Medicare Benefits Schedule - Item 55143

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Category 5 - DIAGNOSTIC IMAGING SERVICES

55143

55143 - Additional Information

Item Start Date:
01-Aug-2020
Description Updated:
15-Sep-2020
Schedule Fee Updated:
01-Aug-2020

Group
I1 - Ultrasound
Subgroup
7 - Transthoracic Echocardiogram and Stress Echocardiogram.

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.0.1, IR.1.1 and IR.1.2 

Repeat pharmacological or exercise stress echocardiography if:

(a)     the patient has had a service associated with a service to which item 55141, 55145 or 55146 applies provided in the previous 24 months; and

(b)    the patient has symptoms of ischaemia that have evolved and are not adequately controlled with optimal medical therapy; and

(c)     the service is requested by a specialist or a consultant physician; and

(d)    not being a service associated with a service to which item 11704, 11705, 11707, 11714, 11729 or 11730 applies; and

(e)    not being a service associated with a service to which an item in Subgroup 3 applies 

For any particular patient, applicable not more than once in 12 months (R)

Bulk bill incentive

Fee: $417.45 Benefit: 75% = $313.10 85% = $354.85

(See para IN.0.19, IN.1.10, IR.0.1, IR.1.1, IR.1.2, IR.1.3 of explanatory notes to this Category)


Associated Notes

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.0.19

Bulk Billing Incentive

Out-of-hospital services (except item 61369) attract higher benefits when they are bulk billed by the provider. 

For other than items in Group I5 – Magnetic Resonance Imaging (MRI) - benefits for bulk billed services are payable at 95% of the schedule fee for the item.  For MRI services, benefits for bulk billed services are payable at 100% of the schedule for the item.

Related Items: 55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55048 55049 55054 55065 55066 55068 55070 55071 55073 55076 55079 55084 55085 55118 55126 55127 55128 55129 55130 55132 55133 55134 55135 55137 55141 55143 55145 55146 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55600 55603 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55729 55736 55739 55759 55762 55764 55766 55768 55770 55772 55774 55812 55814 55844 55846 55848 55850 55852 55854 55856 55857 55858 55859 55860 55861 55862 55863 55864 55865 55866 55867 55868 55869 55870 55871 55872 55873 55874 55875 55876 55877 55878 55879 55880 55881 55882 55883 55884 55885 55886 55887 55888 55889 55890 55891 55892 55893 55894 55895 56001 56007 56010 56013 56016 56022 56028 56030 56036 56101 56107 56219 56220 56221 56223 56224 56225 56226 56233 56234 56237 56238 56301 56307 56401 56407 56409 56412 56501 56507 56620 56622 56623 56626 56627 56628 56629 56630 56801 56807 57001 57007 57201 57341 57351 57352 57353 57354 57360 57506 57509 57512 57515 57518 57521 57522 57523 57524 57527 57541 57700 57703 57706 57709 57712 57715 57721 57901 57902 57905 57907 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58927 58933 58936 58939 59103 59300 59302 59303 59305 59312 59314 59318 59700 59703 59712 59715 59718 59724 59733 59739 59751 59754 59763 59903 59912 59925 59970 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078 60500 60503 60506 60509 60918 60927 61109 61310 61313 61314 61321 61324 61325 61328 61329 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61421 61425 61426 61429 61430 61433 61434 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61461 61462 61469 61473 61480 61485 61495 61499 61505 61523 61524 61525 61529 61541 61553 61559 61565 61620 61622 61628 61632 61647 61650 63001 63004 63007 63010 63040 63043 63046 63049 63052 63055 63058 63061 63064 63067 63070 63073 63101 63111 63114 63125 63128 63131 63151 63154 63161 63164 63167 63170 63173 63176 63179 63182 63185 63201 63204 63219 63222 63225 63228 63231 63234 63237 63240 63243 63271 63274 63277 63280 63301 63304 63307 63322 63325 63328 63331 63334 63337 63340 63361 63385 63388 63391 63395 63397 63401 63404 63416 63425 63428 63440 63443 63446 63454 63461 63464 63467 63470 63473 63476 63482 63491 63494 63496 63497 63498 63499 63501 63502 63504 63505 63513 63531 63533 63541 63543 63545 63546 63547 63560 64990 64991

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.1.10

Functional studies include stress echocardiograms and myocardial perfusion studies

Functional studies include stress echocardiograms and nuclear myocardial perfusion studies

Indications

Assessment before cardiac surgery or catheter-based interventions to ensure the criteria for intervention are met could include assessment of the severity of aortic stenosis in patients with impaired left ventricular function or obtaining objective evidence of the correlation between functional capacity and ischaemic threshold.

A calcium score of zero is normal in adults and clinician judgement should be applied for scores of 0–10 (does not apply to persons under 17 years).

Providers

Appropriately trained means a provider that meets the level 2 requirements for stress echocardiography as described in the Cardiac Society of Australia & New Zealand Guidelines for Training and Performance in Adult Echocardiography or CSANZ Guidelines for Training and Performance in Paediatric Echocardiography, or an equivalent training standard.

This available at: https://www.csanz.edu.au/wp-content/uploads/2015/04/Adult-Echo_2015-February.pdf


A complete echocardiogram refers to services performed under items 55126, 55127, 55128, 55129, 55132, 55134 and 55137.

In most cases, stress echocardiography and myocardial perfusion studies provide equivalent information. Consideration should be given to the radiation burden of any test that is requested when determining the appropriate modality for a patient, and the patient should be fully informed and involved in this decision.

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: 55141 55143 55145 55146

Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.0.1

Stress echocardiography indications and requirements of use

1. For any particular patient, item 55141, 55143, 55145 or 55146 applies if one or more of the following is applicable:

  1. if the patient displays one or more of the following symptoms of typical or atypical angina:
    1. constricting discomfort in the:
      1. front of the chest; or
      2. neck; or
      3. shoulders; or
      4. jaw; or
      5. arms; or
    2. the patient’s symptoms, as described in subparagraph (3)(a)(i), are precipitated by physical exertion; or
    3. the patient’s symptoms, as described in subparagraph (3)(a)(i), are relieved by rest or glyceryl trinitrate within 5 minutes or less; or
  2. if the patient has known coronary artery disease and displays one or more symptoms that are suggestive of ischaemia:
    1. which are not adequately controlled with medical therapy; or
    2. have evolved since the last functional study; or
  3. if the patient qualifies for one or more of the following indications:
    1. assessment of myocardial ischaemia with exercise is required if a patient with congenital heart lesions has undergone surgery and reversal of ischemia is considered possible; or
    2. assessment indicates that resting 12 lead electrocardiogram changes are consistent with coronary artery disease or ischaemia, in a patient that is without known coronary artery disease; or
    3. coronary artery disease related lesions, of uncertain functional significance, which have previously been identified on computed tomography coronary angiography or invasive coronary angiography; or
    4. assessment by a specialist or consultant physician indicates that the patient has potential non-coronary artery disease, where a stress echocardiography study is likely to assist the diagnosis; or
    5. assessment indicates that the patient has undue exertional dyspnoea of uncertain aetiology; or
    6. a pre-operative assessment of a patient with functional capacity of less than 4 metabolic equivalents confirming that surgery is intermediate to high risk, and the patient has at least one of following conditions:
      1. ischaemic heart disease or previous myocardial infarction; or
      2. heart failure; or
      3. stroke or transient ischaemic attack; or
      4. renal dysfunction (serum creatinine greater than 170umol/L or 2 mg/dL or a creatinine clearance of less than 60 mL/min); or
      5. diabetes mellitus requiring insulin therapy: or
    7. assessment before cardiac surgery or catheter-based interventions is required to:
      1. increase the cardiac output to assess the severity of aortic stenosis; or
      2. determine whether valve regurgitation worsens with exercise and/or correlates with functional capacity; or
      3. correlate functional capacity with the ischaemic threshold; or
    8. for patients where silent myocardial ischaemia is suspected, or due to the patient’s cognitive capacity or expressive language impairment, it is not possible to accurately assess symptom frequency based on medical history.

 
2. For any particular patient, the request for a service to be provided under item 55141, 55143, 55145 or 55146 must identify the symptom/s or clinical indications/s, as outlined in subclause 1.1.1(3).
 

3. For any particular patient, item 55141, 55143, 55145 or 55146 applies to a service if:

  1. the diagnostic imaging procedure is performed on premises equipped with resuscitation equipment, which includes a defibrillator; and
  2. the diagnostic imaging procedure is performed by a person trained in exercise testing and cardiopulmonary resuscitation who is in personal attendance during the procedure; and
  3. a second person trained in exercise testing and cardiopulmonary resuscitation is located at the diagnostic imaging premise where the procedure is performed and is immediately available to respond at the time the exercise test is performed on the patient, if required; and
  4. one of the persons mentioned in paragraphs (b) and (c) must be a medical practitioner.

 
4. Limitation of ultrasound items 55141, 55143, 55145 and 55146

  1. For any particular patient, a service under item 55141, 55143, 55145 and 55146 does not apply if:
    1. the patient has body habitus or other physical condition/s (including heart rhythm disturbance) to the extent where a stress echocardiography would not provide adequate information; or
    2. the patient is unable to exercise to the extent where a stress echocardiography would not provide adequate information; or
    3. results of a previous imaging service indicate that a stress echocardiography service would not provide adequate information.

Related Items: 55141 55143 55145 55146

Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.1.1

Repeat Stress echo requirements 55143

1. For any particular patient, item 55143 applies to a service if:

  1. the service is for an exercise stress echocardiography and includes all of the following:
    1. two-dimensional recordings before exercise (baseline) from at least 2 acoustic windows; and
    2. matching recordings at or immediately after peak exercise, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and
    3. recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and
    4. resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and
    5. blood pressure monitoring and the recording of other parameters (including heart rate); or
  2. the service is for a pharmacological stress echocardiography and includes all of the following:
    1. two-dimensional recordings before drug infusion (baseline) from at least 2 acoustic windows; and
    2. matching recordings at least twice during drug infusion, including a recording at the peak drug dose, which include at least parasternal short and long axis views, and apical 4-chamber and 2 chamber views; and
    3. recordings on digital media with equipment permitting display of baseline and matching peak images on the same screen; and
    4. resting electrocardiogram and continuous multi-channel electrocardiogram monitoring and recording during stress; and
    5. blood pressure monitoring and the recording of other parameters (including heart rate).

Related Items: 55143

Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.1.2

Echocardiography and attendance requirements

1. For any particular patient, a service associated with an attendance item listed in Part 2 of the general medical services table does not apply if a service to which item 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145 or 55146 applies is provided on the same day; unless:

  1. the attendance service is provided after the service where clinical management decisions are made; or
  2. the decision to perform the service on the same day was made during the attendance service subject to clinical assessment.

Related Items: 55126 55127 55128 55129 55132 55133 55134 55137 55141 55143 55145 55146

Category 5 - DIAGNOSTIC IMAGING SERVICES

IR.1.3

Echocardiography Multiple Services Rule (EMSR)

1. If one or more services in paragraph (a) is rendered with one or more services in paragraph (b) for the same patient on the same day by the same medical practitioner, then the item with the lesser fee will be reduced by 40% of the fee.

 
2. The items applicable to the echocardiography multiple services fee reduction rule are:

  1. a service to which one or more of items 55126, 55127, 55128, 55129, 55132, 55133, 55134 or 55137 apply; and
  2. a service to which one or more of items 55141, 55143, 55145 or 55146 apply.

Related Items: 55126 55127 55128 55129 55132 55133 55134 55137 55141 55143 55145 55146


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