Members are strongly encouraged to provide feedback on the ‘implementation of Medicare Benefits Schedule (MBS) Review Taskforce recommendations relating to the computed tomography angiography (CTA) for the investigation of pulmonary embolism’ proposal as outlined below.  

Please send any comments to Jenny Johnson (j.johnson@acrrm.org.au) by Monday, 7 September.

Background
Up to 1 May 2020, there were two items for non-coronary CT angiography (CTA).  Item 57350 applied for a number of conditions, including investigation for emboli.  That item applied once per patient in a 12 month period and was not anatomical specific.  Item 57351 applied to a subsequent scans in the 12 month period and did not specify anatomical regions either.  Both of these items were able to be requested by GPs and specialists. 

The Medicare Benefits Schedule Review Taskforce recommendations relating to CTA, were that:

  • item 57350 would be split into three items, covering arteries of the head and neck (item 57352), arteries of the abdomen, chest and upper arms (item 57353) and lower arteries (item 57354).  These items would have no time restriction but the GPs now need to consult with a specialist before requesting them; and
  • there be no changes to item 57351. 

These recommendations were implemented on 1 May 2020. 

As advised, it has since been identified that the descriptors for the new items as recommended by the Taskforce only cover the aorta and vessels originating from the aorta and that the recommendation was not intended to limit the requesting of GP requesting of CTA for suspected pulmonary embolism.  Until the error is fixed, the Department is interpreting item 57353 to cover the pulmonary arteries but unfortunately is unable to immediately do anything about the requesting restriction at this stage because it covers more than the investigation of pulmonary emboli. 

A new item descriptor has now been drafted for CTA of the pulmonary arteries which will hope will correct this anomaly when implemented.  The descriptor meets with the intent of the original Taskforce recommendation.

Draft item descriptor – item 57357

57357

Computed tomography—angiography with intravenous contrast medium of any or all, or any part, of the pulmonary arteries and their branches, including any scans performed before intravenous contrast injection—one or more data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy or digital recording of multiple projections, if:

  1. the service is not a service to which another item in this group applies; and
  2. the service is performed for the exclusion of pulmonary arterial stenosis, occlusion, aneurysm or embolism;
  3. the service is not a study performed to image the coronary arteries; and
  4. either:

(i) the service is requested by a specialist or consultant physician; or

(ii) in the case of a service for the exclusion of indications other than pulmonary embolism, the service is requested by a general practitioner and the request indicates that the patient’s case has been discussed with a specialist or consultant physician (R) (Anaes.)

517.65