View Associated Notes
Category 5 - DIAGNOSTIC IMAGING SERVICES
57364 - Additional Information
Note: the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: TR.8.3 (item 38247), TR.8.2 (item 38249) or item 38252 if subclause (iv) applies.
Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner, if:
(a) the service is requested by a specialist or consultant physician; and
(b) at least one of the following apply to the patient:
(i) the patient has stable symptoms and newly recognised left ventricular systolic dysfunction of unknown aetiology;
(ii) the patient requires exclusion of coronary artery anomaly or fistula;
(iii) the patient will be undergoing non-coronary cardiac surgery;
(iv) the patient meets the criteria to be eligible for a service to which item 38247, 38249 or 38252 applies, but as an alternative to selective coronary angiography will require an assessment of the patency of one or more bypass grafts
(R)
(Anaes.)
Fee: $784.85 Benefit: 75% = $588.65 85% = $686.15
(See para IN.0.19, IN.2.1, TR.8.2, TR.8.3, TR.8.6 of explanatory notes to this Category)
Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
TR.8.2
Selective Coronary Angiography Indications
Clause 5.10.17A Items 38244, 38247, 38307, 38308, 38310, 38316, 38317 and 38319—patient eligibility and timing
(1) A patient is eligible for a service to which item 38244, 38247, 38307, 38308, 38310, 38316, 38317 or 38319 applies if:
(a) subclause (2) applies to the patient; and
(b) a service to which the item applies has not been provided to the patient in the previous 3 months, unless:
(i) the patient experiences a new acute coronary syndrome or angina, as described in paragraph (2)(a), (b) or (c), in that period; or
(ii) for a service to which item 38316, 38317 or 38319 applies—the service was provided to the patient in that period as a subsequent stage following an initial primary percutaneous coronary intervention procedure.
(2) This subclause applies to a patient who has:
(a) an acute coronary syndrome evidenced by any of the following:
(i) ST segment elevation;
(ii) new left bundle branch block;
(iii) troponin elevation above the local upper reference limit;
(iv) new resting wall motion abnormality or perfusion defect;
(v) cardiogenic shock;
(vi) resuscitated cardiac arrest;
(vii) ventricular fibrillation;
(viii) sustained ventricular tachycardia; or
(b) unstable angina or angina equivalent with a crescendo pattern, rest pain or other high-risk clinical features, such as hypotension, dizziness, pallor, diaphoresis or syncope occurring at a low threshold; or
(c) either of the following, detected on computed tomography coronary angiography:
(i) significant left main coronary artery disease with greater than 50% stenosis or a cross-sectional area of less than 6 mm2;
(ii) severe proximal left anterior descending coronary artery disease (with stenosis of more than 70% or a cross-sectional area of less than 4 mm2 before the first major diagonal branch).
Related Items: 38244 38247 38307 38308 38310 38316 38317 38319 57364
Category 3 - THERAPEUTIC PROCEDURES
TR.8.3
Acute Coronary Syndrome - Selective Coronary Angiography and Percutaneous Coronary Intervention Indications
Clause 5.10.17B Items 38248 and 38249—patient eligibility
(1) A patient is eligible for a service to which item 38248 or 38249 applies if:
(a) subclause (2) applies to the patient; or
(b) the patient is recommended for coronary angiography as a result of a heart team conference that meets the requirements of subclause (3).
(2) This subclause applies to a patient who has:
(a) limiting angina or angina equivalent, despite an adequate trial of optimal medical therapy; or
(b) high risk features, including at least one of the following:
(i) myocardial ischaemia demonstrated on functional imaging;
(ii) ST segment elevation, sustained ST depression, hypotension or a Duke treadmill score of minus 11 or less, demonstrated by stress electrocardiogram testing;
(iii) computed tomography coronary angiography evidence of one or more coronary arteries with stenosis of 70% or more; or
(iv) left ventricular dysfunction with an ejection fraction of less than 40% or segmental wall motion abnormality at rest
(3) For the purposes of paragraph (1)(b), the requirements for a heart team conference are as follows:
(a) the conference must be conducted by a team of specialists or consultant physicians practising in the speciality of cardiology or cardiothoracic surgery, including each of the following:
(i) an interventional cardiologist;
(ii) a non-interventional cardiologist;
(iii) a specialist or consultant physician; and
(b) the team must:
(i) assess the patient’s risk and technical suitability to receive the service; and
(ii) make a recommendation about whether or not the patient is suitable for invasive coronary angiography; and
(c) a record of the conference must be created, and must include the following:
(i) the particulars of the assessment of the patient during the conference;
(ii) the recommendations made as a result of the conference;
(iii) the names of the members of the team making the recommendations.
Category 3 - THERAPEUTIC PROCEDURES
TR.8.6
Heart Team Conferences - Items 38248, 38249, 38311, 38313, 38320, 38322 and 57364
Definition of a heart team conference: relevant to items 38248, 38249, 38311, 38313, 38320, 38322 and 57364
(a) A heart team conference is a team of 3 or more participants who are cardiac specialists; where:
- the first participant is a specialist or consultant physician who is an interventional cardiologist; and
- the second participant is a specialist or consultant who is a non-interventional cardiologist; and
- the third participant is a specialist or consultant physician; and
(b) the team assesses a patient’s risk and technical suitability to receive the service; and
(c) the result of the heart team conference’s assessment is that the team makes a recommendation about whether or not the patient is suitable for selective coronary angiography (for items 38248, 38249, 38320) or percutaneous coronary intervention (for items 38311, 38313, 38320, 38322) ; and
(d) the particulars of the assessment and recommendation/s, and the names of those providers making the recommendation/s are recorded in writing.
Note: For non-complex stable triple vessel disease, providers are encouraged to include a cardiothoracic surgeon in the heart team.
Category 5 - DIAGNOSTIC IMAGING SERVICES
IN.0.19
Bulk Billing Incentive
Out-of-hospital services attract higher benefits when they are bulk billed by the provider.
For all diagnostic imaging items (except those in Group 6 – Management of Bulk Billed Services and items 61369, 61466, 61485) benefits for bulk billed services are payable at 95% of the schedule fee for the item.
Related Items: 55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55048 55049 55054 55065 55066 55068 55070 55071 55073 55076 55079 55084 55085 55118 55126 55127 55128 55129 55130 55132 55133 55134 55135 55137 55141 55143 55145 55146 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55600 55603 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55729 55736 55739 55740 55741 55742 55743 55757 55758 55759 55762 55764 55766 55768 55770 55772 55774 55812 55814 55844 55846 55848 55850 55852 55854 55856 55857 55858 55859 55860 55861 55862 55863 55864 55865 55866 55867 55868 55869 55870 55871 55872 55873 55874 55875 55876 55877 55878 55879 55880 55881 55882 55883 55884 55885 55886 55887 55888 55889 55890 55891 55892 55893 55894 55895 56001 56007 56010 56013 56016 56022 56028 56030 56036 56101 56107 56219 56220 56221 56223 56224 56225 56226 56233 56234 56237 56238 56301 56307 56401 56407 56409 56412 56501 56507 56553 56620 56622 56623 56626 56627 56628 56629 56630 56801 56807 57001 57007 57201 57341 57352 57353 57354 57357 57360 57362 57364 57506 57509 57512 57515 57518 57521 57522 57523 57524 57527 57541 57700 57703 57706 57709 57712 57715 57721 57901 57902 57905 57907 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58927 58933 58936 58939 59103 59300 59302 59303 59305 59312 59314 59318 59700 59703 59712 59715 59718 59724 59733 59739 59751 59754 59763 59970 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078 60500 60503 60506 60509 60918 60927 61109 61310 61313 61314 61321 61324 61325 61328 61329 61340 61345 61348 61349 61353 61356 61357 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61394 61397 61398 61402 61406 61409 61410 61413 61414 61421 61425 61426 61429 61430 61433 61434 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61461 61462 61469 61473 61480 61495 61499 61505 61523 61524 61525 61529 61541 61553 61559 61563 61564 61565 61612 61620 61622 61628 61632 61647 61650 63001 63004 63007 63010 63040 63043 63046 63049 63052 63055 63058 63061 63064 63067 63070 63073 63101 63111 63114 63125 63128 63131 63151 63154 63161 63164 63167 63170 63173 63176 63179 63182 63185 63201 63204 63219 63222 63225 63228 63231 63234 63237 63240 63243 63271 63274 63277 63280 63301 63304 63307 63322 63325 63328 63331 63334 63337 63340 63361 63385 63388 63391 63395 63397 63401 63404 63416 63425 63428 63440 63443 63446 63454 63461 63464 63467 63470 63473 63476 63482 63491 63494 63496 63497 63498 63499 63501 63502 63504 63505 63513 63531 63533 63541 63543 63545 63546 63547 63549 63560 63563 64990 64991
Category 5 - DIAGNOSTIC IMAGING SERVICES
IN.2.1
Indications for Computed Tomography Coronary Angiography (CTCA) Non-Coronary Artery Indication
Heart rate during CTCA should be less than 65 beats per minute wherever possible, and sublingual glyceryl trinitrate (GTN) should be administered immediately prior to scanning where clinically appropriate.
The presence of coronary calcium alone does not preclude CTCA.
Discussions of the results, findings or interpretation of a study are reasonably expected to be part of a formal report. Discussion of these findings with a patient does not constitute a separate consultation. 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 separate consultation.
Indication (b)(iv) of the item recognises the increasing role of CTCA as an alternative to selective coronary angiography (invasive) in the assessment of the coronary arteries (including bypass grafts).
The service only applies if the patient meets the requirements of Notes: TR.8.3 (item 38247), TR.8.2 (item 38249) or item 38252 if subclause (iv) of the item applies.
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