Outcomes: Medicare Benefits Schedule Review Taskforce meeting 12 February 2016

On 12 February 2016, the Medicare Benefits Schedule (MBS) Review Taskforce held its seventh meeting. Following is an outcomes summary from the meeting.

Page last updated: 22 March 2016

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Obsolete MBS items

Members noted that the first tranche of Clinical Committees identified of 23 potentially obsolete MBS items—that is, items which relate to services which have no clinical purpose in contemporary practice or are better covered under other items, or items which are no longer used for the purpose for which they were introduced. These items, by Committee, are:
  • Diagnostic imaging - 58706, 58924, 59503, 59715, 59736, 59760, 61465
  • Ear, nose, and throat surgery - 11321, 18246, 41680, 41695, 41758, 41761, 41846, 41849, 41852
  • Gastroenterology - 13500, 13503, 30493, 32078, 32081
  • Obstetrics - 16504
  • Thoracic medicine - 11500
Members also noted that each of these diagnostic imaging items are subject to a capital sensitivity measure (denoted in the MBS by the symbol (K)), and each has a ‘mirror’ item (an item that contains an identical item descriptor with a different item number, denoted by the symbol (NK)—see below) with a reduced Schedule fee that is claimable for services provided on older equipment. Should the primary items be removed from the MBS, the mirror items would automatically also be removed.
  • 58706 (K) / 58708 (NK)
  • 58924 (K) / 58926 (NK)
  • 59503 (K) / 59504 (NK)
  • 59715 (K) / 59716 (NK)
  • 59736 (K) / 59737 (NK)
  • 59760 (K) / 59761 (NK)
  • 61465 (K) / 61711 (NK)
Members noted that public consultation on the proposed obsolescence of these items was conducted from 21 December 2015 to 8 February 2016.

In the event, the feedback resulted in no changes to the Committees’ original views on these items. Noting the Department’s summaries of the stakeholder feedback on each group of items, the Taskforce arrived at the following conclusions. Top of page

1. That the following items are obsolete and should be removed from the MBS at the earliest opportunity.

Diagnostic imaging

ItemService - short descriptor
58924Graham’s Test (cholecystography), with preliminary plain films and with or without tomography - (R)
58926[Mirror item] Graham’s Test (cholecystography), with preliminary plain films and with or without tomography - (R)(NK)
59503Pelvimetry, not being a service associated with a service to which item 57201 applies (R)
59504[Mirror item] Pelvimetry, not being a service associated with a service to which item 57201 applies (R)(NK)
59736Vasoepididymography, 1 side (R)
59737[Mirror item] Vasoepididymography, 1 side (R)(NK)
59760Peritoneogram (herniography) with or without contrast medium including preparation - performed on a person >14 years of age (R)
59761[Mirror item] Peritoneogram (herniography) with or without contrast medium including preparation - performed on a person >14 years of age (R)(NK)
61465Venography (R)
61711[Mirror item] Venography (R)(NK)
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Ear, nose and throat surgery

ItemService - short descriptor
11321Glycerol induced cochlear function changes assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff's tests)
18246Glossopharyngeal nerve, injection of an anaesthetic agent
41680Cryotherapy to nose in the treatment of nasal haemorrhage (Anaes.)
41695Turbinates, cryotherapy to (Anaes.)
41758Division of pharyngeal adhesions (Anaes.)
41761Postnasal space, direct examination of, with or without biopsy (Anaes.)
41849Larynx, direct examination of, with biopsy (Anaes.) (Assist.)
41852Larynx, direct examination of, with removal of tumour (Anaes.) (Assist.)
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Gastroenterology

ItemService - short descriptor
13500Gastric hypothermia by closed circuit circulation of refrigerant in the absence of gastrointestinal haemorrhage
13503Gastric hypothermia by closed circuit circulation of refrigerant for upper gastrointestinal haemorrhage
32078Sigmoidoscopic examination with diathermy or resection of 1 or more polyps where the time taken is ≦45 minutes (Anaes.)
32081Sigmoidoscopic examination with diathermy or resection of 1 or more polyps where the time taken is > 45 minutes (Anaes.)

Thoracic medicine

ItemService - short descriptor
11500Bronchospirometry, including gas analysis

Obstetrics

ItemService - short descriptor
16504Treatment of habitual miscarriage by injection of hormones each injection up to a maximum of 12 injections, where the injection is not administered during a routine antenatal attendance
The Taskforce noted that, in its submission to the consultation, the Royal Australian and New Zealand College of Radiologists (RANZCR) disagreed that item 59760 is obsolete because a peritoneogram is required prior to percutaneous Tenkoff catheter placement. The Taskforce, however, did not support RANZCR’s view, noting that current practice would prefer the use of CT rather than an invasive catheter, and noting that the low number of services indicates that the item is not being used for that purpose. The Taskforce agreed that the Committee’s agreed position on the item’s obsolescence should stand. Top of page

2. That the following diagnostic imaging items are obsolete in relation to adult patients, and should be amended by the Diagnostic Imaging Clinical Committee to restrict access to paediatric patients.

ItemService - short descriptor
59715Bronchography, 1 side, with or without preliminary plain films and with preparation and contrast injection - (R)
59716[Mirror item] Bronchography, 1 side, with or without preliminary plain films and with preparation and contrast injection - (R)(NK)
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3. That the following items are of questionable utility in their current form but, rather than be removed completely from the MBS, should be referred back for further consideration.

Diagnostic imaging

ItemService - short descriptor
58706Intravenous Pyelography, with or without preliminary plain films and with or without tomography - (R)
58708[Mirror item] Intravenous Pyelography, with or without preliminary plain films and with or without tomography - (R)(NK)
In relation to items 58706 / 58708, the Taskforce suggests that if the Diagnostic Imaging Clinical Committee determines that the item is not obsolete, then consideration be given to rewording the item descriptor to specify that the service is only to be used for pre- and post-operative assessment of renal pelvis filling, functioning and emptying, as advised in the submission from RANZCR.

Ear, nose and throat surgery

ItemService - short descriptor
41846Larynx, direct examination of the supraglottic, glottic and subglottic regions, not being a service associated with any other procedure on the larynx or with the administration of a general anaesthetic (Anaes.)
In relation to item 41846, the Taskforce noted the ENT Surgery Clinical Committee’s awareness of the practice of some clinicians of claiming item 41846 for stroboscopy. However, and the Committee’s strong view that the item should not be used for this purpose, but that a separate item be developed for stroboscopy, at which time item 41846 could be removed from the MBS. Top of page

4. That a decision on the gastroenterology item 30493 (Biliary manometry) should be deferred pending further consideration by that Clinical Committee.


In reaching these conclusions and making the associated recommendations to the Government, the Taskforce is mindful of the potential adverse impact on patient care of the removal of an item from the MBS. However, the Taskforce is confident—in light of the opinions of the relevant Clinical Committees, the views of stakeholders, and the Taskforce’s own expertise—that the removal of the items listed below will have no undesirable clinical consequences. Rather, their removal will improve patient care overall by removing the option of the sub-optimal care these items represent, and encouraging the use of better investigations and procedures listed on the MBS.