Reference
PB 23 + split BB / 93680 Smoking cessation = $135
PB 23 + split BB / 2713 / 2712 / 2715 Mental health = $160
PB 23 + split BB / 73806 / 16500 Anetnatal care = $140
PB 23 + split BB / 93644 COVID = $125
PB 23 + split BB procedure / test
Procedures: Implanon, Zoladex, I+D abscess, Laceration, Fracture, Foreign body, Biopsy
Tests: Urine BCG, ECG, Spirometry, ABI
HMMR
MBS Billing Update 2023
Most of us:
Use only a few MBS item numbers
Underbill everything
Aren’t compliant with MBS rules
The reasons for this:
It’s easier billing timed-based consults such as 23s and 36s
It requires less time on documentation
No one has actually read the MBS
Too much effort to learn the rules
Fear of being audited
MBS Guides
ASGP - https://www.asgp.com.au/public/143/files/ASGP%20MBS%20Summary.pdf
Australian Doctor - https://www.ausdoc.com.au/wp-content/uploads/2023/02/MBS-card_MAR23.pdf
Sydney North Health Network - https://sydneynorthhealthnetwork.org.au/wp-content/uploads/2020/11/SNPHN-MBS-Item-numbers-Nov-2020-final-online-version.pdf
Ask MBS
Can email askMBS@health.gov.au for clarification on specific item numbers
HNE Pathways
Guide to MBS - https://hne.communityhealthpathways.org/310515.htm
Facebook groups
Most questions you have about MBS have been asked before and answered by other GPs
Business for Doctors - https://www.facebook.com/businessfordoctors/
MBS Education for Health Professionals
Services Australia - https://www.servicesaustralia.gov.au/mbs-education-for-health-professionals?context=20
Questions + Mini audit
If anyone thinks it may be helpful, I’m happy to do a mini MBS audit on your patients.
Look at a few days of billings, see what you did in those consults, and identify any mistakes and more importantly any missed billing opportunities.
(? CPD points)
MBS Updates March 2023
Can’t bill ear toilet microscopy (41647) unless other disorders of the ear present
Business for Doctors
Run by GP Dr. Armstrong - Probably knows more than anyone else about the MBS
Useful 1-day workshop, 8 hours = $700
Printed MBS guide = $100, worth skimming once
Website + videos = $30 / month
Videos
Combination Billing in MBS - https://player.vimeo.com/video/759008068
Mental Health and MBS - https://player.vimeo.com/video/478274206
Skin Cancer Medicine and MBS - https://player.vimeo.com/video/496743259
Combination billings model
Uses all available MBS items numbers
Billing for services that you are already providing and are not getting paid for
Pros
Makes more money
Reduces out of pocket cost to the patient
More compliant with MBS rules
Cons
Takes time and effort to learn
Need to know and be compliant with MBS rules
More documentation
Higher risk audit because earning more
Co-billing
Billing multiple items together in one transaction
BB 721 + 723 + 10990
Split billing
Billing multiple item numbers in different transactions, usually PB and then BB
PB 23 presenting complaint (10min) + split BB 2713 (22min) unrelated
Combination Billing Tips
If planning to add combination billing into your practice:
Aim for 1 x combination billing per hour initially
Eventually, increase this to 2 per hour
Initially might need to drop 1 or 2 appointments per session to allow time to document correctly
Should be able to bill $400 per hour consistently
Combination Billing Rules
Always write notes in order of the presenting complaint
Usually privately bill the presenting complaint to simplify
If audited, need to know presenting complaint
Document each item number thoroughly + contemporaneously
Don’t leave notes open to complete later
Be certain time is equal to the minimum combination time
Always notify the patient of consult fees, including bulk-billing items
“We spent a bit of time doing extra things today that medicare has specific payments for. Thankfully it doesn’t cost you any more and actually saves you money. Reception will put through some extra items numbers as a second transaction. It doesn’t cost you anything”
Split bill when privately billing the initial presentation
Make notations as recommended
Presenting complaint
Clinically urgent
Not related
Time-stamping
Not normal aftercare
Underestimate rather than overestimate
Only bill services that meet MBS requirements in their entirety
Follow-up rejected claims
Spend 5 minutes checking billings at end of the day
Audits
Six reasons for audits
80/20 rule
80 total services per day for more than 20 days per year
Excludes COVID vaccines
Excludes BB incentive numbers
30/20 rule
30 phone services per day for more than 20 days per year
Top tier billing e.g. top 5% of GPs
A rapid increase in billing
e.g. Jump from 200k per year billings to 700k per year billings
Outlier billing pattern e.g. 90% consults are 44, billing 20 x 721 in a day
Snitches get stitches
Complaints about obvious infractions e.g. billing deceased patients
Audits shouldn’t matter if you are compliant with the rules of the MBS
Time-based consults
F2F / Phone / Video
3 / 91890 / 91790 = $40 (OOP cost = $20)
23 /91891 / 91800 = $85 (OOP cost = $45)
F2F / V
36 / 91801 = $145 (OOP cost = $70)
36 / 91801 + $35 gap (OOP cost = $35)
44 / 91802 = $190 (OOP cost = $75)
Time-based consults should only be billed if another more accurate item number doesn’t exist
E.g. Inserting an implanon and billing a 23 or 36 instead of a 14206 is incorrect
22-minute consult
Tricky billing area. Traditionally could be in any of these ways:
23 PB = 1 item + 12min chat about patients European holiday
36 BB = 3-month old, 100 yo, the patient is a doctor, chronic disability
36 PB = 5 items, optimal consult, diagnosed cancer, cured depression
There is a fourth billing option.
36 PB + $35 gap = (Costs $110, OOP cost = $35)
This might be appropriate for a 22 min consult where you do more than a 23 PB but not enough to justify a 36 PB
A better option than billing a 23 PB as earns more money and reduces the OOP cost from $45 to $35
Procedure + Time-based consult
You can bill a time-based consult with any procedure as long as there is an actual consult performed and documented.
E.g. If inserting an implanon, there’s no reason not to spend at least 6 minutes talking about contraception education, periods, STIs, CST, breast screening, PCOS, acne, alcohol, exercise, HEEADSSS, family history, DV screening, vaccines, or update MHR.
PB 14206 (Implanon) = $85
+ split BB 73806 (urine BHCG) = $10
+ BB 23 (consult - not related - time 10min) = $40
Total = $135
Sample billing notes
PB 14206 + split BB 73806 + BB 23 consult, not related, time = ^ min
Implanon insertion and removal
30062 (removal) = $60
14206 (insertion) = $40
You can’t bill an Implanon removal and insertion on the same arm, through the same hole in the skin, because of the rules.
You would bill 30026 for removal + 23 for insertion
Can bill 30062 + 14206 if taken out of the left arm and inserted into the right
Sample billing notes
PB 30062 + split BB 14206
PB 30062 + split BB 23 consult, not related, time = ^ min
Smoking Cessation
F2F: 93680 / V: 93690 / P: 93700 = $40 = <20 min
F2F: 93683 / V: 93693 / P: 93703 = $70 = >20 min
Phone, telehealth, F2F.
Unlimited amount of billings, even if the patient is pre-contemplative.
Unrestricted: Can bill with any other item number
Criteria:
History
Nicotine dependence +/- exam
Arrange interventions + referrals
Plan
Advice + preventative information
Antenatal care
F2F: 16500 / V: 91853 / P: 91858 = $40
You can bill 23 + 16500 at the first presentation and diagnosis of pregnancy.
PB 23 (unrelated) = $85
+ split BB 73806 (Urine BHCG) = $10
+ BB 16500 = $40
Total = $135
(+/- Smoking cessation +/- Non-directive counselling)
Sample documentation
1/ Presenting complaint
Pt suspects pregnancy, planned / unplanned, LMP, Periods, Contraception, Medication R/V, MH R/V, IPV screen, BP etc
PB 23, presenting complaint, diagnosis of pregnancy, start time 15:40
2/ Urine pregnancy test
= Positive
BB 73806
3/ Antenatal consult
Discussed care options etc
BB 16500, start time 15:50
Sample billing notes:
23 PB consult, time = ^ min + split 73806 BB + 16500 BB, not related
Unrelated Items
Can bill a 3 / 23 at any antenatal consult if an issue unrelated to pregnancy is managed:
Iron or Vitamin D deficiency
Chlamydia / Gonorrhoea
Asthma management
28 weeks+ Planning and management of pregnancy
16591 = $130
Criteria:
Pregnancy has progressed past 28 weeks and practitioner is providing shared care but not undertaking the birth
Mental health assessment including drug and alcohol use and domestic violence
Payable once per pregnancy
MBS: 16591
4-8 weeks post-partum
F2F: 16407 / V: 91851 / P: 91856= $75
Criteria:
4 to 8 weeks after the birth
20 minutes
Includes mental health assessment, screen for drugs, alcohol + DV
Payable once per pregnancy
MBS: 16407
Non-Directive Pregnancy Support Counselling
F2F: 4001, V: 92136, P: 92138= $80
Free training via GP Learning
Need to wait for a letter to arrive before billing
Unrestricted - can be billed with any other item number
Criteria:
Pregnant or pregnant within 12 months
At least 20 min
Up to 3 services per patient per pregnancy, resets each pregnancy
Useful for unplanned pregnancy, TOP, miscarriage, FDIU, peripartum depression
If the consult is 36 + 4001 + 2713, then the minimum time is 20 min each component, total consult needs to be 1 hour+
Sexual and Reproductive Health
V: 92715 / P: 92731 = < 5 min = $11
V: 92718 / P: 92734 = 5 - 20 min = $40
V: 92721 / P: 92737 = 20 - 40 min = $75
V: 92724 / P: 92740 = > 40 min = $110
Available for telephone and telehealth
Unplanned pregnancy, menopause, cervical screening counselling, menorrhagia, dysmenorrhea, contraception, endo, PCOS, STI counselling, libido, ED, infertility, blood-borne diseases HIV, Hep, Malaria
Criteria:
History
Arrange investigation as necessary
Management plan
Preventative health
Any phone consult involving reproductive health with other issues could be
PB 91891 = $85
+ split BB 92734 = $40
Total = $125
Sample billing:
PB 91891 consult, time = ^ min + split BB 92734, not related
MBS: 92734
COVID-19 vaccine suitability
93644 = $35
Assess COVID-19 vaccine suitability
Must be bulk billed
Must have vaccine available to give
MBS: 93644 / 10660 Notes: AN.44.1
10660 = $40
Criteria:
In-depth discussion associated with 93644
Lasting more than 10 min
Detailed history
Complex exam and management
Bulk-billed
Can be claimed only once per patient
Can be co-claimed
Sample billing:
BB 93644 + BB 10660
COVID-19 Anti-viral Treatment Assessment
93716 = $75
Criteria:
> 20 min
History
Investigation if needed
Plan + follow up
Treatment including antivirals if appropriate
Preventative health if appropriate
Confirm COVID-19 diagnosis officially, record this
End Dec 31, 2023
No co-claiming same attendance
Flu clinic options
6 x 10 min appointments per hour
3 = Fluvax only = $20
23 = Fluvax + more = $40
Update file (smoking, alcohol, allergies, family history, ethnicity, clean up past history, upload MHR summary)
Measure (BP, Ht, Weight, Waist)
Print script if your patient (simple only - Ventolin, Advantan)
Discuss what’s due and suggest rebooking (721 / 723 / 707 / 715, CST, Mammogram, FOBT, BMD)
Vaccine (Shingles, Pneumovax, Boostrix, 2nd Hep A)
93644 = COVID-19 suitability = $35
Flu vaccine and COVID19 vaccine can be billed together. See Notes: AN.44.1
ATAGI has advised that a COVID-19 vaccination and an influenza vaccination can be administered at the same time. These services may be provided during the same attendance.
A vaccine suitability assessment MBS item would be billed for the COVID-19 vaccination. Influenza vaccine services are typically administered with standard MBS attendance items.
Sample billing:
BB 23 consult, not related, time = min + BB 93644
93680 = Smoking cessation = $30
Particularly if your patient and you have already had a smoking cessation discussion previously
Chronic Disease
721 = $150
723 = $120
732 = $75
Chronic disease last >6 months
If not sure if a condition qualifies, it probably doesn’t, don’t bill it and check later
The minimum billing time for 721 / 723 is 12 months, 732 is 3 months
Medicare suggests billing 2 yearly for 721 / 723 and 6 monthly for 732
Should be billing lots of GPMP 721 only for simple chronic conditions e.g. asthma, eczema, psoriasis, OSA, OA
Can bill 2 x 732 on the same day, need to annotate whether GPMP or TCA and time of each
TCA 723 needs 2 additional team members, one can be a doctor
Need evidence that team members will accept the patient before billing 723, could be a phone call
Any specialist letter counts as an acceptance
Need to re-obtain acceptance every time you bill 723
Can’t bill time-based consults with 721 / 723 / 732
Often audited: Main errors are usually proformas and not personalising, not using SMARTER goals
SPECIFIC, MEASURABLE, ACHIEVABLE, RELEVANT, TIMELY - EVALUATED, REVISED
Can choose to privately bill 721 or 723
PB 723 ($155 with $120 rebate) + split BB 721 +/- 10990
Total = $300, pt OOP = $35
Health Assessments
701 = $62 (<30 min)
703 = $145 (30-45min)
705 = $200 (45-60m)
707 = $280 (60m+)
Time with our wonderful nurses count, book 20-60 min with a Nurse, aim for 705 or 707
Criteria:
45-49 high-risk chronic diseases (every 3 years)
40-40 high-risk diabetes (once)
75+ (every 12 months)
Residential care residents (every 12 months)
Intellectual disability (every 12 months) - CHAP
Refugees (once)
Former ADF (once)
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=707
ATSI Peoples Health Assessment
715 = $220
Every 9 months
Three categories <15, 15yo to 54yo, 55+
Different elements depending on age group
History, exam, investigations
Overall assessment
Appropriate interventions
Advice + Info
Keep a record, offer to the patient/carer
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=715
Healthy Heart Assessment
699 = $75
Patients age 30 years + at risk of developing cardiovascular disease (every 12 months)
20min +
? Currently ends June 2023
Can bill 699 + 23 if clinically urgent
Criteria:
History
Exam, BP, Cholesterol
Interventions, referrals
Plan
Preventative health advice
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=699&qt=item&criteria=699
Addit 01/03/2023: Nurse time counts as per AN.14.2
http://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&qt=NoteID&q=AN.14.2
Mental Health Care Plans
2715 = $100 (20-40m)
2717 = $140 (40m+)
2712 + 2713 = $75
Training required for higher value item numbers 2715 / 2717
Eligibility criteria Chapter V of ICD-10 from 1996 - Primary care version
https://apps.who.int/iris/bitstream/handle/10665/41852/0889371482_eng.pdf?sequence=1&isAllowed=y
Excluding delirium, dementia, tobacco use disorders and mental retardation
Assessment
Record agreement
History including presenting complaint
MSE
Assessing risk + co-morbidity
Diagnosis and/or formulation
Outcome tool
Plan
Record agreement, including formulation/diagnosis / provisional diagnosis
Referral + treatment options
Agreeing on goals with patient
Psychoeducation
Crisis plan if appropriate
Make arrangements - referrals, treatment, support, review, follow up
Document
MBS
2715/2717 can be billed 12 monthly
“A new plan should not be prepared unless clinically required and generally not within 12 months”
Live document - should be updated each MH consult 2712 (can’t find evidence that needs formal adding to MHCP if 2713 done)
The first 2712 can occur at 1 month
Medicare does not expect more than 2 reviews in 12 months
Initial maximum of 6 sessions with a psychologist, need to specify the number of sessions
Can then do 4 more for a total of 10 / calendar year
Tips
Read the MBS description
Should usually be done over multiple consults, particularly if a newer patient
Need to rule out organic contributing factors, substance use
Can use a provisional diagnosis or formulation
Don’t diagnose something unless fulfils ICD-10 criteria.
Anxiety / Depression isn’t a diagnosis, Document ICD-10 code if able.
Careful diagnosing conditions such as major depression for a transient life stressor e.g. grief, bullying, exam stress, relationship breakdown
Diagnosis has tremendous implications for applying for defence force, life insurance especially if suicide, and for a patient’s overall well-being e.g. incorrect labelling of BPD in 18yo
Can accumulate time for MHCP billing over multiple consults
Consult 1 - Fatigue (10min = 23 PB) + Start MHCP for anxiety (10min - nothing billed)
Consult 2 - Review blood tests (10min = 23 PB) + Continue MHCP (10 min - nothing billed)
Consult 3 - MHCP only for 25 min (+ 10 mins + 10min) = 2717
** MBS Billing - Part II **
Update from last time
Nurse time counts for 699
MHCP live document, should update with 2712, don’t need to update with 2713
HPMI MBS talk tonight
23 + 2713 / 2712 / 2715 / 2717
Allowed when the presenting complaint is NOT mental health and the consult turns into mental health
Minimum time = 26 minutes (20 min + 6 min)
Must be time-stamped and timing sent to Medicare
23 PB presenting complaint, 10 min = $85
+ split 2713 BB not related 25 min = $75
Total = $160
Sample billing:
23 PB presenting complaint, time = ^ min + split 2713 BB not related, time = ^ min
2713 / 2712 / 2715 / 2717 + 23
Only claimable if the 23 is clinically urgent - “acute”
Anything that cannot wait until tomorrow due without possibly causing an adverse outcome
2713 PB 22 min - presenting complaint + split 23 BB not related - clinically urgent - 8 min
Sample billing:
2713 PB presenting complaint, time = ^ min + split 23 BB not related, clinically urgent, time = ^ min
2713 + non-urgent
If you do a mental health consultation and then a non-urgent pap smear for example
You can’t bill 2713 + 23 accurately as this is non-urgent and not allowed
You can then default to a time-based consultation of 36 or 44
Home Medication Review HMR
900 = $160
If a patient presents for HMR - Can’t bill 900 + 23
However, you can bill 23 for any other presenting complaint + then bill 900 opportunistically
Can be billed with any item number opportunistically
Generally not more frequent than 12 monthly unless clinically indicated
Patients like them, pharmacists like them, pharmacist rebate = $220, pharmacist limit is 30 / month
Think of all patients on medication as potentially eligible.
Commencing Insulin / T2DM
Drugs of addiction - Opioids, Benzos, Chronic pain
Psychotropics - Stimulants / SSRI / SNRI / Antipsychotics
IHD / CVA / Anticoagulants / Warfarin
Criteria
Having a chronic medical condition or a complex medication regimen; and
Not having their therapeutic goals met
Targets
5 or more medications
12 or more doses of medication per day
Significant changes made to medication in the last three months
Narrow therapeutic index
Symptoms suggestive of an adverse drug reaction
Suboptimal response to treatment
Suspected non-compliance
Language barrier, dexterity problems, impaired sight
Numerous doctors and specialists
Recent discharge
Pharmacist only gets paid if fulfils criteria
Otherwise patient may have a private fee
Procedure
Explanation + consent
Refer to pharmacist
Pharmacist talks to patient, sends report to GP
Patient sees GP
GP discusses report
GP rings pharmacist to discuss
Copy offered to patient
Copy offered to HMMR pharmacist + dispensing pharmacist
Document with shortcuts
Bill
Can arrange to do all HMR with 1 pharmacist and schedule a phone call every month to review all patients over that time frame
Chronic Disease Combinations
Yearly review. Book 20 to 60 min with Nurse.
Book 721 + 723 ( 1 to 2 yearly ) + 732 / 732 ( 3 to 6 monthly )
12 monthly 721/723 + 3 monthly 732/732 (x3)
12 monthly 721/723 + 4 monthly 732/732 (x2)
18 monthly 721/723 + 6 monthly 732/732 (x2)
24 monthly 721/723 + 6 monthly 732/732 (x3)
+/- Health assessment ( 707 / 715 )
Might be appropriate to do 721 / 723 / 707 all at once e.g. 75yo, non-compliant diabetic, the only time you can guarantee you will see them is once a year before their RMS forms are due
CHAP assessments
+/- Home Medications Review ( 900 )
Offer during 721 / 723, bill opportunistically at the next appointment
+/- Mental health review ( 2712 / 2713 )
Can’t do 721 + MHCP for the same condition, need a chronic disease AND a mental health diagnosis
Can’t generally use 10 x psychologist appointments in MHCP and 5 x allied health in TCA for a psychologist.
Could justify if 2 significant mental health conditions requiring different types of treatment (PTSD + Depression + Bipolar + Autism + ADHD) or if a concurrent medical condition that might benefit from psychology (e.g. Chronic pain, obesity management, coming to terms with a cancer diagnosis, low mood post-AMI).
+/- Smoking cessation ( 93680 )
+/- COVID-19 assessment (93644)
+/- Investigations + Procedures
+/- Antenatal care (16500)
+/- Non-directive pregnancy counselling (4001)
+/- 10997 +/- 10090
Investigations
ECG (11707) = $20
Criteria:
ECG trace to inform decision making
Does not need to be fully interpreted or reported
Spirometry (11506 ) = $20
Criteria:
Pre + post bronchodilator
To confirm, assess or monitor COPD / asthma / other lung diseases
Spirometry (11505) = $40
Criteria:
Pre + post bronchodilator
3 or more recordings
Once per 12 months
ABI (11610) = $60
Criteria:
Measurement of posterior tibial, dorsalis pedis and brachial arterial pressures bilaterally using Doppler
Calculate systemic pressure indices for evaluation of lower extremity arterial diseases
Hard copy trace and report
Urine BHCG (73806) = $10
Criteria:
Pregnancy test by 1 or more immunochemical methods
Zoladex
14206 (insertion) = $30
Same as Implanon.
Fractures
Can bill fracture management item numbers if seen and diagnosed in public ED if you are managing ongoing.
Can’t if managed in private ED.
47471 (rib fracture) = $40
MBS: 47471
47348 Carpal bone (not scaphoid)- treatment of #; AC 6 weeks $83.15
47354 Scaphoid Bone- treatment of #; AC 3 months $149.90
47301 Phalanx fractures- closed reduction with Local anaesthesia; AC 6 weeks $76.80
47361 Distal end radius and/or ulna- cast immobilisation; AC 8 weeks $116.60
47378 Shaft of radius or ulna- cast immobilisation; AC 8 weeks $148.60
47387 Shaft of radius and ulna- cast immobilisation; AC 3 months $241.40
47405 Radial head/neck fracture closed reduction; AC 8 weeks $166.45
47396 Olecranon- immobilisation and or reduction; AC 8 weeks $166.45
47423 Proximal Humerus- treatment of #; AC 3 months $191.50
47444 Shaft of Humerus- treatment of #; AC 3 months $199.90
47462 Clavicle- treatment of #; AC 4 weeks $99.80
47471 Ribs- for 1 or more #s and can be charged for each attendance $38.05
47466 Sternum- treatment of #; AC 4 weeks $99.80
47735 Nasal bones- treatment of #; AC 4 weeks $38.10
Lacerations
30026 (superficial, <7cm, not face) = $45
30032 (superficial, <7cm, face or neck) = $90
Includes wound glue and staples (sutures, tissue adhesive resin or clips)
Foreign body
Most foreign bodies have an item number.
30064 = $120 (subcut FB)
Removal of subcut foreign body requiring incision and exploration +/- wound closure
MBS: 30064
30061 = $25 (superficial FB)
Removal of superficial foreign body including cornea / sclera
MBS: 30061
41500 = $90 (FB from ear)
Removal of foreign body from ear other than simple syringing.
MBS: 41500
41659 = $70 (FB from nose)
Removal of FB other than by simple probing
MBS: 41659
Incision and Drainage
30216 = $30 (Aspiration Haematoma)
30219 = $30 (I+D Haematoma / Abscess / Furuncle)
Aspiration of haematoma, furuncle, small abscess or similar lesion
Burns dressing
30003 = $30 (localised)
30006 = $40 (extensive)
Can be billed for each dressing, but requires the doctor to physically place the dressing on the skin
Can’t bill 23 / 36 if the consult is only burns dressing
Epistaxis
41677 = $80 (Nosebleed, arrest by cautery or packing)
MBS: 41677
Nail removal
46513 = $50 (Nail removal, finger)
47904 = $50 (Nail removal, toe)
Abandoned surgery
30001 = 50% of the procedure fee
Is co-billed with the original planned procedure number
Criteria:
Patient is in a procedure room
Patient or operatively site is sufficiently anaesthetised to do the procedure
Patient is positioned or the operative site is prepared with antiseptic or draping
MBS: 30001
Unrestricted items
Can bill these with any items numbers
16500 - Antenatal care
4001 - Non-directive pregnancy counselling
93680 - Smoking cessation
93644 - COVID vaccine suitability assessment
Diagnostic and therapeutic procedures, pathology, imaging
Multiple attendances
Different problems, 9am sore throat + 4pm ankle # - Can bill both, annotate with times + unrelated.
Same problem, ankle # and returned after Xray - Can combine time of both consults.
Nursing
ATSI health worker or Nurse numbers can be billed even if you aren’t in the practice
10987 - Claimed by Nurse if ATSI pt has a 715, up to 10 per year
10988 - Immunisation is given by Nurse to ATSI pt
10989 - Wound management by Nurse to ATSI pt
No item number for saying hello to a patient when the Nurse gives a vaccine.
Needs to be an actual consult completed
Document or it didn’t happen
Should probably be a 3, not a 23 unless you do more than 6 min
Pathology
Several common pathology tests have MBS criteria
Iron studies
Thyroid function
Vitamin D
HbA1c
Hepatitis serology
Blood group
When ordering pathology for both private and MBS rebatable tests, you should provide two separate pathology forms.
Indicate which is private and which is MBS rebatable.
Vitamin D
Check criteria, advise the patient of private fee, and privately order if they do not meet criteria
Signs and symptoms of osteoporosis
Increased ALP
High or low PTH, CMP
Malabsorption
Deeply pigmented skin, chronic lack of sun exposure for cultural, medical, occupational or residential reasons
Medications that lower Vit D
CKD
Rickets
Infant of a mother with known low Vit D
Exclusively breastfed baby and at least one other risk factor above
Sibling under 16 with known low Vit D
Worker’s compensation / Insurance
SIRA WC Rates
SIRA Work Cover Rates - February 2023
AA010 / T = $44 (<5 min)
AA020 / T = $89 (5 to 20 min)
AA030 / T = $162 (20 to 40 min)
AA040 / T = $250 (40 min +)
Time-based consults
WC001 = $50 (Initial certificate bonus)
Initial certificate of capacity, payable once
The first presentation of WC injury should always be WC001 + usually AA030
WC002 = $25 / 5 min (discussions)
Criteria:
Discussion with employer
Case conferencing
Visiting worksites
Reviewing injury management or recovery at work plans
Addition requested reports
WC004 = $ Cost price (dressings)
Dressing, bandages
WC005 = $60 for electronic record, $40 paper + per page
Providing copies of medical records
Including doctors notes if requested
>20 min consult
Always check the time
Uncommonly is a Work Cover certificate < 20 minutes
Should mostly be billing AA030 not AA020
Insurance medical report requests
Insurance companies are jerks
Bill the maximum or WC rate equivalent
WC consult + non-WC issues e.g. script
Bill WC number e.g. AA020 + close file
Open file + bill 3 / 23 etc
Better to separate consults for when Work Cover requests patient notes later
Multiple patients
Often you see a patient with a parent, partner or carer.
If you choose to do a consult for the other family members, document it and bill it.
Kids check + vaccines - 2/52, 6/52, 4/12, 6/12, 12/12
+ 3/23 BB for mother
Birth history + trauma, LUSCS scar healing
Breastfeeding
Contraception
Mental health and parental stress + cope
Sick kid with sick sibling/parent
Patient + their carer
Any couple that comes in together
Kid + parent
+ 3/23 BB
Infectious diseases, URTI, Gastro, Impetigo
Joint mental health issues
Environmental exposures
Carer stress
Travel consult for a family
+ 23 BB for everyone
Water hygiene, mosquito avoidance, vaccinations
Not Discussed
Case conferences
Focus Psychological strategies
Skin lesions
Eating disorders
DVA + CVC
Sample combination for a patient
10yo kid post admission to JHH for acute asthma via ambulance
Background atopy, eczema, hayfever, anaphylaxis peanuts
Multiple medications.
3 x hospitalisations for bronchiolitis when younger
First appointment - 23 + 2713 (asthma check, debrief anxiety, post-traumatic experience, based on formulation)
Second appointment - 23 / 36 + 11506 (spirometry), review asthma + spirometry, refer for HMR 900 + spend 10 minutes on starting MHCP formulation
Third appointment - Nurse + GP, 721 + 723, do asthma + anaphylaxis action plan, spend 10 minutes on mental health formulation
Fourth appointment - Finish MHCP 2717. Spend 25 minutes and accumulate extra minutes from previous appointments used for mental health to get time over 40 minutes
Fifth appointment - Asthma + anaphylaxis review, Nurse first, 23 + 10997, opportunistic 900 if done
Notes from HPMI MBS meeting 16/03/2023
TCA
Usual GP + 2 other members, one of which can be another doctor
Need Practice Nurse included allowing billing of 10997 when reviewed
Each member must provide a different service
Not all need to be medical or allied health
Family not included
Need to discuss steps with the patient, record agreeance
SMARTER goals and actions needed to take
Offer copy to the patient
Bill 721 and put 723 on hold until received confirmation
Date 723 bill is the date confirmation received
TCA heavily audited
TCA confirmation needs collaboration and useful information, not just a signed agreement letter
The letter sent off needs a request of what is desired from the team member to help the patient
Can’t review TCA if no collaboration in the time frame between reviews
TELEHEALTH
After March 31, 2023
Need email agreement to BB telehealth from patient
Need to email patient with details of consult