Medicare Benefits Schedule - Item 13881

Search Results for Item 13881

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

13881

13881 - Additional Information

Item Start Date:
01-Nov-2005
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

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

AIRWAY ACCESS, ESTABLISHMENT OF AND INITIATION OF MECHANICAL VENTILATION, in an Intensive Care Unit, not in association with any anaesthetic service, by a specialist or consultant physician for the purpose of subsequent ventilatory support (H)

Fee: $151.00 Benefit: 75% = $113.25

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


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.1.9

Intensive Care Units - (Items 13870 to 13888)

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 respiratory failure for at least 24 hours; and

(ii)     invasive cardiovascular monitoring; and

(b)      is supported by:

(i)      at least one specialist 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, provided suitable cover is available. Outside normal working hours the specialist must be immediately contactable and, if required, available to return to the ICU within a reasonable time.

"exclusively rostered" means that the specialist's sole clinical commitment is to intensive care. 

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


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