Medicare Benefits Schedule - Item 38252

Search Results for Item 38252

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Category 3 - THERAPEUTIC PROCEDURES

38252

38252 - Additional Information

Item Start Date:
01-Jul-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2024

Group
T8 - Surgical Operations
Subgroup
6 - Cardio-Thoracic
Subheading
1 - Cardiology Procedures

Note: (pre-operative assessment - graft) the service only applies if the patient meets the requirements of the descriptor and the requirements of Note: TR.8.5

Selective coronary and graft angiography:

(a) for a symptomatic patient with valvular or other non-coronary structural heart disease; and

(b) as part of the management of the patient for:

(i) pre-operative assessment for planning non-coronary cardiac surgery, including by transcatheter approaches; or

(ii) evaluation of valvular heart disease or other non-coronary structural heart disease where clinical impression is discordant with non-invasive assessment; and

(c) with placement of one or more catheters and injection of opaque material into the native coronary arteries; and

(d) if free coronary grafts attached to the aorta or direct internal mammary artery grafts are present—with placement of one or more catheters and injection of opaque material into those grafts (irrespective of the number of grafts); and

(e) with or without left heart catheterisation, left ventriculography or aortography; and

(f) including all associated imaging;

other than a service associated with a service to which item 38200, 38203, 38206, 38244, 38247, 38248, 38249 or 38251 applies—applicable once each 12 months

Multiple Operation Rule

(Anaes.)

Fee: $1,613.75 Benefit: 75% = $1,210.35 85% = $1,511.35

(See para IN.2.1, TN.8.215, TN.8.216, TR.8.5 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.215

Discussions of Findings and Abandoned Procedures

Discussions of the results

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 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.

Abandoned T8 Surgical Procedures and Selective Coronary Angiography

The new selective coronary angiography items now have time restrictions applied whether claimed by the same or different providers. It is important for the patient that if a provider cannot complete (abandoned) a comprehensive diagnostic angiography that appropriately informs the diagnosis and treatment pathway or is discontinued due to the clinical status of the patient, item 30001 is claimed. This will allow claiming by the provider who subsequently completes the entire diagnostic angiography service taking into consideration the time restrictions for each of the selective angiography items.

 

Related Items: 38244 38247 38248 38249 38251 38252

Category 3 - THERAPEUTIC PROCEDURES

TN.8.216

Claiming restrictions to graft patients

Claiming Guidance

This item is only claimable when the patient has graft arteries present and has undergone angiographic investigation of the native coronary arteries and any graft arteries, which can include but is not limited to free coronary grafts attached to the aorta or direct internal mammary artery grafts.

Related Items: 38247 38249 38252

Category 3 - THERAPEUTIC PROCEDURES

TR.8.5

Selective Coronary Angiography and Percutaneous Coronary Intervention - Documentation Requirements

Clause 5.10.17D Restriction on items 38244, 38247, 38248, 38249, 38251, 38252, 38307, 38308, 38310, 38311, 38313, 38314, 38320, 38322, 38323, 38316, 38317 and 38319—reports and clinical notes

Items 38244, 38247, 38248, 38249, 38251, 38252, 38307, 38308, 38310, 38311, 38313, 38314, 38320, 38322, 38323, 38316, 38317 and 38319 apply to a service provided to a patient only if a report or clinical note:

(a) is prepared for the service; and

(b) includes documentation that demonstrates how the item applies to the service, including how the patient is eligible for the service.

Related Items: 38244 38247 38248 38249 38251 38252 38307 38308 38310 38311 38313 38314 38316 38317 38319 38320 38322 38323

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.

Related Items: 38247 38249 38252 57364


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