Medicare Benefits Schedule - Note TN.1.10

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Category 3 - THERAPEUTIC PROCEDURES

TN.1.10

Procedures Associated with Intensive Care - (Items 13818, 13842, 13847, 13848 and 13857)

Item 13818 covers the insertion of a right heart balloon catheter (Swan-Ganz catheter).  Benefits are payable under this item only once per day except where a second discrete operation is performed on that day. 

Benefits are payable under items 13876 (within an ICU) and 11600 (outside an ICU) once only for each type of pressure, up to a maximum of 4 pressures per patient per calendar day, and irrespective of the number of the practitioners involoved in monitoring the pressures. 

If a service covered by Item 13842 is provided outside of an ICU, in association with, for example, an anaesthetic, benefits are payable for Item 13842 in addition to Item 13870 where the services are performed on the same day.  Where this occurs, accounts should be endorsed "performed outside of an Intensive Care Unit" against Item 13842. 

Items 13847 and 13848

Item 13847 covers management of counterpulsation by intraaortic balloon on the first day and includes initial and subsequent consultations and monitoring of parameters. Insertion of the intraaortic balloon is covered under item 38609 Management on each day subsequent to the first is covered under item 13848. 

"management" of counterpulsation of intraaortic  balloon means full heamodynamic assessment and management on several occasions during the day. 

Item 13857 covers the establishment of airway access and initiation of ventilation on a patient outside intensive care for the purpose of subsequent ventilatory support in intensive care. Benefits are not payable under Item 13857 where airway access and ventilation is initiated in the context of an anaesthetic for surgery even if it is likely that following surgery the patient will be ventilated in an ICU. In such cases the appropriate anaesthetic item/s should be itemised. 

Medicare benefits are not payable for sampling by arterial puncture under Item 13839 in addition to Item 13870 (and 13873) on the same day.  Benefits are payable under Item 13842 (Intra-arterial cannulation) in addition to Item 13870 (and 13873) when performed on the same day.

 

Related Items: 11600 13818 13842 13847 13848 13857 13870 13876


Related Items

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

11600

11600 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2008
Schedule Fee Start Date:
01-Jul-2019

BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day up to a maximum of 4 pressures (not being a service to which item 13876 applies and where not performed in association with the administration of general anaesthesia)

Fee: $70.40 Benefit: 75% = $52.80 85% = $59.85

(See para TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13818

13818 - Additional Information

Item Start Date:
01-Jul-1993
Description Start Date:
01-May-1994
Schedule Fee Start Date:
01-Jul-2019

RIGHT HEART BALLOON CATHETER, insertion of, including pulmonary wedge pressure and cardiac output measurement

(Anaes.)

Fee: $115.50 Benefit: 75% = $86.65 85% = $98.20

(See para TN.1.10 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13842

13842 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-May-1994
Schedule Fee Start Date:
01-Jul-2019

INTRAARTERIAL CANNULATION for the purpose of taking multiple arterial blood samples for blood gas analysis

Fee: $70.40 Benefit: 75% = $52.80 85% = $59.85

(See para TN.1.10 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13847

13847 - Additional Information

Item Start Date:
01-Nov-2005
Description Start Date:
01-Nov-2005
Schedule Fee Start Date:
01-Jul-2019

COUNTERPULSATION BY INTRAAORTIC BALLOON management on the first day including initial and subsequent consultations and monitoring of parameters

(Anaes.)

Fee: $158.60 Benefit: 75% = $118.95 85% = $134.85

(See para TN.1.10 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13848

13848 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-May-1994
Schedule Fee Start Date:
01-Jul-2019

COUNTERPULSATION BY INTRAAORTIC BALLOON  management on each day subsequent to the first, including associated consultations and monitoring of parameters

Fee: $133.15 Benefit: 75% = $99.90 85% = $113.20

(See para TN.1.10 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13857

13857 - Additional Information

Item Start Date:
01-Nov-1994
Description Start Date:
01-Nov-2005
Schedule Fee Start Date:
01-Jul-2019

AIRWAY ACCESS, ESTABLISHMENT OF AND INITIATION OF MECHANICAL VENTILATION (other than in the context of an anaesthetic for surgery), outside an Intensive Care Unit, for the purpose of subsequent ventilatory support in an Intensive Care Unit

Fee: $148.75 Benefit: 75% = $111.60 85% = $126.45

(See para TN.1.10 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13870

13870 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

(Note: See para T1.8 of Explanatory Notes to this

Category for definition of an Intensive Care Unit)


    

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on the first day (H)

Fee: $367.90 Benefit: 75% = $275.95

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13876

13876 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

CENTRAL VENOUS PRESSURE, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure, continuous monitoring by indwelling catheter in an intensive care unit and managed by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - once only for each type of pressure on any calendar day (up to a maximum of 4 pressures) (H)

Fee: $78.15 Benefit: 75% = $58.65

(See para TN.1.9, TN.1.10, TN.1.11 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