Medicare Benefits Schedule - Item 269

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Category 1 - PROFESSIONAL ATTENDANCES

269

269 - Additional Information

Item Start Date:
01-Jul-2018
Description Start Date:
01-Jul-2018
Schedule Fee Start Date:
01-Jul-2019

Group
A7 - Acupuncture and Non-Specialist Practitioner Items
Subgroup
8 - Non-Specialist Practitioner attendances associated with Practice Incentive Program payments

Professional attendance at a place other than consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner in an eligible area, that completes the minimum requirements of the Asthma Cycle of Care

The fee for item 268, plus $21.10 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 268 plus $1.65 per patient.
Ready Reckoner

(See para AN.7.1, AN.7.21 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: 300% of the Derived fee for this item, or $500, whichever is the lesser amount


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.7.1

Attendances by Medical Practitioners

Items 179-181, 185-187, 189-197, 203-206, 215-287, 371, 372, 733-789, 792, 812-892, 90092-93, 90095-96, 90183, 90188, 90202, and 90212 relate to attendances rendered by a medical practitioner who is not a general practitioner, specialist or consultant physician, and who:


(a) is registered under section 3GA of the Act, to the extent that the person is practising during the period in respect of which, and in the location in respect of which, he or she is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or


(b) is covered by an exemption under subsection 19AB(3) of the Act; or


(c) first became a medical practitioner before 1 November 1996. 

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 251 252 253 254 255 256 257 259 260 261 262 263 264 265 266 268 269 270 271 272 276 277 279 281 282 283 285 286 287 371 372 733 737 741 745 761 763 766 769 772 776 788 789 792 812 827 829 867 868 869 873 876 881 885 891 892 90092 90093 90095 90096 90183 90188 90202 90212

Category 1 - PROFESSIONAL ATTENDANCES

AN.7.21

Medical Practitioner Completion of the Asthma Cycle of Care (Items 265 to 271)

Eligibility

Items 265 to 271 are available to medical practitioners providing services in eligible areas.

Eligible area means an area that is a Modified Monash 2 area, Modified Monash 3 area, Modified Monash 4 area, Modified Monash 5 area, Modified Monash 6 area or Modified Monash 7 area.

Medical practitioners providing services in a Modified Monash 1 area should use the items in Group A19, Subgroup 3.

A locator map to identify a medical practice's Modified Monash Model Area location is available at the DoctorConnect website at http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/locator

Guidance Notes

Item numbers 265, 266, 268, 269, 270 and 271 should be used in place of the usual attendance item when a consultation completes the minimum requirements of the Asthma Cycle of Care. The Practice Incentives Program (PIP) Asthma Incentive is for patients with moderate to severe asthma who in the opinion of the medical practitioner could benefit from review, eg those whose asthma management could be improved.

At a minimum the Asthma Cycle of Care must include:

  • At least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation);
  • Documented diagnosis and assessment of level of asthma control and severity of asthma;
  • Review of the patient's use of and access to asthma-related medication and devices;
  • Provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan - discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records);
  • Provision of asthma self-management education to the patient, and
  • Review of the written or documented asthma action plan.

The Asthma Cycle of Care should be provided to a patient by one medical practitioner or in exceptional circumstances by another medical practitioner within the same practice. In most cases, this will be the patient's usual medical practitioner. Completion of the Asthma Cycle of Care does not preclude referral to a specialist, but a specialist consultation cannot be counted as one of the two visits.

The patient's medical record should include documentation of each of these requirements and the clinical content of the patient-held written asthma action plan.

These items will only be payable for the completion of one Asthma Cycle of Care for each eligible patient per 12 month period, unless a further Asthma Cycle of Care is clinically indicated by exceptional circumstances.

If a subsequent Asthma Cycle of Care is indicated and the incentive item is to be claimed more than once per 12 month period for a patient, then the patient's invoice or Medicare voucher should be annotated to indicate that the Asthma Cycle of Care was required to be provided within 12 months of another Asthma Cycle of Care.

The minimum requirements of the Asthma Cycle of Care may be carried out in two (2) visits or if necessary as many visits as clinically required. The National Asthma Council's website provides a guide for completion of the Asthma Cycle of Care.

The visit that completes the Asthma Cycle of Care should be billed using the appropriate item listed in Group A7 Subgroup 8.

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Asthma Cycle of Care.

In addition to attracting a Medicare rebate, recording a completion of an Asthma Cycle of Care through the use of these items, will initiate an Asthma Service Incentive Payment (SIP) through the PIP.

A PIP Asthma SIP is available for completing the minimum requirements of the Asthma Cycle of Care for individual patients as specified above. The SIP will be paid to the medical practitioner who provided the service if the service was provided in a medical practice participating in the PIP Asthma Incentive. More detailed information on the PIP Asthma Incentive is available from the Department of Human Services PIP enquiry line on 1800222032 or from the Department of Human Services website.

For more detailed information regarding asthma diagnosis, assessment and best practice management refer to the National Asthma Council's website.

Assessment of Severity

Generally, patients who meet the following criteria can be assumed to have been assessed as having moderate to severe asthma:

  • Symptoms on most days, OR
  • Use of preventer medication, OR
  • Bronchodilator use at least 3 times per week, OR
  • Hospital attendance or admission following an acute exacerbation of asthma.

Where the general rule does not apply to a particular patient, the classification of severity described by the current edition of the National Asthma Council's Asthma Management Handbook can be used. Visit the National Asthma Council's website for more details.

Related Items: 265 266 268 269 270 271


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