Medicare Benefits Schedule - Note A49

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Category 1 - PROFESSIONAL ATTENDANCES

A49

Attendances by Medical Practitioners who are Emergency Physicians - (Items 501 to 536)

Items 501 to 536 relate specifically to attendances rendered by medical practitioners who are holders of the Fellowship of the Australasian College for Emergency Medicine (FACEM) and who participate in, and meet the requirements for, quality assurance and maintenance of professional standards by the ACEM.

 

Items 501 to 511 cover five categories of attendance based largely on the tasks undertaken in a recognised emergency medicine department of a private hospital by the practitioner during the attendance on the patient rather than simply on the time spent with the patient.  The emergency department must be part of a hospital and this department must be licensed as an "emergency department" by the appropriate State government authority.

 

The attendances for items 501 to 515 are divided into five categories relating to the level of complexity, namely:

(i)               Level 1

(ii)              Level 2

(iii)             Level 3

(iv)             Level 4

(v)              Level 5

 

To assist medical practitioners who are emergency physicians in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

 

LEVEL 1

This item is for the obvious and straightforward cases and the practitioner's records would reflect this.  In this context "limited examination", means examination of the affected part if required, and management of the action taken.

 

LEVEL 2

The description of this item introduces the words "expanded problem focussed history" and "formulation and documentation of a diagnosis and management plan in relation to one or more problems".  In this context an "expanded problem focussed history" means a history relating to a specific problem or condition; and "formulation and documentation of a management plan" includes formulation of the decision or plan of management and any immediate action necessary such as advising or counselling the patient, ordering tests, or referring the patient to a specialist medical practitioner or other allied health professional.  The essential difference between Levels 1 and 2 relate not to time but to complexity. 

 

LEVEL 3

Further levels of complexity are implied in these terms by the introduction of "medical decision making of moderate complexity".

 

LEVEL 4

This item covers more difficult problems requiring the taking of a "detailed history" and "detailed examination of one or more systems", with or without liaison with other health care professionals and subsequent discussion with the patient, his or her agent and/or relatives.

 

LEVEL 5

This item covers the difficult problems where the diagnosis is elusive and highly complex, requiring consideration of several possible differential diagnoses, and the making of decisions about the most appropriate investigations and the order in which they are performed.  These items also cover cases which need prolonged discussion.  It involves the taking of a comprehensive history, comprehensive examination and involving medical decision making of high complexity.

 

In relation to the time in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

 

Related Items: 501 503 507 511 515


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

501

501 - Additional Information

Item Start Date:
01-Nov-2002
Description Start Date:
01-Nov-2002
Schedule Fee Start Date:
01-Nov-2012

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine-attendance for the unscheduled evaluation and management of a patient, involving straightforward medical decision making that requires:

(a) taking a problem focussed history; and

(b) limited examination; and

(c) diagnosis; and

(d) initiation of appropriate treatment interventions

Fee: $34.20 Benefit: 75% = $25.65 85% = $29.10

(See para A49 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

503

503 - Additional Information

Item Start Date:
01-Nov-2002
Description Start Date:
01-Nov-2002
Schedule Fee Start Date:
01-Nov-2012

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine-attendance for the unscheduled evaluation and management of a patient, involving medical decision making of low complexity that requires:

(a) taking an expanded problem focussed history; and

(b) expanded examination of one or more systems; and

(c) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(d) initiation of appropriate treatment interventions

Fee: $57.80 Benefit: 75% = $43.35 85% = $49.15

(See para A49 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

507

507 - Additional Information

Item Start Date:
01-Nov-2002
Description Start Date:
01-Nov-2002
Schedule Fee Start Date:
01-Nov-2012

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine-attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires:

(a) taking an expanded problem focussed history; and

(b) expanded examination of one or more systems; and

(c) ordering and evaluation of appropriate investigations; and

(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(e) initiation of appropriate treatment interventions

Fee: $97.05 Benefit: 75% = $72.80 85% = $82.50

(See para A49 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

511

511 - Additional Information

Item Start Date:
01-Nov-2002
Description Start Date:
01-Nov-2002
Schedule Fee Start Date:
01-Nov-2012

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine-attendance for the unscheduled evaluation and management of a patient, involving medical decision making of moderate complexity that requires:

(a) taking a detailed history; and

(b) detailed examination of one or more systems; and

(c) ordering and evaluation of appropriate investigations; and

(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(e) initiation of appropriate treatment interventions; and

(f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient's relatives or agent

Fee: $137.30 Benefit: 75% = $103.00 85% = $116.75

(See para A49 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

515

515 - Additional Information

Item Start Date:
01-Nov-2002
Description Start Date:
01-Nov-2002
Schedule Fee Start Date:
01-Nov-2012

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of his or her specialty of emergency medicine-attendance for the unscheduled evaluation and management of a patient, involving medical decision making of high complexity that requires:

(a) taking a comprehensive history; and

(b) comprehensive examination of one or more systems; and

(c) ordering and evaluation of appropriate investigations; and

(d) formulation and documentation of a diagnosis and management plan in relation to one or more problems; and

(e) initiation of appropriate treatment interventions; and

(f) liaison with relevant health care professionals and discussion with, as appropriate, the patient or the patient's relatives or agent

Fee: $212.60 Benefit: 75% = $159.45 85% = $180.75

(See para A49 of explanatory notes to this Category)


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