Medicare Benefits Schedule - Note TN.1.11

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Category 3 - THERAPEUTIC PROCEDURES

TN.1.11

Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876, 13888 and 13899)

TN.1.11 Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876, 13888 and 13899)

Medicare benefits are only payable for management and procedures in intensive care covered by items 13870, 13873, 13876, 13882, 13885 and 13888 where the service is provided by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care.

Items 13870 and 13873

Medicare Benefits Schedule fees for Items 13870 and 13873 represent global daily fees covering all attendances by the intensive care specialist in the ICU (and attendances provided by support medical personnel) and all electrocardiographic monitoring, arterial sampling and, bladder catheterisation performed on the patient on the one day. If a patient is transferred from one ICU to another it would be necessary for an arrangement to be made between the two ICUs regarding the billing of the patient. 

Items 13870 and 13873 should be itemised on accounts according to each calendar day and not per 24 hour period. For periods when patients are in an ICU for very short periods (say less than 2 hours) with minimal ICU management during that time, a fee should not be raised. 

Item 13876

Item 13876 covers the monitoring of pressures in an ICU. Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of medical practitioners involved in the monitoring of pressures within an ICU. 

Item 11600

Item 11600 covers the monitoring of pressures outside the ICU by practitioners not associated with the ICU. Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of practitioners involved in monitoring the pressures. 

Item 13899

Item 13899 covers the discussion and documentation of goals of care for a gravely ill patient lacking current goals of care by an intensive care specialist outside an Intensive Care Unit. Benefits are paid only once per patient admission (including instances of use of corresponding emergency medicine goals of care items 5039, 5041, 5042 and 5044), unless precipitated by a subsequent ICU referral or Cardiac Arrest/Medical Emergency Team call where the clinical circumstances change substantively with a resultant expectation that the original goals of care require amendment.

Item 13899 cannot be co-claimed with item 13870 or 13873 on the same day.

Notes:

“gravely ill patient lacking current goals of care” and “preparation of goals of care” are defined in the General Medical Services Table.

“gravely ill patient lacking current goals of care” means a patient to whom all of the following apply:

(a)     the patient either:

(i)      is suffering a life‑threatening acute illness or injury; or

(ii)     is suffering acute illness or injury and, apart from the illness or injury, has a high risk of dying within 12 months;

(b)     one or more alternatives to management of the illness or injury are clinically appropriate for the patient;

(c)     either:

(i)      there is not a record of goals of care for the patient that can readily be retrieved by providers of health care for the patient and that identifies interventions that should, or should not, be made in care of the patient; or

(ii)     there is such a record but it is reasonable to expect that, due to changes in the patient’s condition, the goals recorded will change substantially.

“preparation of goals of care” for a patient, by a medical practitioner, means the carrying out of all of the following activities by the practitioner:

(a)     comprehensively evaluating the patient’s medical, physical, psychological and social issues;

(b)     identifying major issues that require goals of care for the patient to be set;

(c)     assessing the patient’s capacity to make decisions about goals of care for the patient;

(d)     discussing care of the patient with the patient, or a person (the surrogate) who can make decisions on the patient’s behalf about care for the patient, and as appropriate with any of the following:

(i)      members of the patient’s family;

(ii)     other persons who provide care for the patient;

(iii)    other health practitioners;

(e)     offering in that discussion reasonable options for care of the patient, including alternatives to intensive or escalated care;

(f)      agreeing with the patient or the surrogate on goals of care for the patient that address all major issues identified;

(g)     recording the agreed goals so that:

(i)      the record can be readily retrieved by other providers of health care for the patient; and

(ii)     interventions that should, or should not, be made in care of the patient are identified.

Patients could be assessed for “a life-threatening acute illness or injury” (and suspicion that alternatives to active management may be an appropriate clinical choice) through the use of tools that assist in predicting end-of-life, such as the Supportive and Palliative Care Indicators Tool (SPICTTM).

“offering reasonable options for care” means that the patient must be provided with reasonable alternatives to continued intensive/active treatment or escalation of care, including where the patient has not directly asked for such information (in recognition that patients may not ask if they are not aware of such alternatives).

“recording the agreed goals” should be undertaken using standard forms (where available) appropriate to the facility in which a patient is receiving care.

Patients with existing goals of care plans are eligible if such records cannot be readily retrieved by the medical practitioners; or if their condition has changed to the point the record does not reflect the patient’s current medical condition and it is reasonable for new goals of care to be developed.

Providers of goals of care services should be appropriately trained to provide end-of-life care options and goals of care discussions.

Item 13899 should not be claimed where the goals of care are defined only in relation to a sub-set of the patient’s major issues.

 

 

Related Items: 11600 13870 13873 13876 13882 13885 13888 13899


Related Items

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

11600

11600 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2008
Schedule Fee Updated:
01-Jul-2020

BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day up to a maximum of 4 pressures (not being a service to which item 13876 applies and where not performed in association with the administration of general anaesthesia)

Fee: $71.45 Benefit: 75% = $53.60 85% = $60.75

(See para TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13870

13870 - Additional Information

Item Start Date:
01-May-1994
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

(Note: See para T1.8 of Explanatory Notes to this

Category for definition of an Intensive Care Unit)


    

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on the first day (H)

Fee: $373.40 Benefit: 75% = $280.05

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13873

13873 - Additional Information

Item Start Date:
01-May-1994
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including all attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on each day subsequent to the first day (H)

Fee: $277.00 Benefit: 75% = $207.75

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13876

13876 - Additional Information

Item Start Date:
01-May-1994
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

CENTRAL VENOUS PRESSURE, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure, continuous monitoring by indwelling catheter in an intensive care unit and managed by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - once only for each type of pressure on any calendar day (up to a maximum of 4 pressures) (H)

Fee: $79.30 Benefit: 75% = $59.50

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13882

13882 - Additional Information

Item Start Date:
01-May-1994
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

VENTILATORY SUPPORT in an Intensive Care Unit, management of, by invasive means, or by non-invasive means where the only alternative to non-invasive ventilatory support would be invasive ventilatory support, by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care, each day (H)

Fee: $118.85 Benefit: 75% = $89.15

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13885

13885 - Additional Information

Item Start Date:
01-May-1994
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

CONTINUOUS ARTERIO VENOUS OR VENO VENOUS HAEMOFILTRATION, in an intensive care unit, management by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - on the first day (H)

Fee: $158.45 Benefit: 75% = $118.85

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13888

13888 - Additional Information

Item Start Date:
01-May-1994
Description Updated:
01-Jan-2015
Schedule Fee Updated:
01-Jul-2020

CONTINUOUS ARTERIO VENOUS OR VENO VENOUS HAEMOFILTRATION, in an intensive care unit, management by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - on each day subsequent to the first day  (H)

Fee: $79.30 Benefit: 75% = $59.50

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13899

13899 - Additional Information

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

Preparation of Goals of Care is provided outside of an intensive care unit. Refer to explanatory note TN.1.11 for further information about Goals of Care attendance

Professional attendance, outside an intensive care unit, for at least 60 minutes spent in preparation of goals of care for a gravely ill patient lacking current goals of care, by a specialist in the specialty of intensive care who takes overall responsibility for the preparation of the goals of care for the patient


Item 13899 cannot be co-claimed with item 13870 or item 13873 on the same day

Fee: $276.25 Benefit: 75% = $207.20 85% = $234.85

(See para TN.1.11 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