Medicare Benefits Schedule - Item 35721

Search Results for Item 35721

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

35721

35721 - Additional Information

Item Start Date:
01-Mar-2022
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Mar-2022

Group
T8 - Surgical Operations
Subgroup
4 - Gynaecological

Radical debulking, involving the radical excision of a macroscopically disseminated gynaecological malignancy from the abdominal and pelvic cavity, where cancer has extended beyond the pelvis, including any of the following:
(a) resection of peritoneum over any of the following:
         (i) the diaphragm;
         (ii) the paracolic gutters;
         (iii) the greater or lesser omentum;
         (iv) the porta hepatis;
(b) cytoreduction of recurrent gynaecological malignancy from the abdominal cavity following previous abdominal surgery, radiation or chemotherapy;
(c) cytoreduction of recurrent gynaecological malignancy from the pelvic cavity following previous pelvic surgery, radiation or chemotherapy;
not being a service to which a service associated with a service to which item 35720 or 35726 applies (H) 

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $3,319.15 Benefit: 75% = $2,489.40

(See para TN.8.2, TN.8.235, TN.8.236 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.2

Multiple Operation Rule

The fees for two or more operations, listed in Group T8 (other than Subgroup 12 of that Group), performed on a patient on the one occasion  are calculated by the following rule:‑

-               100% for the item with the greatest Schedule fee

plus 50% for the item with the next greatest Schedule fee

plus 25% for each other item.

Note:

(a)           Fees so calculated which result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents.

(b)           Where two or more operations performed on the one occasion have Schedule fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.

(c)           The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.

(d)           For these purposes the term "operation" only refers to all items in Group T8 (other than Subgroup 12 of that Group). 

This rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient if the medical practitioner who performed the operation did not also perform or assist at the other operation or any of the other operations, or administer the anaesthetic.  In such cases the fees specified in the Schedule apply. 

Where two medical practitioners operate independently and either performs more than one operation, the method of assessment outlined above would apply in respect of the services performed by each medical practitioner. 

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule. 

There are a number of items in the Schedule where the description indicates that the item applies only when rendered in association with another procedure. The Schedule fees for such items have therefore been determined on the basis that they would always be subject to the "multiple operation rule". 

Where the need arises for the patient to be returned to the operating theatre on the same day as the original procedure for further surgery due to post-operative complications, which would not be considered as normal aftercare - see note TN.8.4, such procedures would generally not be subject to the "multiple operation rule".  Accounts should be endorsed to the effect that they are separate procedures so that a separate benefit may be paid. 

Extended Medicare Safety Net Cap 

The Extended Medicare Safety Net (EMSN) benefit cap for items subject to the multiple operations rule, where all items in that claim are subject to a cap are calculated from the abated (reduced) schedule fee. 

For example, if an item has a Schedule fee of $100 and an EMSN benefit cap equal to 80 per cent of the schedule fee, the calculated EMSN benefit cap would be $80.  However, if the schedule fee for the item is reduced by 50 per cent in accordance with the multiple operations rule provisions, and all items in that claim carry a cap, the calculated EMSN benefit cap for the item is $40 (50% of $100*80%). 

 

Related Items: 13241 32222 32223 32224 32225 32226 32227 32228 32229 35591 35592 35609 35610 35631 35632 35668 35669 35671 35721 35724 35751 36504 36505 36507 36508 36836 37226

Category 3 - THERAPEUTIC PROCEDURES

TN.8.235

Gynaecological Oncologist or MDT Review

If the procedure is for glandular high grade abnormality or any suspected invasive cancer the procedure should be performed by a gynaecological oncologist or only after discussion with, or review by, a gynaecological oncologist or gynaecological oncology multidisciplinary team (MDT).

Related Items: 35536 35548 35560 35561 35562 35564 35609 35610 35647 35648 35667 35668 35720 35721 35723 35724

Category 3 - THERAPEUTIC PROCEDURES

TN.8.236

Radical Debulking with abdominal cavity involvement (Item 35721)

This procedure should be undertaken by a person with appropriate training in line with the National Framework for Gynaecological Cancer Control.

This item includes the extensive dissection and removal of the peritoneum from organs contained in the abdominal/pelvic cavity, including bowel, bladder, spleen, pancreas or liver.

This item does not include resection of bowel, bladder, spleen, pancreas or liver.

This item should not be used for staging procedures for gynaecological malignancy. 

This item should not be used for a lymph node recurrence without involvement of peritoneal surfaces.

Related Items: 35721


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