Medicare Benefits Schedule - Note AN.33.1

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Category 1 - PROFESSIONAL ATTENDANCES

AN.33.1

TAVI CASE CONFERENCE - (ITEMS 6080 AND 6081)

Items 6080 and 6081 apply to a TAVI Case Conference organised to discuss a patient’s suitability to receive the service described in Item 38495 for Transcatheter Aortic Valve Implantation (TAVI). 

For items 6080 and 6081 a TAVI Case Conference is a process by which:

(a)    there is a team of 3 or more participants, where:

        (i)     the first participant is a cardiothoracic surgeon; and

        (ii)    the second participant is an interventional cardiologist; and

        (iii)   the third participant is a specialist or consultant physician who does not perform a service described in Item 38495 for the patient being assessed; and

        (iv)   either the first or the second participant is also a TAVI Practitioner; and

(b)    the team assesses a patient’s risk and technical suitability to receive the service described in Item 38495, taking into account matters such as:

        (i)      the patient’s risk and technical suitability for a surgical aortic valve replacement; and

        (ii)     the patient’s cognitive function and frailty; and

(c)    the result of the assessment is that the team makes a recommendation about whether or not the patient is suitable to receive the service described in Item 38495; and

(d)    the particulars of the assessment and recommendation are recorded in writing.  

TAVI Practitioner

For items 6080 and 6081 a TAVI Practitioner is either a cardiothoracic surgeon or interventional cardiologist who is accredited by Cardiac Accreditation Services Limited.  

Accreditation by Cardiac Accreditation Services Limited must be valid prior to the service being undertaken in order for benefits to be payable under item 38495.  

The process for accreditation and re-accreditation is outlined in the Transcatheter Aortic Valve Implantation - Rules for the Accreditation of TAVI Practitioners, issued by Cardiac Accreditation Services Limited, and is available on the Cardiac Accreditation Services Limited website, www.tavi.org.au. 

Cardiac Accreditation Services Limited is a national body comprising representatives from the Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 

Coordination of a TAVI Case Conference

For item 6080, coordination means undertaking all of the following activities in relation to a TAVI Case Conference:

  1. ensuring that the patient is aware of the purpose and nature of the patient’s TAVI Case Conference and has consented to their TAVI Case Conference;
  2. recording the day the conference was held, and the times the conference started and ended;
  3. recording the names of the participants of the conference;
  4. provision of expertise to inform the recommendation resulting from the case conference;
  5. recording minutes of the TAVI Case Conference including the recommendation resulting from the conference;
  6. ensuring that the patient is aware of  the recommendation. 

Attendance at a TAVI Case Conference

For item 6081, attendance means undertaking all of the following activities in relation to a TAVI Case Conference:

  1. retaining a record of the day the conference was held, and the times the conference started and ended;
  2. retaining a record of the names of the participants;
  3. provision of expertise to inform the recommendation resulting from the case conference;
  4. retaining a record of the recommendation resulting from  the conference.

General requirements

The TAVI Case Conference must be arranged in advance, within a time frame that allows for all the participants to attend.  A TAVI Case Conference is to last at least 10 minutes and a minimum of three suitable participants (as defined under the item requirements), 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. 

A record of the TAVI Case Conference which contains: a list of the participants; the times the conference commenced and concluded; a description of the assessment of suitability; and a summary of the outcomes must be kept in the patient's record. The notes and summary of outcomes must be provided to all participants. 

Prior informed consent must be obtained from the patient, or the patient's agent. In obtaining informed consent the TAVI Practitioner coordinating the TAVI Case Conference should ensure the patient has been:

  • Informed that his or her medical history, diagnosis and care preferences will be discussed with other case conference participants;
  • Informed that he or she may incur a charge for the service for which a Medicare rebate will be payable.

Medicare benefits are only payable in respect of the service provided by the coordinating TAVI Practitioner or the attending interventional cardiologist, cardiothoracic surgeon or independent specialist or consultant physician. Benefits are not payable for another medical practitioner organising a case conference or for attendance by other medical practitioners at a TAVI Case Conference.

It is expected that a patient would not normally require more than one TAVI Case Conference in determining suitability for the services described in Item 38495.  As such, item 6080 is only payable once per patient in a five year period.  Item 6081 is payable only twice per patient in a five year period.

Items 6080 and 6081 do not preclude the claiming of a consultation on the same day if other clinically relevant services are provided. 

Related Items: 6080 6081 38495


Related Items

Category 3 - THERAPEUTIC PROCEDURES

38495

38495 - Additional Information

Item Start Date:
01-Nov-2017
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

TAVI, for the treatment of symptomatic severe aortic stenosis, performed via transfemoral delivery, unless transfemoral delivery is contraindicated or not feasible, in a TAVI Hospital on a TAVI Patient by a TAVI Practitioner – includes all intraoperative diagnostic imaging that the TAVI Practitioner performs upon the TAVI Patient.

(Not payable more than once per patient in a five year period.)

(Anaes.) (Assist.)

Fee: $1,455.10 Benefit: 75% = $1,091.35 85% = $1,371.70

(See para AN.33.1, TN.8.135 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

6080

6080 - Additional Information

Item Start Date:
01-Nov-2017
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Coordination of a TAVI Case Conference by a TAVI Practitioner where the TAVI Case Conference has a duration of 10 minutes or more.

(Not payable more than once per patient in a five year period.)

Fee: $51.70 Benefit: 75% = $38.80 85% = $43.95

(See para AN.33.1, TN.8.135 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

6081

6081 - Additional Information

Item Start Date:
01-Nov-2017
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2019

Attendance at a TAVI Case Conference by a specialist or consultant physician who does not also perform the service described in item 6080 for the same case conference where the TAVI Case Conference has a duration of 10 minutes or more.

(Not payable more than twice per patient in a five year period.)

Fee: $38.55 Benefit: 75% = $28.95 85% = $32.80

(See para AN.33.1, TN.8.135 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