availability to intensive care if required. 

For Neonatal Intensive Care Units an 'Intensive Care Unit' means a separate hospital area that:

(a)              is equipped and staffed so as to be capable of providing to a patient, being a newly-born child:

(i)   mechanical ventilation for a period of several days; and

(ii)  invasive cardiovascular monitoring; and

(b)              is supported by:

 (i)     at least one consultant physician in the specialty of paediatric medicine, appointed to manage the unit, and who is immediately available and exclusively rostered to the ICU during normal working hours; and

(ii)     a registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and

(iii)a registered nurse for at least 18 hours in each day; and

(c)              has defined admission and discharge policies. 

Medicare benefits are payable under the 'management' items only once per day irrespective of the number of intensivists involved with the patient on that day.  However, benefits are also payable for an attendance by another specialist/consultant physician who is not managing the patient but who has been asked to attend the patient.  Where appropriate, accounts should be endorsed to the effect that the consultation was not part of the patient's intensive care management in order to identify which consultations should attract benefits in addition to the intensive care items. 

In respect of Neonatal Intensive Care Units, as defined above, benefits are payable for admissions of babies who meet the following criteria:-

(i)               all babies weighing less than 1000gms;

(ii)              all babies with an endotracheal tube, and for the 24 hours following endotracheal tube removal;

(iii)             all babies requiring Constant Positive Airway Pressure (CPAP) for acute respiratory instability;

(iv)             all babies requiring more than 40% oxygen for more than 4 hours;

(v)              all babies requiring an arterial line for blood gas or pressure monitoring; or

(vi)             all babies having frequent seizures. 

Cases may arise where babies admitted to a Neonatal Intensive Care Unit under the above criteria who, because they no longer satisfy the criteria are ready for discharge, in accordance with accepted discharge policies, but who are physically retained in the Neonatal Intensive Care Unit for other reasons.  For benefit purposes such babies must be deemed as being discharged from the Neonatal Intensive Care Unit and not eligible for benefits under items 13870, 13873, 13876,  13881, 13882, 13885 and 13888. 

Likewise, Medicare benefits are not payable under items 13870, 13873, 13876,  13881 13882, 13885 and 13888 in respect of babies not meeting the above criteria, but who, for whatever other reasons, are physically located in a Neonatal Intensive Care Unit. 

Medicare benefits are payable for admissions to an Intensive Care Unit following surgery only where clear clinical justification for post-operative intensive care exists.

 

Related Items: 13870 13873 13876 13881 13882 13885 13888

Category 3 - THERAPEUTIC PROCEDURES

TN.1.10

Procedures Associated with Intensive Care - (Items 13818, 13842, 13847, 13848 and 13857)

Item 13818 covers the insertion of a right heart balloon catheter (Swan-Ganz catheter).  Benefits are payable under this item only once per day except where a second discrete operation is performed on that day. 

Benefits are payable under items 13876 (within an ICU) and 11600 (outside an ICU) once only for each type of pressure, up to a maximum of 4 pressures per patient per calendar day, and irrespective of the number of the practitioners involoved in monitoring the pressures. 

If a service covered by Item 13842 is provided outside of an ICU, in association with, for example, an anaesthetic, benefits are payable for Item 13842 in addition to Item 13870 where the services are performed on the same day.  Where this occurs, accounts should be endorsed "performed outside of an Intensive Care Unit" against Item 13842. 

Items 13847 and 13848

Item 13847 covers management of counterpulsation by intraaortic balloon on the first day and includes initial and subsequent consultations and monitoring of parameters. Insertion of the intraaortic balloon is covered under item 38609 Management on each day subsequent to the first is covered under item 13848. 

"management" of counterpulsation of intraaortic  balloon means full heamodynamic assessment and management on several occasions during the day. 

Item 13857 covers the establishment of airway access and initiation of ventilation on a patient outside intensive care for the purpose of subsequent ventilatory support in intensive care. Benefits are not payable under Item 13857 where airway access and ventilation is initiated in the context of an anaesthetic for surgery even if it is likely that following surgery the patient will be ventilated in an ICU. In such cases the appropriate anaesthetic item/s should be itemised. 

Medicare benefits are not payable for sampling by arterial puncture under Item 13839 in addition to Item 13870 (and 13873) on the same day.  Benefits are payable under Item 13842 (Intra-arterial cannulation) in addition to Item 13870 (and 13873) when performed on the same day.

 

Related Items: 11600 13818 13842 13847 13848 13857 13870 13876

Category 3 - THERAPEUTIC PROCEDURES

TN.1.11

Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876)

Medicare benefits are only payable for management and procedures in intensive care covered by items 13870, 13873, 13876, 13882, 13885 and 13888 where the service is provided by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care. 

Items 13870 and 13873

Medicare Benefits Schedule fees for Items 13870 and 13873 represent global daily fees covering all attendances by the intensivist in the ICU (and attendances provided by support medical personnel) and all electrocardiographic monitoring, arterial sampling and, bladder catheterisation.performed on the patient on the one day.  If a patient is transferred from one ICU to another it would be necessary for an arrangement to be made between the two ICUs regarding the billing of the patient. 

Items 13870 and 13873 should be itemised on accounts according to each calendar day and not per 24 hour period.  For periods when patients are in an ICU for very short periods (say less than 2 hours) with minimal ICU management during that time, a fee should not be raised. 

Item 13876

Item 13876 covers the monitoring of pressures in an ICU.  Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of medical practitioners involved in the monitoring of pressures in an ICU. 

Item 11600

Item 11600 covers the monitoring of pressures outside the ICU by practitioners not associated with the ICU. Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of practitioners involved in monitoring the pressures.

 

Related Items: 11600 13870 13873 13876 13881 13882 13885 13888


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