Medicare Benefits Schedule - Item 962

Attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry or paediatrics, as a member of a multidisciplinary case conference team, to participate in a mental health case conference of at least 30 minutes but less than 45 minutes, with the multidisciplinary case conference team

Fee: $178.00 Benefit: 75% = $133.50 85% = $151.30

(See para AN.15.2 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

• Previous - Item 961
• Next - Item 964

A range of items are available for consultant physicians in their speciality of paediatrics or psychiatry to organise and co-ordinate, or participate in, mental health case conferences. They apply for a patient who is being treated under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (MBS) initiative (Better Access) or an eating disorder treatment and management plan (EDTMP).

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.

PATIENT ELIGIBILITY

Case conferences using these new MBS items can be held for patients who have been referred for treatment under Better Access or have an active eating disorder treatment and management plan.

Patients can be referred for treatment under Better Access by a:

• GP or OMP under a mental health treatment plan or psychiatrist assessment and management plan,
• psychiatrist, or
• paediatrician.

Treated under Better Access means a patient has been referred for a:

• focussed psychological strategies service delivered by a GP, OMP, psychologist, social worker or occupational therapist, or
• psychological therapy service delivered by a clinical psychologist

REGULATORY REQUIREMENTS

To organise and coordinate case conference items 946, 948 and 959, the provider must:

1. explain to the patient the nature of a mental health case conference and ask for their agreement to the conference taking place; and
2. record the patient's agreement to the conference; and
3. record the day on which the conference was held, and the times at which the conference started and ended; and
4. record the names of the participants; and
5. offer the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference and provide this summary to other team members; and
6. discuss the outcomes of the conference with the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
7. record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records. 

To participate in mental health case conference items 961, 962 and 964, the provider must:

1. explain to the patient the nature of a mental health case conference and ask for their agreement to the general practitioner's participation in the conference; and
2. record the patient's agreement to the general practitioner's participation; and
3. record the day on which the conference was held, and the times at which the conference started and ended; and
4. record the names of the participants; and
5. record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient's medical records. 

ADDITIONAL INFORMATION

Mental health case conference team members

The case conference must be organised by a medical practitioner (GP, OMP or consultant physician in their specialty of paediatrics or psychiatry) and involve at least two other members of the multidisciplinary case conference team providing different kinds of treatment to the patient. Participating providers must be invited to attend by the organising practitioner.

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 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.

The patient should be given the option to attend the case conference, however may choose not to do so. Family members or carers, as well as other individuals providing support to the patient (such as a close friend, counsellor, teacher or peer worker) can also attend the case conference if the patient has agreed. However, these individuals do not count towards the minimum number of providers required.

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

Claiming frequency

It is expected that a patient would not normally require more than 4 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.

Further sources of information

Further information is also available for providers from the Services Australia provider enquiry line on 132 150.

Related Items: 946 948 959 961 962 964