Under-utilized item numbers : A discussion about new changes to MBS - - PowerPoint PPT Presentation

Under-utilized item numbers:

A discussion about new changes to MBS 6/4/2017

Topics

• 1. Understanding the Existing MBS items – C

&C Lower Limbs(30197)

• 2. Recent changes in MBS numbers items – Ear Case (31358)
• 3. Under-utilized MBS itemnumbers - Bald Area Definition (31361)
• 4. Patient Safety – Investigation of PigmentedLesions
• 5. Melanoma Management in relation to the recent changes in MBS

numbers items – Case of Wider Excision of Melanoma Back(31374)

• 6. Education Hyperlinks – How we can help you

30% revenue is lost by Procedural Doctors and skin cancer clinicsby:

• Not understanding MBS item number use;
• Performing multiple procedures at once:

–Space your excisions (particularly if you BulkBill)

• Poor communication with frontdesk:

–They must understand item numbers as well asyou

• Errors by front staff &errors by you:

–Audit your daily billing –Principal (audit your subcontractor/employee billing sheets)

Existing MBS itemnumbers

Understanding the ExplanatoryNotes

Consider Multiple Lesions onLower Legs

How it works foryou

Procedure 1: –2 x 30071 –Biopsy lesions most likely to be IECs from L + R lowerlegs –Histological report stating IEC x2 Procedure 2: –30197 –Multiple C+Cs to remaining clinical IECs lowerlegs –i.e. 4 C+Cs R lower leg and 6 C+Cs L lower leg –State in chart: histologic confirmation of IEC from R & L lowerlegs

Cryotherapy and SerialCurettage

Cryotherapy and SerialCurettage

RECENT CHANGES IN MBS NUMBERSITEMS

What does itMean to the Procedural GP?

Consider Non-Melanoma Skin Cancer onEar

Best Approach

• Site mid ear - antihelix
• Clinical Diagnosis Ulcerated B

C C

• Lesion size 3mm
• Excisional diameter required to

be documented: 7mm

• Procedural excision(21 x 7mm)
• Removal of underlyingcartilage
• Wedge resection of ear

What do the New MBS Item Numbers Say:

31358

Biopsy to Confirm the ClinicalDiagnosis

What Does This Mean ?

Necessary Excision Diameter >6mm

Relates to this

Necessary Excision Diameter

e.g. 3mm Diameter Two Margins of 2mm Clinical Clearance Each

Thus 3mm lesion + 2mm + 2mm of eachclearance = 7mm Excisional Diameter (> 6mm)

So to useitem number 31358

• Y
• u must have histological confirmation of malignancy

at the site;

• Y
• u must have an excisional diameter of G

R E A T E R THAN6mm

T.8.127 Notes Expand on SizeDocumentation

Documented Image in the PathologyReport

Back to the Case onEar

Wedge Resection of Ear(45665)

Removal of Cartilage during surgery(31340)

Patient Billing ItemNumbers:

45665

• FULL

THICKNESS WEDGE RESECTION

• f ear with direct sutures

Multiple Rule for 31358 &31340 31358

• BASAL

C E L L CARCINOMA OR SQUAMOUS C E L L CARCINOMA(including keratocanthoma), removal from nose, eyelid, lip, ear, digit or genitalia, needs an excisional diameter than 6mm indiameter; 31340

• MUSCLE, BONE OR

CARTILAGE, excision of one or more of, where clinically indicated, where the specimen excised is sent forhistological confirmation, performed in association with excision of malignant tumour of skin covered by item 31255-31335

• 75%of the fee for excision of malignant tumour

Medicare Invoicing

Wedge resection of Ear 45665($277.15) $277.15 E/O TUMOUR E/OCARTILAGE Subject to multiple servicesrule) 31358 (50% of $230.25) 31340 [25% of (75% of $230.25)] $115.13 $43.17 Total $435.45+ gap

Other Under-utilized MBS itemnumbers

Understanding the ExplanatoryNotes

Excisions from BaldArea

Patient Safety

Pigmented Lesion Investigation

PIGMENTED LESIONS:

• No partialbiopsies:

Only ever perform a shave excision, punch excision or aformal excision

• State on request form whether it’s a shaveexcision or punch excision
• When a lesion goes to themargin:

–Excision – OK. Further monitoring is prudent –Biopsy – WeDon’t know – have to put in adisclaimer that the biopsy may/may not be representative of the entire lesion

Dysplastic naevus extending to margins: ‘If the purpose of the biopsy was to remove the entire lesion, re-excision is notrequired. If this is a partial biopsy of larger pigmented lesion, the biopsy may not berepresentative.’

RECENT CHANGES IN MBSNUMBERS ITEMS INVOL VING MELANOMA MANAGEMENT

What does itMean to the Procedural GP?

How do I bill an incomplete excision of a Melanomafrom the back? Which requires widermargins

31374

Back Previous Excision confirmed diagnosis of Melanoma but clearance isincomplete

T.8.127 Notes Expand onManagement

T.8.127 Notes Expand onManagement

According to the Health Department& Head of PSR – Dr David Rankin

• Claim the Melanoma item twice
• First for the Full excision of a suspicious lesion which on histology is

proven to be a Melanoma and

• Again for the Wider excision (completion of incomplete excision)is

done with the appropriate margins for definitive cure / curative intent.

How to use the EducationalHyperlink

CONCLUSION: C H E S T , SKINEXCISION:

• SQUAMOUS C

E L L CARCINOMA(SCC)

• 6mm
• EXCISION

A P P E A R SCOMPLETE. Educational Hyperlink: http://www.infinitypath.com.au/doctor-education/squamous-cell- carcinoma-scc/

Conclusion

1 . C &C of Lower Limbs after biopsy proven malignancy(30197) 2. EarCase

• Excisional diameter meaning with adequate clinical clearance - NHMRCguidelines)

(31358)

• Cartilage item number
• 3. Bald Area definition (31361)
• 4. Patient Safety
• Investigation of PigmentedLesions
• 5. Wider excision of Melanoma(31374)
• Medicare ruling (management of incomplete excision ofmelanoma)
• 6. Education Hyperlinks
• How we can help you

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