Discontinued and abandoned surgery assessing rules in Medicare 011-42060030
This page contains links to the MBS online, education guide for health professionals and examples for keying derived fee item 30001 and scenarios for claiming assistance at discontinued procedures.
Examples of item selection for derived fee item 30001
Table 1: this table provides examples of scenarios for claiming 30001.
Example |
Outcome |
Example A |
Dr Z commenced a surgical operation covered by a single Group T8 (item A). This procedure was discontinued on medical grounds part way through. The items must be claimed and keyed in the following order:
|
Example B |
Dr Y commenced a surgical operation made up of 3 Group T8 items:
The operation was abandoned due to equipment failure. The patient had been positioned on the operation table, anaesthetised and draped, however none of the operations had started. This meets the requirements that the procedure had commenced. The items should be claimed and keyed in the following order:
|
Example C |
Dr X commenced a surgical operation made up of 4 Group T8 items:
The items should be claimed and keyed in the following order with appropriate text stating completed or abandoned:
|
Example D |
A manual inpatient claim has been received with a notional charge and multiple surgical items:
If the claim is keyed with $5,000.00 as charge for the first item on the claims (item I) and $0.00 as the charge for the other items - the system returns the message 5-REQ CHG. Over-key the control line with supervisor access control line. The schedule fee for each surgical (group T8) item will display in the claim. By over-keying the charge amount for each item (excluding items 30001), with their applicable schedule fee, the notional charge can be apportioned (split) across the relevant items. Note: for the benefit to pay correctly, the charge must never be keyed as less than the schedule fee.
Note: for outpatient services, manual patient claims require an invoice/account from the practice displaying the individual charges raised against each item. This ensures the patient’s Extended Medicare Safety Net (EMSN) can be applied correctly. |
Examples of item selection for assistant items 51300 and 51303
Table 2: this table provides examples of scenarios for claiming assistance items 51300 and 51303 at abandoned procedures.
Example |
Description |
Example A |
Dr W assisted at a surgical operation made up of 2 Group T8 MBS items:
The procedure was discontinued on medical grounds. The assistant fee is calculated below:
Item selected is 51300 as the fee is below the threshold specified in the item descriptor. |
Example B |
Dr V assisted at a surgical operation made up of 4 Group T8 items. The first 2 procedures (item O and item P) were completed in full. The third procedure (item Q) was discontinued on medical grounds, and the fourth procedure (item R) was therefore abandoned. All item descriptions for procedures O, Q and R include ‘(Assist)’. The assistant fee is calculated below:
Item selected is 51300 as the aggregate fee calculated is below the threshold specified in the item descriptor. |
Example C |
Dr T assisted at a surgical operation made up of 2 Group T8 items:
The operation was abandoned due to equipment failure. The patient had been positioned on the operation table, anaesthetised and draped however none of the procedures had started. The assistant fee is calculated below:
Item selected is 51303 as the fee is above the threshold specified in the item descriptor. The schedule fee for item 51303 is 20% of the fee of the surgical item and is therefore calculated at $200. |