COVID MBS items Explainer and FAQs, No. 28, 16 April 2020


Dear Doctors and Health Care Workers

Here’s answers to today’s questions.

1.  You mentioned in an earlier bulletin we could charge a 92422 /92431 (132 equivalent) on the phone, then if we need to do a face to face can still charge a 132. Is this correct? 

So firstly, I am sorry if I have confused you. I have consistently said that the single course of treatment rules apply to COVID services. However, there is an anomaly (which may be what you are referring to) where there is no barrier to providing a 132, and then subsequently an item 110.

For all services, the starting point is to ask yourself whether the service you are going to provide is clinically relevant, and then to consider the single course of treatment rules.

You cannot bill 92422/92431 and then bring the patient in and bill a 132 – the claim would be rejected in any event. When you bring the patient in, assuming it is clinically indicated and appropriate, the F2F consult would be a follow up. However, if you are satisfied that the service you provide F2F meets the requirements of an item 110, then it can be billed. As I said, this is an anomaly.

Always allocate MBS item numbers based on the service you provide and never be tempted to allocate item numbers based on higher rebates.

2.  As a Rheumatologist, all of my patients fit the ‘vulnerable’ group. Therefore, do I only have two options?

a) Charge the item numbers for the consult that must be bulk billed, or

b) Charge them another fee from which they cannot claim any Medicare benefit (if I perform a COVID phone or video consultation)? 

It seems to me from the Bulletin that there are some inconsistencies in the law but on the face of it either I bulk bill my patients as they are all vulnerable, or I charge them a fee from which they cannot claim a benefit (i.e. they are now worse off)

Yes, you are correct. These are your two best options. Hopefully your patients in category b) will complain to the department as Medicare eligible taxpayers.

3.  If I am in isolation at home can I do a telehealth ward round from home on Facetime with my registrar onsite and use 110, 116 etc?

No. If you are using non-COVID items, all usual billing rules apply, including personal attendance, even when supervising a Registrar.

4.  I am a Geriatrician working in the public sector. Pre-COVID I reviewed nursing home residents using 122/128. I have now been doing phone consultations with these patients from the nursing homes from hospital. Since there are no telehealth equivalents for 122/128, am I allowed to use the telehealth equivalents for 110/116 for billing?

Yes, all residents of aged care facilities meet the telehealth area criteria and can be billed using usual telehealth item numbers including 141/143 +149. Please contact us if you would like more information. You have a lot of options beyond items 122 and 128.

Thanks everyone

Till tomorrow.

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 29, 17 April 2020…Read more


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