Medicare Benefits Schedule - Note TN.8.183

• Only a single arthroscopy item for each procedure may be utilised per knee.
• This item must be for the most complex procedure undertaken and must not be utilised in conjunction with any other knee arthroscopy item. Refer to the Australian Orthopaedic Association guidelines for appropriate use.
• Osteoarthritis is a progressive disease involving structural and compositional changes of the whole joint. Multiple clinical trials have demonstrated that knee arthroscopic procedures have no clinically meaningful benefit in patients with uncomplicated osteoarthritis.
• Uncomplicated osteoarthritis is defined as a circumstance where the patient's symptoms or illness are not due to obstructive atraumatic chondral, meniscal or chondral lesions, or repairable menisci, sepsis, neoplasia or inflammatory disorders.
• For patients with uncomplicated osteoarthritis, arthroscopy should only be performed in patients with surgeon-confirmed obstructive symptoms (locked or locking knee), or where the identified pathology is atraumatic chondral, meniscal or chondral lesions that are causative of the symptoms.
• Patient selection for knee arthroscopy in the presence of osteoarthritis should conform to the October 2016 Position statement from the Australian Knee Society on arthroscopic surgery of the knee, including reference to the presence of osteoarthritis or degenerative joint disease, or such standards that supersede these.

Related Items: 49570 49572 49574 49576 49578 49580 49582 49584 49586 49590

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Multiple Operation Rule

Diagnosis of knee, by arthroscopic means, when the pre-procedure diagnosis is undetermined, including either or both of the following (if performed):

(a) biopsy;

(b) lavage

(H)

(Anaes.) (Assist.)

Fee: $300.45 Benefit: 75% = $225.35

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Partial meniscectomy of knee, by arthroscopic means, for atraumatic meniscus tear, other than a service to which another item of this Schedule applies if the service described in the other item is for the purpose of treating osteoarthritis (H)

(Anaes.) (Assist.)

Fee: $731.15 Benefit: 75% = $548.40

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Removal of loose bodies of knee, by arthroscopic means—one or more bodies (H)

(Anaes.) (Assist.)

Fee: $731.15 Benefit: 75% = $548.40

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Repair of chondral lesion of knee, by arthroscopic means, including either or both of the following (if performed):

(a) microfracture;

(b) microdrilling;

other than  a service performed in combination with a service to which another item of this Schedule applies if the service described in the other item is for the purpose of performing chondral or osteochondral grafts (H)

(Anaes.) (Assist.)

Fee: $731.15 Benefit: 75% = $548.40

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Release of soft tissue, lateral release or osteoplasty of knee, by arthroscopic means, other than  a service performed in combination with a service to which another item of this Schedule applies if the service described in the other item is for the purpose of stabilising the patellofemoral joint of the knee (H)

(Anaes.) (Assist.)

Fee: $731.15 Benefit: 75% = $548.40

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Partial meniscectomy of knee, by arthroscopic means, for traumatic meniscus tear (H)

(Anaes.) (Assist.)

Fee: $731.15 Benefit: 75% = $548.40

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Meniscal repair of knee, by arthroscopic means (H)

(Anaes.) (Assist.)

Fee: $853.70 Benefit: 75% = $640.30

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Chondral, osteochondral or meniscal graft of knee, by arthroscopic means (H)

(Anaes.) (Assist.)

Fee: $853.70 Benefit: 75% = $640.30

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Synovectomy of knee, by arthroscopic means, for neoplasia or inflammatory arthropathy, other than a service to which another item of this Schedule applies if the service described in the other item is for the purpose of treating uncomplicated osteoarthritis

(Anaes.) (Assist.)

Fee: $853.70 Benefit: 75% = $640.30 85% = $755.00

(See para TN.8.183 of explanatory notes to this Category)

Multiple Operation Rule

Excision of ganglion, cyst or bursa of knee, by open or arthroscopic means, performed as an independent procedure, other than a service associated with a service to which another item in this Group applies

(Anaes.) (Assist.)

Fee: $408.95 Benefit: 75% = $306.75 85% = $347.65

(See para TN.8.183 of explanatory notes to this Category)