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.
part of a therapeutic service. the same service if these services were not restricted. 30476 A procedure that uses a digital scope to visually examine the gastrointestinal tract and provide treatment Consolidate this service with item 30478 These services will be combined with item 30478 to create one general upper interventional item Consolidate services to simplify the item structure for upper gastrointestinal endoscopy services and minimise confusion about which items should be billed by the practitioner 30478 A procedure that uses a digital scope to visually examine the gastrointestinal tract and provide treatment Consolidate this service with item 30476 to form a general therapeutic service (without laser therapy). Argon Plasma Coagulation (APC) a procedure to control bleeding in the gastrointestinal tract should be moved from item 30479 into this item. The Committee recommends Push Enteroscopy (a digital scope to examine the small bowel) currently performed under item 30487 for small bowel intubation to be included in this item Stop billing of this item with The consolidation of items 30476 and 30478 will combine pathologies and treatments previously listed under item 30476. This change will not alter the fee or the intent of this item. The use of APC under this item will benefit patients as the fee will be lower than currently under item 30479. The addition of Push Enteroscopy will allow the removal of lesions in the small bowel under this item This service will not be able to be claimed with item 30479. Need to simplify the item structure these services and minimise confusion about which items should be billed by the practitioner APC is more appropriately provided under item 30478 (lower fee than item 30479) as it no more time consuming of the skills required than other forms of non -laser endoscopic interventions. Push Enteroscopy is an upper gastrointestinal examination or procedure and it is appropriate for this service to be provided under this item 30478.
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
benefit as this will eliminate the need for a second anaesthesia on another day. services. Table B8: Recommendation 8 – Balloon Enteroscopy Item What it does Committee Recommendation What would be different Why 30680 to 30686 A group of diagnostic procedures used to assess the spread of cancer An assessment by the Medical Services Advisory Committee(MSAC) to expand the conditions for these items to manage small bowel disease without anaemia or bleeding The service will better target patients whose indications and conditions require these services. These patients will benefit as they will not be exposed to unnecessary other tests and procedures, including surgery, to manage their condition Currently the items are restricted to patients who present with bleeding and anaemia. This significantly restricts the management of patients with small bowel disease without these symptoms. Table B9: Recommendation 9: Endoscopic Mucosal Resection Item What it does Committee Recommendation What would be different Why New item A procedure to remove very large polyps by using an internal digital scope An assessment by MSAC to consider public funding for this service. The Gastroenterological Patients would not require surgery to remove these polyps which would be safer for the EMR has widespread use in public hospitals but currently under the MBS the only approach for the
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