Medicare Benefits Schedule - Note IN.1.9

Search Results for Note IN.1.9

View Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

IN.1.9

Echocardiogram fetal item (55137)

Providers

This item may be claimed for fetal cardiac evaluation (claimed against the mother). It is expected that this service will be conducted by a paediatric cardiologist trained in fetal echocardiography or appropriately qualified sonographer under the paediatric cardiologist's supervision.

Providers of this item number should meet the:

  • the Cardiac Society of Australia & New Zealand Guidelines for Paediatric Echocardiography for paediatric patients; and
  • be competent to perform fetal echocardiography.

The Cardiac Society of Australia & New Zealand Guidelines for Paediatric Echocardiography are available at

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

Indications

For use when there is suspected or confirmed congenital structural or functional abnormality, fetal cardiac rhythm abnormalities, or where co-pathology, maternal illness or family history creates an increased risk of congenital cardiac abnormality requiring review by a paediatric cardiologist with specialist training and ongoing involvement in fetal cardiology.

Results

Discussion of these findings with a patient (mother) 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.

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

  • the patient was referred for an investigation; and
  • the patient was not known to the provider; and
  • the findings on the investigation appropriately warranted a consultation.

 

 

Related Items: 55137


Related Items

Category 5 - DIAGNOSTIC IMAGING SERVICES

55137

55137 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

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 fetus with suspected or confirmed:

(i) complex congenital heart disease; or

(ii) functional heart disease; or

(iii) fetal cardiac arrhythmia; or

(iv) cardiac structural abnormality requiring confirmation; and

(b) is performed by a specialist or consultant physician practising in the speciality of cardiology with advanced training and expertise in fetal cardiac imaging; and

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

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

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

 

 

Fee: $236.25 Benefit: 75% = $177.20 85% = $200.85

(See para IN.0.19, IN.1.9, IR.1.2, IR.1.3 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