Medicare Benefits Schedule - Note AN.0.23

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Category 1 - PROFESSIONAL ATTENDANCES

AN.0.23

Referred Patient Consultant Physician Treatment and Management Plan (Items 132 and 133)

Patients with at least two morbidities which can include complex congenital, development and behavioural disorders are eligible for these services when referred by their referring practitioner. 

Item 132 should include the development of options for discussion with the patient, and family members, if present, including the exploration of treatment modalities and the development of a comprehensive consultant physician treatment and management plan, with discussion of recommendations for services by other health providers as appropriate. 

Item 133 is available in instances where a review of the consultant physician treatment and management plan provided under item 132 is required, up to a maximum of two claims for this item in a 12 month period. Should further reviews of the consultant physician treatment and management plan be required, the appropriate item for such service/s is 116. 

Where a patient with a GP health assessment, GP management plan (GPMP) or Team Care Arrangements (TCA's) is referred to a consultant physician for further assessment, it is intended that the consultant physician treatment and management plan should augment the GPMP or TCA's for that patient. 

Preparation of the consultant physician treatment and management plan should be in consultation with the patient. If appropriate, a written copy of the consultant physician treatment and management plan should be provided to the patient. A written copy of the consultant physician treatment and management plan should be provided to the referring medical practitioner, usually within two weeks of the consultant physician consultation. In more serious cases, more prompt provision of the plan and verbal communication with the referring medical practitioner may be appropriate. A guide to the content of such consultant physician treatment and management plans which are to be provided under this item is included within this Schedule.

(Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs.) 

REFERRED PATIENT CONSULTANT PHYSICIAN TREATMENT AND MANAGEMENT PLAN 

- The following content outline is indicative of what would normally be sent back to the referring practitioner.

- The consultant physician treatment and management plan should address the specific questions and issues raised by the referring practitioner. 

History

The consultant physician treatment and management plan should encompass a comprehensive patient history which addresses all aspects of the patient's health, including psychosocial history, past clinically relevant medical history, any relevant pathology results if performed and a review of medication and interactions.  There should be a particular focus on the presenting symptoms and current difficulties, including precipitating and ongoing conditions. The results of relevant assessments by other health professionals, including GPs and/or specialists, including relevant care plans or health assessments performed by GPs under the Enhanced Primary Care and Chronic Disease Management should also be noted. 

Examination

A comprehensive medical examination means a full multi-system or detailed single organ system assessment. The clinically relevant findings of the examination should be recorded in the management plan. 

Diagnosis

This should be based on information obtained from the history and medical examination of the patient. The list of diagnoses and/or problems should form the basis of any actions to be taken as a result of the comprehensive assessment. In some cases, the diagnosis may differ from that stated by the referring practitioner, and an explanation of why the diagnosis differs should be included.  The report should also provide a risk assessment, management options and decisions. 

Management plan

Treatment options/Treatment plan

The consultant physician treatment and management plan should include a planned follow-up of issues and/or conditions, including an outline of the recommended intervention activities and treatment options. Consideration should also be given to recommendations for allied health professional services, where appropriate. 

Medication recommendations

Provide recommendations for immediate management, including the alternatives or options. This should include doses, expected response times, adverse effects and interactions, and a warning of any contra-indicated therapies. 

Social measures

Identify issues which may have triggered or are contributing to the problem in the family, workplace or other social environment which need to be addressed, including suggestions for addressing them. 

Other non medication measures

This may include other options such as life style changes including exercise and diet, any rehabilitation recommendations and discussion of any relevant referrals to other health providers. 

Indications for review

It is anticipated that the majority of patients will be able to be managed effectively by the referring practitioner using the consultant physician treatment and management plan. If there are particular concerns about the indications or possible need for further review, these should be noted in the consultant physician treatment and management plan. 

Longer term management

Provide a longer term consultant physician treatment and management plan, listing alternative measures that might be taken in the future if the clinical situation changes. This might be articulated as anticipated response times, adverse effects and interactions with the consultant physician treatment and management plan options recommended under the consultant physician treatment and management plan. 

The Department of Human Services (DHS) has developed an Health Practitioner Guideline to substantiate that a valid referral existed (specialist or consultant physician) which is located on the DHS website.

Related Items: 132 133


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

132

132 - Additional Information

Item Start Date:
01-Nov-2007
Description Start Date:
01-Nov-2011
Schedule Fee Start Date:
01-Jul-2018

Professional attendance by a consultant physician in the practice of his or her specialty (other than psychiatry) of at least 45 minutes in duration for an initial assessment of a patient with at least 2 morbidities (which may include complex congenital, developmental and behavioural disorders) following referral of the patient to him or her by a referring practitioner, if:

(a) an assessment is undertaken that covers:

(i) a comprehensive history, including psychosocial history and medication review; and

(ii) comprehensive multi or detailed single organ system assessment; and

(iii) the formulation of differential diagnoses; and

(b) a consultant physician treatment and management plan of significant complexity is prepared and provided to the referring practitioner, which involves:

(i) an opinion on diagnosis and risk assessment; and

(ii) treatment options and decisions; and

(iii) medication recommendations; and

(c) an attendance on the patient to which item 110, 116 or 119 applies did not take place on the same day by the same consultant physician; and

(d) this item has not applied to an attendance on the patient in the preceding 12 months by the same consultant physician


Not being an attendance on the patient in respect of whom, in the preceding 12 months, payment has been made under this item for attendance by the same consultant physician.

Fee: $267.85 Benefit: 75% = $200.90 85% = $227.70

(See para AN.0.23 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

133

133 - Additional Information

Item Start Date:
01-Nov-2007
Description Start Date:
01-Mar-2013
Schedule Fee Start Date:
01-Jul-2018

Professional attendance of at least 20 minutes duration subsequent to the first attendance in a single course of treatment for a review of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where

a) a review is undertaken that covers:

- review of initial presenting problem/s and results of diagnostic investigations

- review of responses to treatment and medication plans initiated at time of initial consultation comprehensive multi or detailed single organ system assessment,

- review of original and differential diagnoses; and

b) a modified consultant physician treatment and management plan is provided to the referring practitioner that involves, where appropriate:

- a revised opinion on the diagnosis and risk assessment

- treatment options and decisions

- revised medication recommendations


Not being an attendance on a patient in respect of whom, an attendance under item 110, 116 and 119 has been received on the same day by the same consultant physician or locum tenens.


Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under item 132.  Item 133 can be provided by either the same consultant physician or a locum tenens.  


Payable no more than twice in any 12 month period.

Fee: $134.10 Benefit: 75% = $100.60 85% = $114.00

(See para AN.0.23 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