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New item numbers from November 1 - Stuff you need to know |
 Pap smear and preventative health check by a practice nurse (#10094 & #10995)
While item numbers for taking a Pap smear on behalf of a GP (Items 10998 and 10999 - $10.60) have been available to PNs since November 2005, two more item numbers have now been introduced to expand this service.
The new items now include the taking of a Pap smear and preventive health checks associated with women’s sexual and reproductive health that would routinely be undertaken in conjunction with a Pap smear.
At least one of the following checks needs to be performed during a Pap smear visit in order to claim the item:
- checks for sexually transmitted infections (including chlamydia)
- taking of a sexual and reproductive history
- advice on contraception
- breast awareness education
- advice on post natal issues
- continence advice and education.
The visit may also include a smoking, nutrition, alcohol and physical activity (SNAP) behavioural risk factor assessment and/or a blood pressure measurement. It is worth noting here that the pathology can only be ordered by a GP.
While item 10094 ($21.25) is for the taking of a Pap smear and preventive checks by a practice nurse, item 10995 ($21.25 + SIP) requires the same criteria, but is to be used when the patient is a woman between the ages of 20-69 who has not had a cervical smear in the last four years.
The practice nurse performing the Pap smear and preventative check must be credentialed as qualified and trained to take cervical smears and other preventive checks by undertaking an accredited training course. In NSW, this course is the NSW Family Planning Association’s Well Women’s Screening Course and the Health Certificate in Sexual and Reproductive Health (Nursing). Currently there is funding available, with possible funding for accommodation and travel costs through the Alliance of NSW Divisions. For further information, please contact Louise Young, the division’s practice nurse project officer on 6622 4453.
The Australian Better Health Initiative (ABHI), which was announced by the Council of Australian Governments (COAG) in February aims to enhance the capacity of the health system to promote good health and reduce the burden of chronic disease. As well as introducing a 45 year old health check, it also includes new item numbers for cancer care case conferences (Items 871 and 872), which aim to assist a multidisciplinary team approach to the diagnosis and management of cancer and the development of treatment and care plans.
45 year old health check (#717)
The 45 year old health check (Item 717 - $100 rebate) is for patients aged 45-49 at risk of developing a chronic disease. The decision about whether an individual is at risk of developing a chronic disease rests with the clinical judgement of the GP, but a specific risk factor must be identified, such as:
- lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol misuse;
- biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; and
- family history of a chronic disease.
Mandatory requirements of the health check are:
- an overall assessment of the patient’s health, based on the patient’s history and the results of any relevant physical examinations and investigations;
- discussion of the check and any recommended actions with the patient;
- provision or arrangement of any interventions, such as education, counselling, self-management, treatment or referrals to other medical professionals, allied health or social support services; and
- recording of the health check in the patient’s file.
It is also suggested that the patient should be assessed for their readiness to make lifestyle changes and be provided with written information, including the use of the Lifescripts resources, if relevant.
For more information, Q&A, checklists and templates visit the websites of the Department of Health and Ageing at www.health.gov.au/internet/wcms/publishing.nsf/Content/health-epc-45check) or the RACGP www.racgp.org.au/clinicalresources/45. Or you can call Therese or Kerry, your practice support project officers here at the division on 6622 4453.
The Asthma 3+ Visit Plan has changed its name – and it’s easier!
The Asthma 3+ Plan is now known as the Asthma Cycle of Care (Items 2546, 2552, and 2558: Consult Fee + $100 SIP), but the name is not the only thing to change.
The items continue to be for patients with moderate to severe asthma, ie. patients who have symptoms most days, use a preventer medication, use a bronchodilator at least three times a week, or who have had a hospital attendance following an acute exacerbation of their condition. However, the patient is now required to attend the surgery for only two asthma related consultations within a 12-month period, where at least one of the consultations is a planned review organised during a previous visit.
The Asthma Cycle of Care aims to improve asthma management and quality of life. In order to claim the incentive, there needs to be:
- a documented diagnosis;
- assessment of level of asthma control and severity of asthma;
- a review of the patient’s use of and access to asthma related medication and devices;
- provision to the patient of a written or documented asthma action plan;
- provision of asthma self-management education; and,
- a review of the asthma action plan.
While most medical software now includes an electronic version of the asthma action plan, if you would like a pad of hardcopy plans, they are available from the Department of Health and Ageing on 1800 500 053 or from your practice support project officers here at the division.
Changes to the Diabetes Cycle of Care
The Diabetes Cycle of Care (Items 2517, 2521, and 2525: Consult Fee + $40 SIP) has been amended and now requires eye and feet examinations only if relevant. If relevant, the minimum requirements of care that need to be assessed to complete a cycle of care for patients with established diabetes mellitus include:
- Examine feet at least twice every cycle of care.
- Ensure that a comprehensive eye examination is carried out at least once every two years.
Therese Greenlees is the division’s practice support project officer.
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