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Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

12250

12250 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Nov-2023

Group
D1 - Miscellaneous Diagnostic Procedures And Investigations
Subgroup
10 - Other Diagnostic Procedures And Investigations

Overnight investigation of sleep for at least 8 hours of a patient aged 18 years or more to confirm diagnosis of obstructive sleep apnoea, if:

(a) either:

(i) the patient has been referred by a medical practitioner to a qualified adult sleep medicine practitioner or a consultant respiratory physician who has determined that the patient has a high probability for symptomatic, moderate to severe obstructive sleep apnoea based on a STOP‑Bang score of 3 or more, an OSA50 score of 5 or more or a high risk score on the Berlin Questionnaire, and an Epworth Sleepiness Scale score of 8 or more; or

(ii) following professional attendance on the patient (either face‑to‑face or by video conference) by a qualified adult sleep medicine practitioner or a consultant respiratory physician, the qualified adult sleep medicine practitioner or consultant respiratory physician determines that investigation is necessary to confirm the diagnosis of obstructive sleep apnoea; and

(b) during a period of sleep, there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) continuous ECG;

(iv) continuous EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(c) the investigation is performed under the supervision of a qualified adult sleep medicine practitioner; and

(d) either:

(i) the equipment is applied to the patient by a sleep technician; or

(ii) if this is not possible—the reason it is not possible for the sleep technician to apply the equipment to the patient is documented and the patient is given instructions on how to apply the equipment by a sleep technician supported by written instructions; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and cardiac abnormalities) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service mentioned in any of items 11000, 11003, 11004, 11005, 11503, 11704, 11705, 11707, 11714, 11716, 11717, 11723, 11735 and 12203 is provided to the patient

Applicable only once in any 12 month period



Fee: $369.05 Benefit: 75% = $276.80 85% = $313.70

(See para DN.1.17 of explanatory notes to this Category)

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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