Medicare Benefits Schedule - Note IN.1.6

Providers 

1. For patients under 17 years it is expected that this service will be conducted by a paediatric cardiologist or appropriately qualified sonographer under the paediatric cardiologist's supervision.
2. For patients 17 years and over with complex congenital heart disease it is expected that this service will be provided by a specialist practicing in the area of congenital heart disease or appropriately qualified sonographer under the specialist's supervision.

Providers of this service for patients under 17 years should meet the requirements described in the Cardiac Society of Australia & New Zealand guidelines for paediatric echocardiography, and should be competent to perform paediatric echocardiography.

https://www.csanz.edu.au/wp-content/uploads/2016/09/Paeds-Echo-Standards-of-Practice_2015_ratified_11-March-2016.pdf

Providers of this item number for patients 17 years and over with complex congenital heart disease should meet the Level 2 requirements described in the Cardiac Society of Australia & New Zealand Guidelines for Training and Performance in Adult Echocardiography.

https://www.csanz.edu.au/wp-content/uploads/2015/04/Adult-Echo_2015-February.pdf

Indications

Complex congenital heart disease does not include single lesions which are haemodynamically insignificant and uncomplicated.

Examples of non-complex congenital lesions include but are not limited to:

i) isolated atrial septal defect, ii) ventricular septal defect, iii) patent ductus arteriosus, iv) mitral valve prolapse, v) bicuspid aortic valve, vi) other isolated congenital valvular disease including congenital aortic stenosis or vii) aortic root dilation

Accepted for use in those persons under 17 years with significant genetic syndromes or dysrhythmias that are likely to lead to substantial structural or functional abnormalities.

Results

Discussion of these findings with a patient does not constitute a consult. Similarly, discussion(s) during the course of a study or to determine the safety or appropriateness of the study is part of the service and should not be claimed as a consult.

Paediatric Investigations and Consultations

For investigations performed by a specialist paediatric or fetal cardiologist, co-claiming of a consultation with the investigation is permitted even when a consultation was not specifically requested when:

• the paediatric patient was referred for an investigation; and
• the paediatric patient was not known to the provider; and
• the paediatric patient was not under the care of another paediatric cardiologist; and
• the findings on the investigation appropriately warranted a consultation.

The paediatric co-claiming exception should not be applied to adult cardiologists treating or investigating adult congenital heart disease, unless the consultation service is provided after the echocardiographic examination where clinical management decisions are made, or the decision to perform the echocardiographic examination on the same day was made during the consultation service subject to clinical assessment.

Related Items: 55132

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Bulk bill incentive

Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: IR.1.2

Serial real time transthoracic echocardiographic examination of the heart with real time colour flow mapping from at least 4 acoustic windows, with recordings on digital media, if the service:

(a) is for the investigation of a patient who:

(i) is under 17 years of age; or

(ii) has complex congenital heart disease; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology; and

(c) is not associated with a service to which:

(i) another item in this Subgroup applies (except items 55137, 55141, 55143, 55145 and 55146); or

(ii) an item in Subgroup 2 applies (except items 55118 and 55130); or

(iii) an item in Subgroup 3 applies (R)

Fee: $249.95 Benefit: 75% = $187.50 85% = $212.50

(See para IN.0.19, IN.1.6, IN.7.1, IR.1.2, IR.1.3 of explanatory notes to this Category)