Document ID: chunk:federal_register_of_legislation:F2024C01086:clause:1_35414:p3
Version: federal_register_of_legislation:F2024C01086
Segment Type: clause
Provision Reference: sch 1 cl 35414 (pt 3/4)
Character Range: 1778514–1781432

is recommended for the service as a result of a heart team conference that meets the requirements of subclause (4).
 (2) This subclause applies to a patient if:
 (a) the patient has any of the following:
 (i) limiting angina or angina equivalent despite an adequate trial of optimal medical therapy;
 (ii) myocardial ischaemia demonstrated on functional imaging;
 (iii) high risk features such as ST segment elevation, sustained ST depression, hypotension or a Duke treadmill score of minus 11 or less, demonstrated by stress electrocardiogram testing; and
 (b) the patient has either of the following in a vascular territory treated:
 (i) a stenosis of 70% or more;
 (ii)  a fractional flow reserve of 0.80 or less, or non‑hyperaemic pressure ratios distal to the lesions of 0.89 or less; and
 (c) for items 38314 and 38323—either:
 (i) the patient does not have diabetes mellitus and the multi‑vessel coronary artery disease of the patient meets the criterion in subclause (3); or
 (ii) despite a recommendation that surgery is preferable, the patient has expressed a preference for catheter‑based intervention.
 (3) For the purposes of subparagraph (2)(c)(i), the criterion for the multi‑vessel coronary artery disease is that the disease does not involve any of the following:
 (a) stenosis of more than 50% in the left main coronary artery;
 (b) bifurcation lesions involving side branches with a diameter of more than 2.75 mm;
 (c) chronic vessel occlusions for more than 3 months;
 (d) severely angulated or calcified lesions;
 (e) a SYNTAX score of more than 23.
 (4) For the purposes of paragraph (1)(b), the requirements for a heart team conference are as follows:
 (a) the conference must be conducted by a team of specialists or consultant physicians practising in the speciality of cardiology or cardiothoracic surgery, including each of the following:
 (i) an interventional cardiologist;
 (ii) a specialist or consultant physician;
 (iii) for items 38314 and 38323—a cardiothoracic surgeon;
 (iv) for items 38311, 38313, 38320 and 38322—a cardiothoracic surgeon or a non‑interventional cardiologist; and
 (b) the team must:
 (i) assess the patient's risk and technical suitability to receive the service; and
 (ii) make a recommendation about whether or not the patient is suitable for percutaneous coronary intervention; and
 (c) a record of the conference must be created, and must include the following:
 (i) the particulars of the assessment of the patient during the conference;
 (ii) the recommendations made as a result of the conference;
 (iii) the names of the members of the team making the recommendations.

5.10.17D  Restriction on items 38244, 38247, 38248, 38249, 38251, 38252, 38307, 38308, 38310, 38311, 38313, 38314, 38320, 38322, 38323, 38316, 38317 and 38319—reports and clinical notes
  Items 38244, 38247, 38248, 38249, 38251, 38252, 38307, 38308, 38310, 38311, 38313, 38314, 38320,