Medicare Benefits Schedule - Note AN.0.60

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Category 1 - PROFESSIONAL ATTENDANCES

AN.0.60

Attendances by Medical Practitioners who are Emergency Physicians - (Items 5001 to 5036)

Items 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 and 5019 under Group A21 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 Australasian College for Emergency Medicine (ACEM).

Other than for point-of-care ultrasound (see below), only modifying add-on therapeutic and procedural items under Subgroup 14 in Group T1 may be claimed in conjunction with attendance items 5001 to 5019.

Items relating to point-of-care ultrasound services are not separately payable from emergency attendance items 5001 to 5019 where performed for a reason that represents routine use as standard of care in an Emergency Department attendance. For example, the following four (non-exhaustive) reasons:

  1. To identify nerves for the purposes of administering nerve blocks.
  2. To identify vessels, including abdominal aortic aneurysms.
  3. As part of a focused assessment with sonography for trauma (FAST) scan.

Where the “standard of care” principle does not apply, items relating to point-of-care ultrasound services are payable in addition to emergency attendance items 5001 to 5019, where the following three criteria are met:

  1. A formal report is provided and is stored in a manner that reasonably facilities future retrieval / access.
  2. The images are stored in a manner that reasonably facilitates future retrieval / access.
  3. The provider is appropriately credentialed to provide the particular service, by a recognised body for the credentialing of ultrasound services.

For the sake of clarity, hospitals do not constitute recognised bodies for the credentialing of ultrasound services. The ACEM has published policy on the appropriate credentialing for Emergency Medicine ultrasonography, such as the “Policy on Credentialing for Emergency Medicine Ultrasonography”. As noted by ACEM, examples of appropriate credentials include the Diploma in Diagnostic Ultrasound (DDU) and the Certificate in Clinician Performed Ultrasound (CCPU) offered by the Australasian Society for Ultrasound in Medicine (ASUM).

Emergency Attendance Categories

Items 5001 to 5019 cover three categories of attendance to reflect the differing categories of professional involvement required during emergency attendances undertaken in a recognised emergency medicine department of a private hospital, based on the number of differential diagnoses and comorbidities that require consideration rather than simply on the time spent with the patient. The emergency department must be part of a private hospital and this department must be licensed as a “recognised emergency department” by the appropriate State or Territory government authority.

Mirror emergency attendance items (items 5021 to 5036) are provided for medical practitioners who are not emergency physicians to ensure a consistent framework for all emergency attendances, regardless of provider type (see notes below under 'Emergency Medicine Attendances by Medical Practitioners who are not Emergency Physicians').

A new subgroup of therapeutic and procedural add-on items is provided under Subgroup 14 in Group T1 of the MBS for services most commonly performed in emergency medicine (for example, fractures and resuscitation). These items are to be claimed in conjunction with attendances on patients by emergency physicians (items 5001 to 5019) or medical practitioners (5021 to 5036). Explanatory notes for Group T1, Subgroup 14 items are provided in TN.1.22.

The following notes in respect of the three categories are provided to assist emergency physicians and medical practitioners in selecting the appropriate attendance item number for Medicare benefit purposes. The essential difference between the three attendance categories relate not to time but to complexity.

It is recognised that change of shift handovers are common occurrences within the emergency care setting. Emergency physicians and medical practitioners assuming responsibility of care for patients from the first practitioner may bill the attendance items based on the level of complexity and engagement appropriate to the patient’s care.

The attendances for items 5001 to 5019 (and non-emergency physician items 5021 to 5036) are divided into three categories relating to the level of complexity involved in medical decision-making, namely:

  1. Ordinary complexity
  2. Complexity that is more than ordinary but not high
  3. High complexity

Age modifiers have been applied to each category of attendance to reflect the level of additional complexity and professional involvement, namely:

  1. Aged 4 years or over but under 75 years
  2. Aged under 4 years
  3. Aged 75 years or over

Ordinary Complexity

These items are for the consultation, investigation (if required) and management of a single system issue in a patient with no relevant comorbidities where the differential diagnosis is limited.

Includes targeted history and examination, interpretation of relevant investigations (if required), development and initiation of a management plan, relevant GP and specialist communication and associated documentation. These patients would typically be discharged home from the Emergency Department. A period of observation is not required for these patients.

Complexity More than Ordinary but Not High

These items are for the assessment, investigation and management of an undifferentiated presentation or a presentation with a clear diagnosis that needs risk stratification and complication exclusion. Where the diagnosis is clear from the outset, this item should be used when management is time consuming or more than one strategy is required. The attendance may include referral or consultation with alternate specialist(s). These patients may or may not be admitted.

Includes a period of observation in response to initial treatment and / or requiring results of investigations to inform an ongoing management plan, and includes any routine point-of-care procedures (such as ECGs, in-dwelling urinary catheterisation, venous and arterial blood gas sampling, ultrasound in conjunction with procedures such as vascular access or nerve block).

For patients requiring a prolonged period of observation, admission to an emergency department short stay unit may be required.

High Complexity

These items are for the assessment, investigation and management of an undifferentiated ED patient with one or more comorbidities and more than one differential diagnosis.

These items may include time consulting with alternate specialists, liaising with community services and arrangement of admission, pharmacy reconciliation, communication with family, carers and general practitioners; and any routine point-of-care procedures (such as ECGs, in-dwelling urinary catheterisation, venous and arterial blood gas sampling, ultrasound in conjunction with procedures such as vascular access or nerve block).

For patients requiring a prolonged period of observation, admission to an emergency department short stay unit may be required.

Related Items: 5001 5004 5011 5012 5013  5014 5016 5017 5019

Emergency Medicine Attendances by Medical Practitioners who are not Emergency Physicians (Items 5021 to 5036)

Mirror items (5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 and 5036) are provided for emergency medicine attendance services performed by medical practitioners who are not emergency physicians to ensure a consistent framework for all emergency attendances, regardless of provider type.

The mirror items reflect the emergency physician items and are divided into three categories relating to the level of complexity with age modifiers applied to each attendance category.

Related Items: 5021 5022 5027 5030 5031  5032 5033 5035 5036

Related Items: 5001 5004 5011 5012 5013 5014 5016 5017 5019 5021 5022 5027 5030 5031 5032 5033 5035 5036


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

5001

5001 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 4 years or over but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision‑making of ordinary complexity

 

Fee: $62.05 Benefit: 75% = $46.55 85% = $52.75

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5004

5004 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged under 4 years, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of ordinary complexity

Fee: $104.15 Benefit: 75% = $78.15 85% = $88.55

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5011

5011 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 75 years or over, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of ordinary complexity

Fee: $104.15 Benefit: 75% = $78.15 85% = $88.55

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5012

5012 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 4 years or over but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of complexity that is more than ordinary but is not high

Fee: $163.25 Benefit: 75% = $122.45 85% = $138.80

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5013

5013 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged under 4 years, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of complexity that is more than ordinary but is not high

Fee: $205.40 Benefit: 75% = $154.05 85% = $174.60

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5014

5014 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 75 years or over, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of complexity that is more than ordinary but is not high

Fee: $205.40 Benefit: 75% = $154.05 85% = $174.60

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5016

5016 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 4 years or over but under 75 years old, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of high complexity

Fee: $275.60 Benefit: 75% = $206.70 85% = $234.30

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5017

5017 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged under 4 years, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of high complexity

 

Fee: $317.80 Benefit: 75% = $238.35 85% = $270.15

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5019

5019 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 75 years or over, at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine involving medical decision-making of high complexity

Fee: $317.80 Benefit: 75% = $238.35 85% = $270.15

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5021

5021 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 4 years or over but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of ordinary complexity

Fee: $46.50 Benefit: 75% = $34.90 85% = $39.55

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5022

5022 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged under 4 years, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of ordinary complexity

Fee: $78.15 Benefit: 75% = $58.65 85% = $66.45

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5027

5027 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 75 years or over, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of ordinary complexity

Fee: $78.15 Benefit: 75% = $58.65 85% = $66.45

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5030

5030 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 4 years or over but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of complexity that is more than ordinary but is not high

Fee: $122.40 Benefit: 75% = $91.80 85% = $104.05

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5031

5031 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged under 4 years, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of complexity that is more than ordinary but is not high

Fee: $154.05 Benefit: 75% = $115.55 85% = $130.95

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5032

5032 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 75 years or over, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of complexity that is more than ordinary but is not high

Fee: $154.05 Benefit: 75% = $115.55 85% = $130.95

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5033

5033 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient 4 years or over but under 75 years old, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of high complexity

Fee: $206.70 Benefit: 75% = $155.05 85% = $175.70

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5035

5035 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged under 4 years, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of high complexity

Fee: $238.35 Benefit: 75% = $178.80 85% = $202.60

(See para AN.0.60 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5036

5036 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Jul-2022

Professional attendance, on a patient aged 75 years or over, at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) involving medical decision-making of high complexity

Fee: $238.35 Benefit: 75% = $178.80 85% = $202.60

(See para AN.0.60 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