Medicare Benefits Schedule - Item 6029

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View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

6029

6029 - Additional Information

Item Start Date:
01-Nov-2016
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2019

Group
A31 - Addiction Medicine
Subgroup
3 - Addiction Medicine Case Conferences

Attendance by an addiction medicine specialist in the practice of the addiction medicine specialist's specialty, as a member of a multidisciplinary case conference team of at least 2 other formal care providers of different disciplines, to organise and coordinate a community case conference of less than 15 minutes, with the multidisciplinary case conference team

Fee: $44.05 Benefit: 75% = $33.05 85% = $37.45

(See para AN.0.51 of explanatory notes to this Category)


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.51

Case Conferences by Consultant Physician - (Items 820 to 838, 6029 to 6034 and 6064 to 6075)

Items 820, 822, 823, 825, 826, 828, 6029, 6031, 6032, 6034, 6064, 6065, 6067, 6068, 6035, 6037, 6038, 6042, 6071, 6072, 6074 and 6075 apply to a community case conference (including a case conference conducted in a residential aged care facility) organised to discuss one patient in detail and applies only to a service in relation to a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months, or that is terminal, and has complex needs requiring care from a multidisciplinary team. Community case conference items ie 820, 822, 823, 825, 826 and 828 do not apply to an in-patient of a hospital.

For items 830, 832, 834, 835, 837 and 838, a discharge case conference is a case conference carried out in relation to a patient before the patient is discharged from a hospital. Items 830, 832, 834, 835, 837 and 838 are payable not more than once for each hospital admission. 

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient.

A case conference is a process by which a multidisciplinary team carries out the following activities:

-discusses a patient's history;

-identifies the patient's multidisciplinary care needs;

- identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;

-identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and

-assesses whether previously identified outcomes (if any) have been achieved.

For the purposes of items 820, 822, 823, 830, 832, 834, 6029, 6031, 6032, 6034, 6064, 6065, 6067 and 6068 (that is, where a consultant physician organises a case conference) a multidisciplinary team requires the involvement of a minimum of four formal care providers from different disciplines. The consultant physician is counted toward the minimum of four. Although they may attend the case conference, neither the patient nor their informal carer, or any other medical practitioner (except where the medical practitioner is the patient's usual General Practitioner) can be counted toward the minimum of four.

For the purposes of items 825, 826, 828, 835, 837, 838, 6035, 6037, 6038, 6042, 6071, 6072, 6074 and 6075 (that is, where a consultant physician participates in a case conference) a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines. The consultant physician is counted toward the minimum of three. Although they may attend the case conference, neither the patient nor their informal carer, or any other medical practitioner (except where the medical practitioner is the patient's usual General Practitioner) can be counted toward the minimum of three.

For the purposes of items 820, 822, 823, 830, 832, 834, 6029, 6031, 6032, 6034, 6064, 6065, 6067 and 6068 (that is, where a consultant physician organises a case conference), and items 825, 826, 828, 835, 837, 838, 6035, 6037, 6038, 6042, 6071, 6072, 6074 and 6075 (that is, where a consultant physician participates in a case conference) "formal care providers" includes:

-the patient's usual General Practitioner;

-allied health professionals, being: registered nurse, physiotherapist, occupational  therapist, podiatrist, speech pathologist, pharmacist; dietician; psychologist; orthoptist; orthotist and prosthetist, optometrist; audiologist, social worker, Aboriginal and Torres Strait Islander health practitioner, Aboriginal health worker, mental health worker, asthma educator, diabetes educator, dental therapist, dentist; and

-community service providers being: personal care worker, home and community care service provider, meals on wheels provider, education provider and probation officer.

Organisation of a case conference

For items 820, 822, 823, 830, 832, 834, 6029, 6031, 6032, 6034, 6064, 6065, 6067 and 6068, organise and coordinate a community case conference means undertaking the following activities in relation to a case conference:

(a) explaining to the patient or the patient's agent the nature of a case conference, and asking the patient or the patient's agent whether they agree to the case conference taking place; and

(b) recording the patient's or agent's agreement to the case conference; and

(c) recording the day on which the conference was held, and the times at which the conference
started and ended; and

(d) recording the names of the participants; and

(e) putting a copy of that record in the patient's medical records; and

(f) giving the patient or the patient's agent, and each other member of the team a summary of
 the conference; and

(h) giving a copy of the summary of the conference to the patient's usual general practitioner; 
 and

(i) discussing the outcomes of the patient or the patient's agent.

Organisation of a discharge case conference (items 830, 832 and 834), may be provided for private in-patients only, and must be organised by the medical practitioner who is providing in-patient care.

Participation in a case conference

For items 825, 826, 828, 835, 837, 838, 6035, 6037, 6038, 6042, 6071, 6072, 6074, 6075. participation in a case conference must be at the request of the person who organises and coordinates the case conference and includes undertaking the following activities when participating in a case conference:

(a)recording the day on which the conference was held, and the times at which the conference started and ended; and

(b)  recording the matters mentioned in Organisation of a case conference in so far as they relate to the medical practitioner's participation in the case conference, and putting a copy of that record in the patient's medical records.

See Health Insurance (General Medical Services Table) Regulation, Division 2.21.

General requirements

The case conference must be arranged in advance, within a time frame that allows for all the participants to attend. The minimum of three care providers for participating in a case conference or four care providers for organising a case conference must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.

A record of the case conference which contains: a list of the participants; the times the conference commenced and concluded; a description of the problems, goals and strategies; and a summary of the outcomes must be kept in the patient's record. The notes and summary of outcomes must be provided to all participants and to the patient's usual general practitioner.

Prior informed consent must be obtained from the patient, or the patient's agent. In obtaining informed consent the consultant physician should:

-Inform the patient that their medical history, diagnosis and care preferences will be discussed with other case conference participants;

- Provide an opportunity for the patient to specify what medical and personal information they want to be conveyed to, or withheld from, the other care providers;

-Inform the patient that they will incur a charge for the service for which a Medicare rebate will be payable.

Medicare benefits are only payable in respect of the service provided by the coordinating consultant physician or the participating consultant physician. Benefits are not payable for another medical practitioner organising a case conference or for participation by other medical practitioners at a case conference, except where a medical practitioner organises or participates in a case conference in accordance with Items 734 to 779.

The benefit is not claimable (and an account should not be rendered) until all components of these items have been provided. See point G.7.1 of the General Explanatory Notes for further details on billing procedures.

It is expected that a patient would not normally require more than 5 case conferences in a 12 month period.

This item does not preclude the claiming of a consultation on the same day if other clinically relevant services are provided.

Related Items: 820 822 823 825 826 828 830 832 834 835 837 838 6029 6031 6032 6034 6035 6037 6038 6042 6064 6065 6067 6068 6071 6072 6074 6075


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