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 Align MBS reimburse of items Practitioners will be guided To assist practitioner in 32090 and 32093 A diagnostic procedure with approved clinical by the item descriptors and determining the circumstances (32090) using an endoscope to guidelines and algorithms the approved clinical when these services are visually examine the colon Restructure services to better guidelines clinical appropriate. (with or without biopsy) describe clinical indications Patient indications and The clinical circumstances for A therapeutic procedure and intervals for repeat conditions will be better these service will be better (32093) using an endoscope to testing described and they will not defined visually examine the colon to Amend item to better define undergo unnecessary The clinical requirements for a provide treatments or to the extent of the examination colonoscopy or too frequent complete and comprehensive remove polyps ‘to the caecum’ testing. examination will be better Amend the existing NBCSP Patients will benefit from this defined items to align the examination quality measure which will The clinical requirements for a requirements ‘to the caecum’ require a more complete and comprehensive Remove out-of-date comprehensive and examination will be better terminology ‘fibreoptic’ and complete examination to be defined for NBCSP patients ‘flexible’. performed The items should reflect Place restrictions on claiming NBCSP patients will benefit contemporary changes to with other colonoscopy from this quality measure practices and procedures services (same day, same which will require a more Patients would effectively pay practitioner) during a single comprehensive and twice for the same service if
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