Recommendation Impact Statement The recommendation to remove the current claiming restrictions on these diagnostic services will benefit patients as it will allow practitioners to provide specific therapeutic services during the same episode of care. This will mean that patients will not be required to undergo a second sedation. Table 21: Current Endoscopic Ultrasound items Item Item Descriptor Schedule Fee Services 2014–15 Service Change 2011–12 to 2014–15 30688 ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) $364.90 1,545 19% 30690 ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy, WITH FINE NEEDLE ASPIRATION, including aspiration of the locoregional lymph nodes if performed, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) $563.30 779 -6% 30692 ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) $364.90 3,085 40% 30694 ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy, WITH FINE NEEDLE ASPIRATION for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.) $563.30 1,689 61% Source: Publicly available MBS Data (Department of Human Services website)
condition, and where the use of imaging intensification is clinically indicated (Anaes.) Examination of the bowel – colonoscopy and sigmoidoscopy 32023 Endoscopic insertion of stent or stents for large bowel obstruction, stricture or stenosis, including colonoscopy and any image intensification, where the obstruction is due to: a) a pre-diagnosed colorectal cancer, or cancer of an organ adjacent to the bowel; or b) an unknown diagnosis (Anaes.) $555.35 70 n/a 32072 SIGMOIDOSCOPIC EXAMINATION (with rigid sigmoidoscope), with or without biopsy $47.85 22,488 -20% 32075 SIGMOIDOSCOPIC EXAMINATION (with rigid sigmoidoscope), UNDER GENERAL ANAESTHESIA, with or without biopsy, not being a service associated with a service to which another item in this Group applies (Anaes.) $75.05 225 0.4% 32094 ENDOSCOPIC DILATATION OF COLORECTAL STRICTURES including colonoscopy (Anaes.) $551.85 768 4% 32095 ENDOSCOPIC EXAMINATION of SMALL BOWEL with flexible endoscope passed by stoma, with or without biopsies (Anaes.) $127.80 272 9% Source: Publicly available MBS Data (Department of Human Services website)
Summary for Consumers Gastroenterology Clinical Committee recommendations This appendix describes the medical service, recommendations of the Clinical Experts and why the recommendation has been made. Table B1: Recommendation – colonoscopy Item What it does Committee Recommendation What would be different Why 32090 and 32093 A diagnostic procedure (32090) using an endoscope to visually examine the colon (with or without biopsy) A therapeutic procedure (32093) using an endoscope to visually examine the colon to provide treatments or to remove polyps Align MBS reimburse of items with approved clinical guidelines and algorithms Restructure services to better describe clinical indications and intervals for repeat testing Amend item to better define the extent of the examination ‘to the caecum’ Amend the existing NBCSP items to align the examination requirements ‘to the caecum’ Remove out-of-date terminology ‘fibreoptic’ and ‘flexible’. Place restrictions on claiming with other colonoscopy services (same day, same practitioner) during a single Practitioners will be guided by the item descriptors and the approved clinical guidelines Patient indications and conditions will be better described and they will not undergo unnecessary colonoscopy or too frequent testing. Patients will benefit from this quality measure which will require a more comprehensive and complete examination to be performed NBCSP patients will benefit from this quality measure which will require a more comprehensive and To assist practitioner in determining the circumstances when these services are clinical appropriate. The clinical circumstances for these service will be better defined The clinical requirements for a complete and comprehensive examination will be better defined The clinical requirements for a complete and comprehensive examination will be better defined for NBCSP patients The items should reflect contemporary changes to practices and procedures Patients would effectively pay twice for the same service if
episode of anaesthesia Create a new item for the treatment of conditions radiation proctitis, angiodysplasia or bleeding and remove restrictions on the therapy APC for controlling bleeding complete examination to be performed. The updated wording will reflect contemporary clinical practice. These services will not able to be billed with other colonoscopy services on the same day, same patient and practitioner unless under a separate sedation/anaesthesia. A new item for the treatment of specified conditions will simplify the items. other colonoscopy services were allowed to be billed together Separating the specified treatments from the removal of polyp/lesion will simplify the intent of the item. Table B2: Recommendation 2 – same day upper and lower gastrointestinal services endoscopy Item What it does Committee Recommendation What would be different Why 30473, 32090, 32093 Endoscopic examination of the upper and lower gastrointestinal tract during the same episode of care The Gastroenterological Society of Australia to consider the development of clinical practice guidelines on when it is appropriate for both services to be performed Only clinically relevant services will be provided. To assist practitioner in determining the clinical circumstances when both services are appropriate.
Table B3: Recommendation 3.1 – Capsule Endoscopy item amendments and Recommendation 3.2 – Capsule Endoscopy fee review Item What it does Committee Recommendation What would be different Why 11820 Capsule endoscopy (CE) is used to diagnose obscure gastrointestinal bleeding. CE is a way to record images of the digestive tract for use in medicine. The capsule is the size and shape of a pill and contains a miniature camera which the patient swallows and images are taken of the gastrointestinal tract Amend the item to better define the clinical conditions and indications for the service to ensure the intended patient group receives this service Storage requirements for CE imaging to be provided in the explanatory notes to the item A fee review by MSAC The item will better target patients whose indications and conditions require this service. Practitioners will be aware of storage requirements for imaging. A fee review will determine if the item is appropriately priced Iron deficiency anaemia (rather than just anaemia) better describes blood loss symptoms. Investigations for possible causes should be undertake and eliminated prior to performing CE. Advice on storage requirements will support good record keeping for auditing purposes and continuity of care for patients. It is important that the fee represents value for money for the patient and is not driving service volumes. Table B4: Recommendation 4.1 – Endoscopic upper gastrointestinal services and Recommendation 4.2 – Push Enteroscopy Item What it does Committee Recommendation What would be different Why 30473 A diagnostic procedure that uses a digital scope to visually examine the gastrointestinal tract Stop the billing of this item with item 30479 This service will not be able to be claimed with another item that provides the same endoscopic procedure when performed as Where endoscope is required as part of a therapeutic procedure, item 30473 should not be Patient may pay twice for
41819 which is higher than 30475 but lower than 41820 41831 Procedure that uses air or gas under pressure in a balloon that relieves the lower oesophageal muscle tension Amend item to indicate that the service is specific to the treatment of achalasia ( a type of narrowing) The item will better target patients whose indications and conditions require this service The clinical circumstances for this service will be better defined. Table B6: Recommendation 6 – Sigmoidoscopy/Colonoscopy Item What it does Committee Recommendation What would be different Why 32084 A diagnostic procedure using digital scope to visually examine the colon and can include biopsy Amend item to better define the extent of the examination which ‘has not reach the caecum’ and remove terminology. Stop the billing of more than one colonoscopy service during the same episode of sedation/anaesthesia Patients will benefit from this quality measure which will require a more comprehensive and complete examination to be performed. These services will not able to be billed with other colonoscopy services on the same day, same patient and practitioner unless under a separate sedation/anaesthesia. To better define the clinical requirements for a complete and comprehensive examination Patients could effectively pay twice for the same service if other colonoscopy services were allowed to be billed together 32087 A therapeutic procedure using a Amend item to better define Patients will benefit from this The clinical requirements for a
Society of Australia to submit an application and request an expedited assessment by MSAC patient removal of very large polyps is surgery. Table B10: Recommendation 10.2: Obsolete items – second round Item What it does Committee Recommendation What would be different Why 30487 Diagnostic procedure performed on the small bowel To remove item 30487 from the MBS if Push Enteroscopy service is moved to the upper GI endoscopy item 30478 The service will no longer attract a MBS rebate This item has been used for push enteroscopy services but if push enteroscopy is moved under the more appropriate upper GI endoscopic interventional items then item 30487 has no clinical purpose in contemporary practice. 30493 Diagnostic test that measures the pressure of the sphincter (a muscle that regulates the flow of bile and pancreatic secretions To remove item 30493 from the MBS The service will no longer attract a MBS rebate The service is not supported by the published literature and has no place in contemporary clinical practice. Note: Items 13500, 13503, 32078 and 32081 were removed from the MBS on 1 July 2016
et al 2015(8) RCT VCE vs PE 79 pts (40 VCE 39 PE) VCE – 72.5% PE – 48.7% Not specified Aniwan et al 2014(9) DBE vs VCE 30 pts; massive OGIB DBE – 87% VCE 60% Not specified He et al 2014(10) Randomized, single blinded, MSCT vs CE 127 pts with OGIB including overt and obscure MSCT – 47.56% CE – 68.66% Capsule retention - 1.47% Katsinelos et al 2014(11) Prospective multicenter 118 pts median age 66 CE 66.9% Not specified Khan et al 2013(12) Retrospective 122 pts 70% with obscure GI bleeding Overall diagnostic yield 52% Not specified Leung et al 2012(13) Prospective randomized CE vs angiography 60 pts with OGIB CE – 53.3% Angio - 20% Not specified Shishido et al 2012(14) Prospective CE vs DBE 118 pts with OGIB (mean age 62.9 +/- 18.4) CE - 44.9% DBE – 53.4% Not specified Lecleire et al 2012(15) Retrospective 5744 pts with severe OGIB who underwent emergency CE in 24-48 hrs following negative upper and lower endoscopy CE – 67% Not specified Heo et al 2012(16) Retrospective 30 pts with OGIB receiving CE after negative CT enterography CE - 57% Not specified Cuyle et al (17) Retrospective 120 pts with OGIB CE – 47.5% No difference between overt and occult group Presence of CVS comorbidity was assoc with statistically significant increase in diagnostic yield 1 case capsule retention Calabrese et al Retrospective 346 pts with OGIB CE - 59.5% Capsule