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COVID MBS items Explainer and FAQs, No. 37, 29 April 2020

Dear Doctors and Health Care Workers

Here are the answers to today’s questions.

1.  A fellow physician worked at my private specialist clinic for few months. Had own provider number and billing set up. They have now left to join a public hospital position full time and want to transfer all new and review patients to me. Should a referral to me on each patient, with consent be the best way to do it?

This is actually a very interesting question.

So, in regards new patients, you can take over any referral named to your colleague and no consent is required. This is based on the following interpretation of the current law contained on the Services Australia website here (accessed today):

“Referrals for specialist treatment

Patients can be referred to a specialist or consultant physician for treatment of their condition. The referral must include:

Referrals don’t need to be made out to a certain specialist or consultant physician. Referrers should let patients choose where to present the referral, this also applies to electronic referrals.

In regards review patients, your colleague should write a referral to you transferring the care of the patient. Noting this is not a locum arrangement but a complete transfer of the care of the patient to you.

2.  a) Regarding COVID physician telehealth (phone) consult item 91835.  Understand that the doctor needs to have a F2F backup option if patient needs to be examined. We have a long term oncology patient due for f/u but pt has decamped interstate (and emerged from quarantine) to be with family for the duration of the COVID lockdown/s. At pt’s request, we have sent their medical summary and relevant reports to their temporary GP interstate.  Pt has requested a phone consult with us for next scheduled review and also to discuss continuity of care. Can item 91835 be billed via Medicare as pt would not be able to come into our rooms if anything requiring F2F arises during the phone review.  We will be recommending a referral to a local specialist in any case for the duration of relocation.

There is nothing in the relevant Determination specifically stating a backup F2F option must be available.

The regulated requirement is ‘clinical relevance’ as usual and the facts sheets provided by the Department state that practitioners should ensure the provision of a telehealth service is ‘safe and clinically appropriate.’

You can claim item 91835 in the circumstances you have described as long as you deem it safe and clinically appropriate.

b) We also have some Sydney based patients who have moved to their second homes in the Southern Highlands but these patients can drive to our rooms if F2F required and I consider them valid candidates for medicare COVID telehealth consult billing where telehealth clinically appropriate regardless of being out of town. Is this correct?

See above. No problem here.

3.  I am a resp and sleep physician. My patients on the whole find phone much easier than face timing/Skype. Is there a mandate to use face to face or is phone acceptable if reflected with the correct billing codes? 

There is a legislated requirement to use video over phone if both you and the patient have video capacity. Here it is below as it applies to specialist services:

“2.1.1 Application of COVID-19 specialist, consultant physician and consultant psychiatrist phone services

(1)   An item in Subgroup 7, 8, 9, 18, 24 or 26 of Group A40 does not apply if the rendering practitioner and the patient have the capacity to undertake an attendance by telehealth.”

Telehealth in this context means video.

So, video is not mandatory, and the provision is vaguely worded as are much of the new laws. What does ‘have the capacity’ mean?

Many practitioners are reporting that patients are preferring telephone over video, so best advice is to offer video if possible and  keep very good records and document well what you actually said and what the patient said in reply, making clear the patient insisted they wanted the consultation to proceed via phone.

Thanks everyone

Stay safe!

Margaret and the Synapse team.

COVID MBS items explainer and FAQs No. 38, 1 May 2020…Read more

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