Medicare Benefits Schedule - Item 17620

Professional attendance by a medical practitioner in the practice of anaesthesia for a consultation on a patient undergoing advanced surgery or who has complex medical problems involving a detailed history and comprehensive examination of multiple systems and the formulation of a written patient management plan documented in the patient notes - and of more than 30 minutes but not more than 45 minutes duration, not being a service associated with a service to which items 2801 - 3000 apply

Fee: $137.05 Benefit: 75% = $102.80 85% = $116.50

(See para TN.6.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $411.15

• Previous - Item 17615
• Next - Item 17625

Pre-anaesthesia consultations are covered by items in the range 17610 - 17625. 

Pre-anaesthesia consultations comprise 4 time-based items utilising 15 minute increments up to and exceeding 45 minutes, in conjunction with content-based descriptors.  A pre-anaesthesia consultation will attract benefits under the appropriate items based on BOTH the duration of the consultation AND the complexity of the consultation in accordance with the requirements outlined in the content-based item descriptions. 

Whether or not the proposed procedure proceeds, the pre-anaesthetic attendance will attract benefits under the appropriate consultation item in the range 17610 - 17625, as determined by the duration and content of the consultation. 

The following provides further guidance on utilisation of the appropriate items in common clinical situations: 

(i) Item 17610 (15 mins or less) - a pre-anaesthesia consultation of a straightforward nature occurring prior to investigative procedures and other routine surgery. This item covers routine pre-anaesthesia consultation services including the taking of a brief history, a limited examination of the patient including the cardio-respiratory system and brief discussion of an anaesthesia plan with the patient.    

(ii) Item 17615 (16-30 mins) - a pre-anaesthesia consultation of between 16 to 30 minutes duration AND of significantly greater complexity than that required under item 17610. To qualify for benefits patients will be undergoing advanced surgery or will have complex medical problems. The consultation will involve a more extensive examination of the patient, for example: the cardio-respiratory system, the upper airway, anatomy relevant to regional anaesthesia and invasive monitoring. An anaesthesia plan of management should be formulated, of which there should be a written record included in the patient notes. 

(iii) Item 17620 (31-45 mins) - a pre-anaesthesia consultation of high complexity involving all of the requirements of item 17615 and of between 31 to 45 minutes duration. The pre-anaesthesia consultation will also involve evaluation of relevant patient investigations and the formulation of an anaesthesia plan of management of which there should be a written record in the patient notes. 

(iv) Item 17625 (more than 45 mins) - a pre-anaesthesia consultation of high complexity involving all of the requirements of item 17615 and item 17620 and of more than 45 minutes duration. The pre-anaesthesia consultation will also involve evaluation of relevant patient investigations as well as discussion of the patient's medical condition and/or anaesthesia plan of management with other relevant healthcare professionals.  An anaesthesia plan of management should be formulated, of which there should be a written record included in the patient notes. 

Some examples of advanced surgery that may require a longer consultation under items 17615-17625 would include:

· Bowel resection

· Caesarean section

· Neonatal surgery

· Major laparotomies

· Radical cancer resection

· Major reconstructive surgery eg free flap transfers, breast reconstruction

· major joint arthroplasty

· joint reconstruction

· Thoracotomy

· Craniotomy

· Spinal surgery eg spinal fusion, discectomy

· Major vascular surgery eg aortic aneurysm repair, arterial bypass surgery, carotid artery endarterectomy 

Some examples of complex medical problems in relation to items 17615-17625 would include:                  

· Major cardiac problems - e.g cardiomyopathy, unstable ischaemic heart disease, heart failure

· Major respiratory disease - e.g COPD, respiratory failure, acute lung conditions eg. infection and asthma,

· Major neurological conditions - CVA, intra/extra cerebral haemorrhage, cerebral palsy and/or major intellectual disability, degenerative conditions of the CNS

· Major metabolic conditions - e.g unstable diabetes, uncontrolled hyperthyroidism, renal failure, liver failure, immune deficiency

· Anaesthetic problems - eg past history of awareness, known or anticipated difficulty with securing the airway, malignant hyperpyrexia, drug allergy,

· Other conditions -

- patients with history of stroke/TIA's presenting for vascular surgery

- patients on anti-platelet agents presenting for major surgery requiring management of anticoagulant status

- patients with poor respiratory/cardiac function presenting for major surgery requiring management of perioperative medications, analgaesia and monitoring 

NOTE I:

It is important to note that:

· patients undergoing the types of advanced surgery listed above but who are otherwise of reasonable health and who, therefore, do not require a longer pre-anaesthesia consultation as provided for under items 17615-17625, would qualify for benefits under item 17610; and

· not all patients  with complex medical problems will qualify for a longer consultation under items 17615-17625. For example, patients who have reasonably stable diabetes may only require a short consultation, covered  under item 17610. Similarly, patients with reasonably well controlled emphysema (COPD) undergoing minor surgery may only require a short pre-anaesthesia consultation (item 17610), whereas the same patient scheduled for an upper abdominal laparotomy and with recent onset angina with the possible need for ICU postoperatively may require a longer consultation. 

NOTE II:

· Consultation services covered by pain specialists items in the range 2801-3000 cannot be claimed in conjunction with items 17610-17625

· The consultation time under items 17610 - 17625 only applies to the period of active attendance on the patient and does not include time spent in discussion with other health care practitioners.

· The requirement of a written patient management plan in items 17615-17625   or the discussion of the management plan with other health care professions, where this occurs, does not relate to and cannot be claimed in conjunction GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans or Case Conference items in Group A15 of the MBS.

Related Items: 17610 17615 17620 17625