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Related Items: 12203 12204 12205 12207 12208 12250

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Related Items: 12254 12258 12261 12265 12268 12272

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Related Items: 12210 12213 12215 12217 12218 12219

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Overnight investigation, for a patient aged 18 years or more, for a sleep‑related breathing disorder, following professional attendance by a qualified adult sleep medicine practitioner or a consultant respiratory physician (either face‑to‑face or by video conference), if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified adult sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring and recording, in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen)

(ix) position; and

(d) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and assessment of clinically significant alterations in heart rate and limb movement) 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, 11713, 11714, 11716, 11717, 11723, 11735 or 12250 is provided to the patient; and

(h) previous studies have demonstrated failure of continuous positive airway pressure or oxygen; and

(i) if the patient has severe respiratory failure—a further investigation is indicated in the same 12 month period to which items 12204 and 12205 apply to a service for the patient, for the adjustment or testing, or both, of the effectiveness of a positive pressure ventilatory support device (other than continuous positive airway pressure) in sleep

Applicable only once in any 12 month period

Fee: $703.80 Benefit: 75% = $527.85 85% = $599.30

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

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Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) 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 report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period in which item 12210 or 12218 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non‑invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12210 or 12218 applied for the patient, and further titration of respiratory support is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12210 or 12218 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support; and

(h) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

Applicable once in the 12 month period that starts when the first of the 3 studies mentioned in subparagraph (g)(i) or (ii) is provided

Fee: $840.10 Benefit: 75% = $630.10 85% = $735.60

(See para DN.1.37 of explanatory notes to this Category)

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Overnight paediatric investigation, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) 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 report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period in which item 12210, 12213, 12218 or 12219 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non‑invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which any of items 12210, 12213, 12218 and 12219 applied for the patient, and further titration is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which any of items 12210, 12213, 12218 and 12219 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support; and

(h) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

Applicable once in the 12 month period that starts when the first of the 3 studies mentioned in subparagraph (g)(i) or (ii) is provided

Fee: $756.80 Benefit: 75% = $567.60 85% = $652.30

(See para DN.1.37 of explanatory notes to this Category)

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