Medicare Benefits Schedule - Note IN.1.9

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

• Previous - Note IN.1.8
• Next - Note IN.1.10

Bulk bill incentive

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: $249.95 Benefit: 75% = $187.50 85% = $212.50

(See para IN.0.19, IN.1.9, IR.1.2, IR.1.3 of explanatory notes to this Category)