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Diagnosis of hypertension through ambulatory blood pressure monitoring

A new MBS item for diagnosis of hypertension through ambulatory blood pressure monitoring for people with suspected hypertension (high blood pressure) to be used from 1 November 2021.

The Medical Services Advisory Committee (MSAC) established that ambulatory blood pressure monitoring is superior in predicting cardiovascular outcomes and diagnostic accuracy compared to in-clinic blood pressure monitoring and concluded that management of hypertension is best placed in primary care setting. 

The MBS website www.mbsonline.gov.au provides a complete package of care to the patient suspected of hypertension, commencing with the application of the monitor and includes the subsequent consultation with the patient for the analysis and discussion of results and preparation of a treatment plan.  

Follow the link below to find the relevant Fact Sheets on MBS Online.

http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/factsheet-current 

Overview: The descriptor has been amended to reflect changes recommended by the MBS Review Taskforce and Implementation Liaison Group on Cardiac Services that were unintentionally omitted from the 1 July 2021 cardiac related changes.

Descriptor:  Computed tomography of the coronary arteries performed on a minimum of a 64 slice (or equivalent) scanner if:

(a) the request is made by a specialist or consultant physician; and

(b) the patient has stable or acute symptoms consistent with coronary ischaemia; and

(c) the patient is at low to intermediate risk of an acute coronary event, including having no significant cardiac biomarker elevation and no electrocardiogram changes indicating acute ischaemia (R) (Anaes.).

Restrictions/requirements not listed in the item descriptor:

Benefits are not payable for item 57360 more than once in a 5 year period following a service to which itself or 57364 applies that detected no obstructive coronary artery disease unless the patient meets the eligibility criteria for selective coronary angiography (items 38244, 38247, 38248 or 38249. The eligibility criteria for items 38244, 38247 are set out in clause 5.10.17A of the General Medical Services Table (GMST), while the criteria for items 38248 and 38249 are set in clause 5.10.17B of the GMST.

Clauses 5.10.17A and B of the GMST are restated at Attachment A to this guide. Indication: The three changes made to this item are:

1. It is no longer necessary for it to be known that the patient does not have coronary artery disease at the time the request is made. The item can be claimed if the patient has known coronary artery disease.
2. The 5 year frequency restriction on the claiming of this item does not apply if obstructive coronary artery disease was detected as part of the previous service.
3. The 5 year frequency restriction does not apply if no obstructive coronary disease was detected at the previous service AND the patient meets the criteria for item 38244, 38247 or 38249 – selective invasive coronary angiography. The criteria for these items are set out in explanatory notes TR8.2 and TR8.3.

The changes effectively increase the population eligible for the item and provide a non-invasive alternative to selective coronary angiography.

MBS fee: $716.90 (no change) Benefit: No change.

Medicare Benefits Schedule

Quick refer: QRG-1-November-2021-DI-MBS-changes.30.09.21

MBS changes to Cardiac Procedural Items – go to MBS Fact Sheet

There were four new items for the provision of Transcatheter Mitral Valve repair (TMVr) using the MitraClipTM implant introduced to the MBS on 1 July 2021. Two distinct mitral valve regurgitation patient populations will have access to MBS rebates for TMVr when the MitraClipTM implant is utilised for patients unable to undergo open surgical management. These new items offer a less invasive approach through transcatheter repair using the MitraClipTMimplant.

Two new procedural items will be introduced:
Item 38461 – degenerative (primary) moderate-severe mitral valve regurgitation deemed to be at high risk for surgical mitral valve replacement; and
Item 38463 – functional (secondary) moderate-severe mitral valve regurgitation deemed to be at high risk for surgical mitral valve replacement.

Two new attendance items will be introduced for the purpose of determining a patient’s eligibility for a TMVr service:
Item 6082 – coordination of a TMVr suitability case conference
Item 6084 – attendance at a TMVr suitability case conference

The changes are the outcome of Government agreement to recommendations from the independent Medical Services Advisory Committee (MSAC). MSAC appraises medical services, health technologies and health programs for public funding through an assessment of their comparative safety, clinical effectiveness, cost effectiveness and total cost, using the best available evidence. The changes support current best practice and reflect contemporary advancements in cardiac intervention for some of the most vulnerable people with heart disease.

Go to MBS Fact Sheet

Written Summary of MBS ICS Item Changes for CSANZ Members
An extensive summary guide of the new ICS items prepared by Michael Feneley, Mark Pitney and Roger Allan that fully explains the new Interventional Cardiology items to be implemented on 1 July.

 UPDATE OF CSANZ SUMMARY GUIDE RE NEW ICS ITEMS

CSANZ Members Forum – 15 June 2021
An online forum for CSANZ Members was held on 15 June chaired by Michael Feneley and Mark Pitney to explain the changes. 

 Link to Vimeo for Recorded Forum

In the Media
Article in The Australian on 9 June 2021 – see media clipping here.