The Pathology Clinical Committee supports an education program aimed at requesters of TFTs as a way to discourage use in patients taking thyroid replacement therapy. The education program should include consumers. The Pathology Clinical Committee supports the proposal to change fT4 and fT3 testing to be a pathologist-determinable test after an abnormal TSH test result. The Pathology Clinical Committee recommends amendments to item 66719 as follows. Table 6: Current and proposed new item descriptor for item 66719 Current item descriptor Proposed new item descriptor
Antibodies to tissue antigens (acetylcholine receptor, adrenal cortex, heart, histone, insulin, insulin receptor, intrinsic factor, islet cell, lymphocyte, neuron, ovary, parathyroid, platelet, salivary gland, skeletal muscle, skin basement membrane and intercellular substance, thyroglobulin, thyroid microsome or thyroid stimulating hormone receptor) – detection, including quantitation if required, of 1 antibody. (Item is subject to rule 6.) Pending 43 71166 Detection of 2 antibodies described in item 71165. (Item is subject to rule 6.) Pending 43 71167 Detection of 3 antibodies described in item 71165. (Item is subject to rule 6.) Pending 43 71168 Detection of 4 or more antibodies described in item 71165. (Item is subject to rule 6.) Pending 43 71169 A test described in item if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP 1 test. (Item is subject to rule 6 and 18.) Pending 43
Summary for consumers This table describes the medical service, the recommendation(s) of the clinical experts and why the recommendation(s) has been made. Recommendation 1: TSH (thyroid-stimulating hormone) Item What it does Committee recommendation What would be different Why 66716 Measures blood levels of the hormone that stimulates the thyroid gland, to assess thyroid disease. Include guidance on when the test is appropriate for doctors to request. The test would be avoided in patients who do not show thyroid disease symptoms, unless they are pregnant or at high risk of thyroid disease. To testing with current medical guidelines, such as the RACGP Choosing Wisely recommendations. Recommendation 2: TFTs (thyroid function tests) Item What it does Committee recommendation What would be different Why 66719 Measures levels of thyroid hormones to assess thyroid disease. Include guidance on when the test is appropriate for doctors and pathologists to request. The test be avoided in patients when the results can be unreliable and misleading. To align testing with current medical guidelines. Recommendation 3: New item for TFTs Item What it does Committee recommendation What would be different Why New item Measures all thyroid hormone levels. Create a new item that includes the measurement of all thyroid hormone levels in patients with totally suppressed hormone (TSH). An additional test would be available that measures the levels of all thyroid hormones in patients with totally suppressed TSH. For most patients TFT tests don't include testing all thyroid hormones, but for some with suppressed TSH the additional tests will offer more information about the severity and prognosis of their overactive thyroid and identify patients with toxic levels of thyroid hormones. Recommendation 4: Oral glucose tolerance and challenge Item What it does Committee recommendation What would be different Why
66545 Measures blood sugar levels to test for diabetes mellitus in pregnancy. Remove this item from the MBS. This item would no longer be available. This item is out of date. 66542, 66548 Measures sugar levels to test for diabetes mellitus. Include use in pregnant women and certain specific patient groups, plus guidance on who those specific patient groups are. The test would be able to be done in pregnant and specific patient groups. To testing with current medical guidelines as recommended by the Australian Diabetes in Pregnancy Society. Recommendation 5: Quantitation of glycated haemoglobin (how much oxygen-carrying protein in red blood cells is bound to sugar) Item What it does Committee recommendation What would be different Why 66551 Measures blood sugar levels to test for diabetes mellitus. Restrict to a maximum of four tests per year. Test would be limited to four times per year per patient. To testing with the current Health Insurance Regulation 2015. 66554 Measures blood sugar levels to test for diabetes mellitus. Restrict to a maximum of six tests per year. The test be limited to six times per year per patient. To align testing with the current Health Insurance Regulation 2015. Recommendation 6: Quantitation of glycated haemoglobin (how much oxygen-carrying protein in red blood cells is bound to sugar) Item What it does Committee recommendation What would be different Why 66841 Measures blood sugar levels to test for diabetes mellitus. Specify medical situations in which the test should be used. Increase the number of tests to a maximum of two per year. The test would be prevented from being used to see if diabetes is present, except in pregnant women or people at high risk of thyroid disease. To the number of tests with current medical guidelines, such as the Australian Diabetes Society Position Statement 2015 as well as the RACGP, World Health Organisation and American Diabetes Association’s advice. Recommendation 7: Quantitation of fructosamine (blood fructose level) Item What it does Committee recommendation What would be different Why 66557 Measures blood fructose (sugar) levels to test for diabetes mellitus. Specify when the test should be used and provide guidance on appropriate use of this test. Doctors will have clear guidance on when they can use this test. The test would only be used in appropriate medical situations. The test may not have been used optimally.