Table B3: Recommendation 3.1 – Capsule Endoscopy item amendments and Recommendation 3.2 – Capsule Endoscopy fee review Item What it does Committee Recommendation What would be different Why The item will better target Iron deficiency anaemia 11820 Capsule endoscopy (CE) is used to Amend the item to better patients whose indications (rather than just anaemia) diagnose obscure gastrointestinal define the clinical conditions and conditions require this better describes blood loss bleeding. CE is a way to record and indications for the service service. symptoms. Investigations for images of the digestive tract for to ensure the intended patient Practitioners will be aware of possible causes should be use in medicine. The capsule is the group receives this service storage requirements for undertake and eliminated size and shape of a pill and Storage requirements for CE imaging. prior to performing CE. contains a miniature camera which imaging to be provided in the A fee review will determine if Advice on storage the patient swallows and images explanatory notes to the item the item is appropriately requirements will support are taken of the gastrointestinal A fee review by MSAC priced good record keeping for tract auditing purposes and continuity of care for patients. It is important that the fee represents value for money for the patient and is not driving service volumes. Table B4: Recommendation 4.1 – Endoscopic upper gastrointestinal services and Recommendation 4.2 – Push Enteroscopy Item What it does Committee Recommendation What would be different Why 30473 A diagnostic procedure that uses a Stop the billing of this item with This service will not be able to be Where endoscope is required as digital scope to visually examine item 30479 claimed with another item that part of a therapeutic procedure, the gastrointestinal tract provides the same endoscopic item 30473 should not be procedure when performed as Patient may pay twice for
Table B3: Recommendation 3.1 – Capsule Endoscopy item amendments and Recommendation 3.2 – Capsule Endoscopy fee review Item What it does Committee Recommendation What would be different Why 11820 Capsule endoscopy (CE) is used to diagnose obscure gastrointestinal bleeding. CE is a way to record images of the digestive tract for use in medicine. The capsule is the size and shape of a pill and contains a miniature camera which the patient swallows and images are taken of the gastrointestinal tract Amend the item to better define the clinical conditions and indications for the service to ensure the intended patient group receives this service Storage requirements for CE imaging to be provided in the explanatory notes to the item A fee review by MSAC The item will better target patients whose indications and conditions require this service. Practitioners will be aware of storage requirements for imaging. A fee review will determine if the item is appropriately priced Iron deficiency anaemia (rather than just anaemia) better describes blood loss symptoms. Investigations for possible causes should be undertake and eliminated prior to performing CE. Advice on storage requirements will support good record keeping for auditing purposes and continuity of care for patients. It is important that the fee represents value for money for the patient and is not driving service volumes. Table B4: Recommendation 4.1 – Endoscopic upper gastrointestinal services and Recommendation 4.2 – Push Enteroscopy Item What it does Committee Recommendation What would be different Why 30473 A diagnostic procedure that uses a digital scope to visually examine the gastrointestinal tract Stop the billing of this item with item 30479 This service will not be able to be claimed with another item that provides the same endoscopic procedure when performed as Where endoscope is required as part of a therapeutic procedure, item 30473 should not be Patient may pay twice for