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2019 December 14 |
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2019 December 14 |
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2019 December 14
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2019 December 14 |
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2019 December 14 |
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14 DECEMBER HEALTH FUNDS UPDATE
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• TAC have corrected some inaccuracies in their fees for time items up to 2 hours.
• We are still waiting on a November update for ADF_BUPA.
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ASA RVG SCHEDULE
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The ASA RVG schedule was earlier updated according to changes published by the AMA effective November 2019. These changes largely follow the changes made in the Medicare schedule and have not yet been confirmed by the ASA. We have reinstated the following items that were deleted from the AMA schedule effective 1 November. It is unclear at present whether payments will be made for these items for procedures done after 1 November.
CF705 ANAESTHESIA for diagnostic laparoscopy in the upper abdomen
CG805 ANAESTHESIA for diagnostic laparoscopy in the lower abdomen
CH953 ANAESTHESIA for endometrial ablation or resection in association with hysteroscopy
CS927 ANAESTHESIA for small bowel enema, barium or other opaque study of the small bowel
CV001 COLLECTION OF BLOOD FOR AUTOLOGOUS TRANSFUSION
CV016 PULMONARY ARTERY PRESSURE MONITORING
CV017 LEFT ATRIAL PRESSURE MONITORING VIA LEFT ATRIAL CATHETER
CV018 INVASIVE PRESSURE MONITORING - not otherwise listed
CV019 MEASUREMENT OF THE MECHANICAL OR GAS EXCHANGE FUNCTION OF THE RESPIRATORY SYSTEM
CV024 CENTRAL VENOUS PRESSURE MONITORING
CV028 INTRA ARTERIAL PRESSURE MONITORING
CV070 CARDIOPLEGIA, BLOOD OR CRYSTALLOID, administration by any route
The latest issue of the ASA’s Australian Anaesthetist magazine notes that the following changes to the MBS will not be adopted by the ASA.
21922 – MBS drop to 6 units – ASA remains at 7 units (CS922).
21936 – MBS drop to 5 units – ASA remains at 6 units (CS936).
22070 – MBS deleted – ASA remains (CV070).
25015 – MBS <4, >=75 – ASA <4, but remains at >=70.
These modifications have been made to the latest AA items file (19.94)
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AGE MODIFIER 25015
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There has been some confusion over the use of the age modifier for patients between the ages of 3 and 4. Initially this was to be applicable to all patients less than 4 years of age, but the description in the Medicare schedule was modified to state ‘not more than 3 years’. Because of this, Medicare and some funds have been rejecting the modifier for patients between 3 and 4. We have followed this up with the ASA, and have received the following communication from Medicare. We interpret this as meaning that the modifier will continue to be applicable to patients between 3 and 4, and that rejected claims will be adjusted. It may be wise to hold off on sending claims using the modifier until the situation is resolved.
The Australian Government Department of Human Services would like to advise that there is an issue with the age restriction for children on anaesthetic item 25015.
The Department of Health is working towards resolving the issue and the outcome will be published on MBS online. In addition, we will email you with instructions on what you will need to do to resubmit rejected claims.
The ASA issued the following statement on 12 Dec:
The changes to the Medicare Benefits Schedule following the MBS Review came into effect on November 1. The newly amended age modifier item (25015) is being rejected by Medicare for children aged between 3 and 4 years. The new MBS item descriptor effective 1st November initially referred to “for a patient less than 4 years…” but has been changed by the Department a few weeks ago to “for a patient not more than 3 years…”. We are in discussions with the Department and are seeking a speedy resolution of this issue.
As noted above, the modifier in the ASA schedule will be adjusted to include the < 4 yrs criteria, but the original >=70 years criteria will remain unchanged.
A program update will be issued shortly to accommodate the changes to the age modifier rules. At present, the system will insert an MBS age modifier for patients between 3 and 4, and we don’t expect this to change. However, the >=75 criteria is currently in effect for the ASA items, and a program update is required to correct this back to the >=70 criteria. For the present, the modifier can be added manually to accounts for patients between 70 and 75.