Medicare Benefits Schedule - Note A44

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Category 1 - PROFESSIONAL ATTENDANCES

A44

Completion of the Asthma Cycle of Care - (Items 2546 - 2559 and 2664 - 2677)

The item numbers 2546, 2547, 2552, 2553, 2558, 2559 and 2664, 2666, 2668, 2673, 2675 and 2677 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 doctor 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 GP or in exceptional circumstances by another GP 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 A18 Subgroup 3 and Group A19 Subgroup 3.

 

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.

 

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.

 

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 general 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 1800 222 032 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: 2546 2547 2552 2553 2558 2559 2664 2666 2668 2673 2675 2677


Related Items


LEVEL B

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:

a)     taking a patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation


AND which completes the minimum requirements of the Asthma Cycle of Care.

Category 1 - PROFESSIONAL ATTENDANCES

2546

2546 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner at consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Fee: $37.05 Benefit: 100% = $37.05

(See para A5, A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2547

2547 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner at a place other than consulting rooms, lasting less than 20 minutes and including any of the following that are clinically relevant:

(a) taking a patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

The fee for item 2546, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2546 plus $2.00 per patient.
Ready Reckoner

(See para A5, A44 of explanatory notes to this Category)


LEVEL C

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:

a)     taking a detailed patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation


AND which completes the minimum requirements of the Asthma Cycle of Care.

Category 1 - PROFESSIONAL ATTENDANCES

2552

2552 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner at consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Fee: $71.70 Benefit: 100% = $71.70

(See para A5, A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2553

2553 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 20 minutes and including any of the following that are clinically relevant:

(a) taking a detailed patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

The fee for item 2552, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2552 plus $2.00 per patient.
Ready Reckoner

(See para A44 of explanatory notes to this Category)


LEVEL D

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:

a)     taking an extensive patient history;

b)     performing a clinical examination;

c)     arranging any necessary investigation;

d)     implementing a management plan;

e)     providing appropriate preventive health care;

in relation to 1 or more health-related issues, with appropriate documentation


AND which completes the minimum requirements of the Asthma Cycle of Care.

Category 1 - PROFESSIONAL ATTENDANCES

2558

2558 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner at consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

Fee: $105.55 Benefit: 100% = $105.55

(See para A5, A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2559

2559 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Jul-2014

Professional attendance by a general practitioner at a place other than consulting rooms, lasting at least 40 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health-related issues, with appropriate documentation, and that completes the minimum requirements of the Asthma Cycle of Care

The fee for item 2558, plus $25.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2558 plus $2.00 per patient.
Ready Reckoner

(See para A5, A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2664

2664 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Nov-2006
Schedule Fee Start Date:
01-Nov-2001

Professional attendance at consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Fee: $21.00 Benefit: 100% = $21.00

(See para A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2666

2666 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Nov-2006
Schedule Fee Start Date:
01-Nov-2001


Professional attendance at consulting rooms of more than 25 minutes, but not more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Fee: $38.00 Benefit: 100% = $38.00

(See para A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2668

2668 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Nov-2006
Schedule Fee Start Date:
01-Nov-2001


Professional attendance at consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

Fee: $61.00 Benefit: 100% = $61.00

(See para A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2673

2673 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Nov-2001

Professional attendance at a place other than consulting rooms of more than 5 minutes, but not more than 25 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $16.00 plus $0.70 per patient.
Ready Reckoner

(See para A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2675

2675 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Nov-2001


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 who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $35.50 plus $0.70 per patient
Ready Reckoner

(See para A44 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

2677

2677 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Jan-2013
Schedule Fee Start Date:
01-Nov-2001


Professional attendance at a place other than consulting rooms of more than 45 minutes in duration by a medical practitioner who practises in general practice (other than a general practitioner), that completes the minimum requirements of the Asthma Cycle of Care

An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $57.50 plus $0.70 per patient
Ready Reckoner

(See para A44 of explanatory notes to this Category)


COMPLETION OF THE ASTHMA CYCLE OF CARE

Note: Benefits are payable for only one service included in Subgroup 3 or A19, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated.


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

- review of the written or documented asthma action plan.


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