Dear Doctors,
Thank you for your excellent questions overnight. Please keep them coming. Below are responses to questions that came in before 4.30pm today. We received quite a few of the same question, so I have incorporated those into one, where appropriate. Please note that in all of the tables I have included the 100% schedule fee NOT the 85% rebate.
Questions
1. How do you bill Items 141/143 using the COVID items?
You can’t. This is the same as the response yesterday relating to items 132 and 133. It would be far too risky for the Government at this stage to include the high paying physician items, so they have restricted the COVID items to 110 and 116, which you can claim as a Geriatrician.
2. I am an anaesthetist and pain specialist. I cannot claim physician items 110 and 116 because I am not a fellow of the RACP. What item numbers should I use for my pain patients?
Anaesthesia items have not been included because COVID services apply to outpatients only and the vast majority of anaesthetic work occurs in the inpatient setting. However, there is a group of generic ‘Other Medical Practitioner’ and ‘Non-Specialist Practitioner’ item numbers that you can claim.
Please note:
- There are geographical differences between metro and regional settings for these services.
- The MBS services are unreferred. There is no clear indication that the COVID equivalents will also be unreferred, but we assume they will be because of the absence of a referral requirement in the item description.
- The MBS services are paid at the 100% rebate but the COVID services are not. They will be reimbursed at only 85% of the schedule fee.
- Remember your patients have to fit the threshold criteria of ‘vulnerable patients’ described yesterday.
- The two bulk bill incentive items, 10990 (metro) and 10991 (regional) usually apply to these unreferred MBS services and nothing has changed legally to suggest they will not be payable with the new COVID equivalents. Patients need to be under 16 or a concession card holder.
| MBS item | Description | COVID equivalent | Scheduled Fee | Add schedule fee for bulk bill incentive if applicable | Comment |
|---|---|---|---|---|---|
| 53 | Consult 5-25 minutes | 91803 | $21.00 | $7.50 | Metro |
| 54 | Consult 26-45 minutes | 91804 | $38.00 | ||
| 57 | Consult more than 45 minutes | 91805 | $61.00 | ||
| 185 | Consult 5-25 minutes | 91806 | $30.55 | $11.35 | Regional |
| 189 | Consult 26-45 minutes | 91807 | $59.15 | ||
| 203 | Consult more than 45 minutes | 91808 | $87.10 |
3. There don’t seem to be any COVID-19 items for new patients for psychiatrists. Does this mean I cannot bill an initial consultation for vulnerable patients who have been waiting for some time to see me?
There are no initial attendance COVID items that are the equivalent of psychiatry items 291, 296, 293 etc. It appears the Government is restricting all high paying items. So, the answer to your question is yes, you cannot claim an initial attendance, even if you have a qualifying ‘vulnerable’ patient. However, there are two items that fall into the ‘non-specialist practitioner’ category that you can claim, but for which the rebates are obviously much less than the psychiatry items.
Details below:
| Usual MBS item | Description | COVID equivalent | Scheduled fee |
|---|---|---|---|
| 371 | FPS 30-40 minutes | 91844 | $88.70 |
| 372 | FPS more than 40 minutes | 91845 | $126.90 |
4. Can you please clarify that pain specialists who are not physicians are not entitled to bill COVID item numbers?
Pain specialists who are not RACP fellows (usually anaesthetists) can claim the items in point 2.
5. Are initial consults allowed with COVID item numbers?
Yes. Items 104 (surgeons) and 110 (physicians) both have COVID equivalents and can be claimed provided other criteria are met. See yesterday’s bulletin.
6. If I am isolated at home can I do a telephone/telehealth consult with the patient who is also at their home or does the patient have to come to the pain clinic? I mean, can both the doctor and patient be at home?
Yes. Provided all criteria are met regarding vulnerability of patient, or the doctor is isolated, or both, then you can both be at home and on the phone and be eligible to claim the relevant COVID service.
7. I use palliative care item numbers 3005, 3010 and am not eligible to claim 116 or 110. Which COVID items should I use to bill my cancer patients during this period?
You would have to use the items in point 2.
8. There is a legal requirement that patients sign the DB4 form when being bulk billed, to evidence their consent. There is a convoluted method for doing this for telehealth consults via email. Does this apply for the COVID services as well?
This is a great question and one I have been pondering. So, Section 20B of the Health Insurance Act which creates the legal requirement for the patient’s signature has not changed. However, the Government is unlikely to audit this component of COVID billing because they do not require doctors to retain the signed vouchers anyway. For more on this listen to the RACP Pomegranate Health recent episode – Billing in Byzantium. I explained the legalities around this on that podcast.
Best advice is to revert to the basics and retain any evidence you can relating to the patient’s consent to bulk bill. This is best practice, and in a time when Medicare will be increasingly vulnerable to abuse, the Government will be grateful for your efforts. There is always the option to select ‘unable to sign’ on the DB4 and then you can enter in the text field something like ‘COVID patient’, ‘vulnerable patient’ or ‘I have COVID.’
9. Can the COVID codes be used if the doctors themselves are seen as vulnerable persons ie. A pregnant psychiatrist?
Currently no. Health professionals can only use the COVID services if either their patients are vulnerable (see definition in yesterday’s bulletin) or if they themselves are at risk. Here is the definition of a health professional at risk, and pregnancy is unfortunately not included.
A health professional at risk for COVID-19 means a person that:
- has been diagnosed with COVID-19 but who is not a patient of a hospital; or
- has been required to isolate themselves in quarantine in accordance with home isolation guidance issued by the Australian Health Protection Principal Committee The most recent update from the Australian Health Protection Principal Committee was on 12 March 2020 and can be read at this link https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-coronavirus-covid-19-statement-on-12-march-2020 and includes this sentence “There is no work restriction on HCW who are casual contacts of COVID-19 cases and are well.”
We hope you have found this helpful. Please share with your colleagues and keep the questions coming. We want to help and will update every day while the questions keep coming.
Margaret & The Synapse Team.
MORE QUESTIONS ANSWERED
COVID MBS items explainer and FAQs No. 3, 18 March 2020… Read more