Professional attendance by a general practitioner to review a GP mental health treatment plan which he or she, or an associated general practitioner has prepared, or to review a Psychiatrist Assessment and Management Plan.

Professional attendance by a general practitioner in relation to a mental disorder and of at least 20 minutes in duration, involving taking relevant history and identifying the presenting problem (to the extent not previously recorded), providing treatment and advice and, if appropriate, referral for other services or treatments, and documenting the outcomes of the consultation.

This can be billed/added to consult numbers such as 23 and 36 if a hCG urine test is done during the consult.

Planning and management, by a practitioner, of pregnancy if: the pregnancy has progressed beyond 28 weeks gestation (including mental health assessment) by shared care GP who is not planning to perform the delivery.

This item can only be billed by a shared care GP and can’t be claimed for a patient where item 16590 (including delivery) is being claimed (usually by GP obs or private obs).

Must be between 4 and 8 weeks after birth; consultation must last at least 20 minutes and include a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; may be billed only once per pregnancy.

Did you know, you can bill Medicare items for aftercare (post-operative treatment) even if someone else performed the procedure?

This includes all post-operative treatment rendered by medical specialists and consultant physicians, and includes all attendances until recovery from the operation, the final check or examination, regardless of whether the attendances are at the hospital, private rooms, or the patient’s home, such as routine aftercare including wound review, dressing removal/change, suture removal.

Certain items exclude aftercare, which means you can bill Medicare items for aftercare even if you performed the procedure.

For example, 30219 – HAEMATOMA, FURUNCLE, SMALL ABSCESS OR SIMILAR LESION not requiring admission to a hospital – INCISION WITH DRAINAGE OF (excluding aftercare).

This can be billed/added to consult if catheterisation of the bladder is required, where no other procedure is performed.

47915
INGROWING NAIL OF TOE, wedge resection for, with removal of segment of nail, ungual fold and portion of the nail bed.

47916
INGROWING NAIL OF TOE, partial resection of nail, with destruction of nail matrix by phenolisation, electrocautery, laser, sodium hydroxide or acid but not including excision of nail bed.

The excision of warts and seborrheic keratoses attracts benefits on an attendance basis with the exceptions outlined in T8.13 of the explanatory notes to this category. Excision of pre-malignant lesions including solar keratoses where clinically indicated are covered by items 31357, 31360, 31362, 31364, 31366, 31368 and 31370.

The excision of suspicious pigmented lesions for diagnostic purposes attract benefits under items 31357, 31360, 31362, 31364, 31366, 31368 and 31370.

Malignant tumours are covered by items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369 and 31371 to 31376.

Items 31357, 31360, 31362, 31364, 31366, 31368, 31370 require that the specimen be sent for histological examination.

Items 31356, 31358, 31359, 31361, 31363, 31365, 31367, 31369, 31371-31376 also require that a specimen has been sent for histological confirmation of malignancy, and any subsequent specimens are sent for histological examination. Confirmation of malignancy must be received before itemisation of accounts for Medicare benefits purposes.

Where histological results are available at the time of issuing accounts, the histological diagnosis will decide the appropriate itemisation. If the histological report shows the lesion to be benign, items 31357, 31360, 31362, 31364, 31366, 31368 or 31370 should be used.

It will be necessary for practitioners to retain copies of histological reports.

Information from DoH website.

A Diagnostic biopsy of skin, as an independent procedure, if the biopsy specimen is sent for pathological examination.

Including punch and shave biopsy of a suspicious skin lesion billed at the time of the procedure, can be billed for each biopsy done on the same or that day (i.e. if 3x punch biopsies done bill 30071,30071,30071).

Includes-multiple billing rule:

Where you are paid 100% of the first billed number, 50% second and 25% of the third (and subsequent procedures i.e. $52.50+$26.25+$13.13=$91.86 for x3 biopsies).

Item number: 3
Professional attendance at consulting rooms (other than a service to which another item applies) by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management-each attendance.

LEVEL A
A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner’s records. In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

Item number: 23
Professional attendance by a general practitioner at consulting rooms (other than a service to which another item in the table applies), lasting less than 20 minutes and including any of the following that are clinically relevant:
a) taking a patient history;
b) performing a clinical examination;
c) arranging any necessary investigation;
d) implementing a management plan;
e) providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

LEVEL B
A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health-related issues. The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner’s record. In the item descriptor singular also means plural and vice versa.

As described, for a brief consult where no other action is taken, then a level A consult is warranted. Keep in mind, it is the doctor’s time only that is taken into the decision for what level is attributed, not the nursing+doctor’s time. For example,billing an Item 3 for a brief consult with the only action being a flu vaccination administered by the nursing staff.

Level B (less than 20min attendance) that is provided in consulting rooms (i.e. at the practice):

• on a public holiday;
• on a Sunday;
• before 8am, or after 1pm on a Saturday;
• before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.

Similarly, there are after hour item numbers for the other in-practice consultations:

Items 585, 588, 591, 594, 599, 600 apply only to a professional attendance that is provided:

• on a public holiday;
• on a Sunday;
• before 8am, or after 12 noon on a Saturday;
• before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

(a)   the attendance includes any of the following that are clinically relevant:

(i) taking a detailed patient history;
(ii) arranging any necessary investigation;
(iii) implementing a management plan;
(iv) providing appropriate preventative health care.

Item number: 699
Professional attendance for a heart health assessment by a general practitioner at consulting rooms lasting at least 20 minutes and must include:

(a) collection of relevant information, including taking a patient history that is aimed at identifying cardiovascular disease risk factors, including diabetes status, alcohol intake, smoking status, cholesterol status (if not performed within the last 12 months) and blood glucose;
(b) a physical examination, which must include recording of blood pressure;
(c) initiating interventions and referrals to address the identified risk factors;
(d) implementing a management plan for appropriate treatment of identified risk factors;
(e) providing the patient with preventative health care advice and information, including modifiable lifestyle factors;

with appropriate documentation.

Item number: 177
Professional attendance for a heart health assessment by a medical practitioner (other than a specialist or consultant physician) at consulting rooms lasting at least 20 minutes and must include:

(a) collection of relevant information, including taking a patient history that is aimed at identifying cardiovascular disease risk factors, including diabetes status, alcohol intake, smoking status, cholesterol status (if not performed within the last 12 months) and blood glucose;
(b) a physical examination, which must include recording of blood pressure;
(c) initiating interventions and referrals to address the identified risk factors;
(d) implementing a management plan for appropriate treatment of identified risk factors;
(e) providing the patient with preventative health care advice and information, including modifiable lifestyle factors;

with appropriate documentation.