Category 3 - THERAPEUTIC PROCEDURES
TN.10.4
Deriving the Schedule Fee under the RVG
The Schedule fee for each component of anaesthesia (base items, time items and modifier items) in the RVG Schedule is derived by applying the unit value to the total number of anaesthesia units for each component. For example:
ITEM | DESCRIPTION | UNITS | SCHEDULE FEE (Units x $20.10) |
20840 | Anaesthesia for resection of perforated bowel | 6 | $120.60 |
23200 | Time - 4 hours 40 minutes | 24 | $482.40 |
25000 | Modifier - Physical sttaus | 1 | $20.10 |
22012 | Central Venous Pressure Monitoring | 3 | $60.30 |
TOTAL | 34 | $683.40 |
After Hours Emergency Services
When deriving the fee for the after hours emergency modifier for anaesthesia or assistance at anaesthesia, the 50% loading applies to the anaesthesia or assistance service from Group T10 and to any additional clinically relevant therapeutic or diagnostic service from Group T10, Subgroup 18, provided during the anaesthesia episode. For example:
ITEM | DESCRIPTION | UNITS | SCHEDULE FEE (Units x $20.10) |
20840 | Anaesthesia for resection of perforated bowel | 6 | $120.60 |
23200 | Time - 4 hours 40 minutes | 24 | $482.40 |
25000 | Modifier - Physical status | 1 | $20.10 |
22012 | Central Venous Pressure Monitoring | 3 | $60.30 |
TOTAL | 34 | Schedule fee = $683.40 | |
25025 | Anaesthesia After Hours Emergency Modifier | Schedule Fee $683.40 x 50% = $341.70 |
Definition of Radical Surgery for the RVG
Where the term radical appears in an item description, it refers to an extensive surgical procedure, performed for the treatment of malignancy. It usually denotes extensive block dissection not only of the malignant tissue, but also of the surrounding tissue, particularly fat and lymphatic drainage systems. See notes T10.18 and T10.22 which clarify the definitions of the words "extensive" and "radical" used in items 20192 and 20474.
Multiple Anaesthesia Services
Where anaesthesia is provided for services covered by multiple items in the RVG, Medicare benefit is only payable for the RVG item with the highest basic unit value. However, the time component should include the total anaesthesia time taken for all services. For example:
ITEM | DESCRIPTION | UNITS | SCHEDULE FEE |
20790 | Anaesthesia for open Cholecystectomy | 8 | $160.80 |
20752 | Incisional Hernia | 6 | (lower value than 20790 = 20752 schedule fee not payable) $120.60 |
23111 | Time - 2hrs 30mins | 11 | $221.10 |
25014 | Physical Status - 75 or over | 1 | $20.10 |
TOTAL | 20 | $402.00 |
Prolonged Anaesthesia
Under the RVG, the previous rules that related to prolonged anaesthesia no longer apply. Where anaesthesia is prolonged beyond that which an anaesthetist would normally encounter for a particular service, the RVG provides for the anaesthetist to claim the total anaesthesia time for the procedure/s.
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