Medicare Benefits Schedule - Note AN.0.61

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Category 1 - PROFESSIONAL ATTENDANCES

AN.0.61

Emergency Medicine Attendances for the provision of Goals of Care (Items 5039, 5041, 5042 and 5044)

Items 5039 and 5041 are for goals of care services, performed by emergency physicians to support gravely ill patients to make informed decisions regarding treatment of their medical condition.

Mirror items (5042 and 5044) are for the provision of goals of care by medical practitioners who are not emergency physicians.

Items 5039 for emergency physicians and 5042 for medical practitioners are for goals of care services to be performed in conjunction with, or after, the new emergency medicine attendance services (items 5001 to 5036). It is expected the doctor would have performed the emergency attendance service on the patient and would be familiar with the patient’s medical issues and circumstances.

Items 5041 for emergency physicians and 5044 for medical practitioners are for goals of care services that are not performed in conjunction with, or after, the new emergency medicine attendance services (items 5001 to 5036). These items are for situations where the doctor would not be familiar with the patient’s medical issues and circumstances and the attendance is for at least 60 minutes.

Notes:

The conditions to be met before services covered by items 5039, 5041, 5042 and 5044 attract benefits are provided under the following definitions of “gravely ill patient lacking goals of care” and “preparation of goals of care” in the GMST.

“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.

Items 5039, 5041, 5042 and 5044 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: 5039 5041 5042 5044

 

 

Related Items: 5039 5041 5042 5044


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

5039

5039 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Nov-2023

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine for preparation of goals of care by the specialist for a gravely ill patient lacking current goals of care if:
(a) the specialist takes overall responsibility for the preparation of the goals of care for the patient; and
(b) the attendance is the first attendance by the specialist for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and
(c) the attendance is in conjunction with, or after, an attendance on the patient by the specialist that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019

Fee: $156.80 Benefit: 75% = $117.60 85% = $133.30

(See para AN.0.61 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5041

5041 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Nov-2023

Professional attendance at a recognised emergency department of a private hospital by a specialist in the practice of the specialist’s specialty of emergency medicine for preparation of goals of care by the specialist for a gravely ill patient lacking current goals of care if:
(a) the specialist takes overall responsibility for the preparation of the goals of care for the patient; and
(b) the attendance is the first attendance by the specialist for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and
(c) the attendance is not in conjunction with, or after, an attendance on the patient by the specialist that is described in item 5001, 5004, 5011, 5012, 5013, 5014, 5016, 5017 or 5019; and
(d) the attendance is for at least 60 minutes

Fee: $294.85 Benefit: 75% = $221.15 85% = $250.65

(See para AN.0.61 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5042

5042 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Nov-2023

Professional attendance at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) for preparation of goals of care by the practitioner for a gravely ill patient lacking current goals of care if:
(a) the practitioner takes overall responsibility for the preparation of the goals of care for the patient; and
(b) the attendance is the first attendance by the practitioner for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and
(c) the attendance is in conjunction with, or after, an attendance on the patient by the practitioner that is described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036

Fee: $117.70 Benefit: 75% = $88.30 85% = $100.05

(See para AN.0.61 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

5044

5044 - Additional Information

Item Start Date:
01-Mar-2020
Description Updated:
01-Mar-2020
Schedule Fee Updated:
01-Nov-2023

Professional attendance at a recognised emergency department of a private hospital by a medical practitioner (except a specialist in the practice of the specialist’s specialty of emergency medicine) for preparation of goals of care by the practitioner for a gravely ill patient lacking current goals of care if:
(a) the practitioner takes overall responsibility for the preparation of the goals of care for the patient; and
(b) the attendance is the first attendance by the practitioner for the preparation of the goals of care for the patient following the presentation of the patient to the emergency department; and
(c) the attendance is not in conjunction with, or after, an attendance on the patient by the practitioner that is described in item 5021, 5022, 5027, 5030, 5031, 5032, 5033, 5035 or 5036; and
(d) the attendance is for at least 60 minutes

Fee: $221.10 Benefit: 75% = $165.85 85% = $187.95

(See para AN.0.61 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