Medicare Benefits Schedule - Note TN.6.2

Referred anaesthesia consultations (other than pre-anaesthesia attendances) where the patient is referred will be covered by new items in the range 17640 - 17655. These new items replace the use of specialist referred items 104 and 105. Items 104 and 105 will no longer apply to referred anaesthesia consultations provided by specialist anaesthetists. 

Referred anaesthesia consultations comprise 4  time-based items utilising 15 minute increments up to and exceeding 45 minutes, in conjunction with content-based descriptors. Services covered by these specialist referred items include consultations in association with the following:

(i) Acute pain management

· Postoperative, utilising specialised techniques eg Patient Controlled Analgesia System (PCAS)

· as an independent service eg pain control following fractured ribs requiring nerve blocks

· obstetric pain management

(ii) Perioperative management of patients

· postoperative management of cardiac, respiratory and fluid balance problems following major surgery

· vascular access procedures (other than intra-operative peripheral vascular access procedures) 

Items 17645 - 17655 will involve the examination of multiple systems and the formulation of a written management plan. Items 17650 and 17655 would also entail the ordering and/or evaluation of relevant patient investigations. 

NOTE :

· It should be noted that the consultation time under items 17640 - 17655 only applies to the period of active attendance on the patient and does not include time spent in discussion with other health care practitioners.

· Consultation services covered by pain medicine specialist items in the range 2801-3000 cannot be claimed in conjunction with items 17640 - 17655.

· The requirement of a written patient management plan in items 17645-17655  or the discussion of the management plan with other health care professions, where this occurs, does not relate to and cannot be claimed in conjunction GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans or Case Conference items in Group A15 of the MBS. 

It would be expected that in the vast majority of cases, the insertion of a peripheral venous cannula (other than in association with anaesthesia) where the patient is referred, would attract benefit under item 17640. However, in exceptional clinical circumstances, where the procedure is considerably more difficult and exceeds 15 minutes, such as for patients with chronic disease undergoing long term intravenous therapy, paediatric patients or patients having chemotherapy, item 17645 would apply.

Related Items: 17640 17645 17650 17655

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ANAESTHETIST, REFERRED CONSULTATION (other than prior to anaesthesia)

(Professional attendance by a specialist anaesthetist in the practice of ANAESTHESIA where the patient is referred to him or her)

-    a BRIEF consultation involving a short history and limited examination

-    AND of not more than 15 minutes  duration, not being a service associated with a service to which items 2801 - 3000 apply

Fee: $48.05 Benefit: 75% = $36.05 85% = $40.85

(See para TN.6.2 of explanatory notes to this Category)

-    a consultation involving a selective history and examination of multiple systems and  the formulation of a written patient management plan

-    AND of more than 15 minutes but not more than 30 minutes duration, not being a service associated with a service to which items 2801 - 3000 apply.

Fee: $95.60 Benefit: 75% = $71.70 85% = $81.30

(See para TN.6.2 of explanatory notes to this Category)

-    a consultation involving a detailed history and comprehensive examination of multiple systems and the formulation of a written patient management plan

-    AND of more than 30 minutes but not more than 45 minutes duration, not being a service associated with a service to which items 2801 - 3000 apply

Fee: $132.40 Benefit: 75% = $99.30 85% = $112.55

(See para TN.6.2 of explanatory notes to this Category)

-    a consultation involving an exhaustive history and comprehensive examination of multiple systems and  the formulation of a written patient management plan following discussion with relevant health care professionals and/or the patient, involving medical planning of high complexity,

-    AND of more than 45 minutes duration, not being a service associated with a service to which items 2801 - 3000 apply.

Fee: $168.60 Benefit: 75% = $126.45 85% = $143.35

(See para TN.6.2 of explanatory notes to this Category)