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Report from the Diagnostic Imaging Clinical Committee - combined report - (Now Closed)

04 Oct 2018

Items reviewed

The Diagnostic Imaging Clinical Committee reviewed a total of 508 MBS items and included imaging of the following body areas and systems:
  • Head and neck (124 items)
  • Spine and pelvis (128 items)
  • Upper and lower limbs (47 items)
  • Organs of the chest, abdomen and pelvis (112 items)
  • General and whole body imaging (16 items)
  • Obstetric imaging (50 items)
  • Magnetic resonance imaging (31 items)
  • Ungrouped items
The review also included the following additional overarching rules and principles:
  • Co-claiming of radiologist attendances with diagnostic imaging items
  • Capital sensitivity measures (services performed on old equipment)
  • Rules and principles related to diagnostic imaging

Proposed item changes

  • The deletion of 8 items (plus all NK items) from the MBS
  • Amendments to 140 items
  • 10 proposed new items
  • Recommendations into additional research in diagnostic imaging
The Committee recommends all remaining items reviewed remain unchanged as they are seen to reflect current best practice.

Report recommendations

The MBS Review Taskforce Diagnostic Imaging Clinical Committee made 38 recommendations in total and these are listed below:

Imaging of the head and neck

Recommendation 1: Consolidate x-ray items for petrous temporal bone (items 57909 and 57923) with mastoid bone (items 57906 and 57920).

Recommendation 2:  Consolidate x-ray items for sinuses (items 57903 and 57917) and facial bones (items 57912 and 57926).

Recommendation 3: The Department of Health (the Department) to facilitate primary care research into why the introduction of GP-requested head MRI hasn’t resulted in a greater reduction in the requesting of head CT.

Recommendation 4: Add explanatory notes about appropriate indications for neck ultrasound to items 55011, 55013, 55032 and 55033.

Imaging of the spine and pelvis

Recommendation 5: The Department to facilitate primary care research into GP requesting practices for CT of the cervical spine.

Imaging of the upper and lower limbs

Recommendation 6: The Department to facilitate research investigating the increased use of musculoskeletal ultrasound services.

Recommendation 7: Split items 56619 and 56659 (CT scan of extremities without contrast) into separate items for CT of the hand, wrist, elbow and shoulder (upper limb) and foot, ankle, knee and hip (lower limb).

Imaging of the organs of the chest, abdomen and pelvis

Recommendation 8: Amend the item descriptor for items 55061, 55062, 55076 and 55079 (both breast ultrasound) to include the indication of “including post-mastectomy surveillance”. 

Recommendation 9: Amend the item descriptor for items 55814 and 55815 (non-referred ultrasound of the chest or abdominal wall) to include the words “not to be claimed in association with any other breast ultrasound item within the MBS”.

General and whole-body imaging

Recommendation 10: Amend the item descriptors for items 55850  and 55851 (musculoskeletal cross-sectional echography in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service) to state that a complete diagnostic musculoskeletal ultrasound report must be produced for the musculoskeletal ultrasound component of the item, each time the service is provided.

Recommendation 11: Amend the item descriptors for items 55848 and 55849 (musculoskeletal cross-sectional echography in conjunction with a surgical procedure using interventional techniques); and 55850 and 55851 (musculoskeletal cross-sectional echography in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service) so that the term “echography” is replaced with “ultrasound” (for items 55848 and 55849) and “diagnostic ultrasound” (for items 55850 and 55851).

Obstetric imaging

Recommendation 12: Remove the list of clinical indications from the item descriptors of <12 weeks and 12-16 weeks pregnancy ultrasound items (items 55700-55705, 55710 and 55711) and replace them with a statement that these items are for “determining the gestation, location, viability or number of foetuses”.

Recommendation 13: Remove the list of clinical indications from the item descriptors of >22 weeks pregnancy ultrasound items (items 55718, 55722, 55723 and 55726) and allow access to these items to rely on clinical judgement.

Recommendation 14: Prohibit claiming of items 55065, 55067, 55068 and 55069 (pelvis ultrasound) for solely pregnancy-related services.

Recommendation 15: Include nuchal translucency (NT) assessment in the item descriptor for 12-16 week ultrasound items (items 55704, 55705, 55710 and 55711), with the addition of an explanatory note identifying NT assessment as an integral part of the examination, and remove current NT assessment items (items 55707, 55708, 55714 and 55716) from the MBS.

Recommendation 16: Create a new item for 12-16 week morphology ultrasound for multiple gestation pregnancies.

Recommendation 17: Create a new item for cervical length assessment for threatened preterm labour.

Magnetic Resonance Imaging (MRI)

Recommendation 18: Create a new item with a higher fee than the current item for MRI contrast agents (item 63491) specific for macrocyclic gadolinium contrast agents.

Recommendation 19: Create a new MRI modifying item for MRI performed in the presence of MRI-compatible pacemakers (and other MRI-compatible implanted devices).

Recommendation 20: Create a new item for MRI of the pelvis for the investigation of subfertility.

Recommendation 21: Create a new item for MRI for the evaluation of cervical cancer for initial staging or re-staging.

Recommendation 22: Create a new item for MRI for the evaluation of rectal cancer for initial staging or re-staging.

Recommendation 23: Create a new item for whole body MRI for children with disseminated malignancy.

Recommendation 24: Create a new item for MRI of the liver for the evaluation of hepatic metastases for initial staging or restaging prior to treatment using interventional techniques.

Recommendation 25: Amend the time period restriction for MRI for the evaluation of Poly Implant Prosthese (PIP) breast implants to 1 service per 24-month period.

Co-claiming of radiologist attendances with diagnostic imaging

Recommendation 26: Restrict radiologists’ co-claiming attendance items with specified diagnostic imaging items.

Recommendation 27: Prohibit the use of ultrasound items 55026 and 55054 for joint injections.

Recommendation 28: Define appropriate claiming of attendance items by radiologists.

Capital sensitivity measures (services performed on old equipment)

Recommendation 29: Remove NK items and availability of MBS rebates for services on older equipment.

Recommendation 30:  Remove remote area exemptions that currently allow the claiming of K items, with a transition period subject to meeting certain conditions.

Multiple services rules and item level restrictions

Recommendation 31: That the multiple services rules for diagnostic imaging services be simplified and streamlined.

Recommendation 32: Amend the item descriptors for items 55065, 55067, 55068 and 55069 (ultrasound of the pelvis) to remove co-claiming restrictions with items 55014, 55016, 55036 and 55037 (ultrasound of the abdomen). 

Recommendation 33: Amend the item descriptors for general ultrasound (not including interventional items), obstetric and gynaecological and musculoskeletal ultrasound to remove co-claiming restrictions with cardiac or vascular ultrasound (with the exception of lower leg ultrasound).

Recommendation 34: Amend the item descriptors for interventional CT (items 57341 and 57345) and interventional fluoroscopy (items 60506, 60507, 60509, 60510, 61109 and 61110) to change the restriction with a diagnostic imaging service of any type to only services in their own subgroups.

Recommendation 35: Create separate items for unilateral and bilateral musculoskeletal ultrasound items with an appropriate fee for each.

Other recommendations

Recommendation 36: Create a new item for dual energy x-ray absorptiometry (DEXA) for patients with breast cancer being treated with aromatase inhibitor therapy, to be referred to the Medical Services Advisory Committee (MSAC) for consideration.

Recommendation 37: Split the current item 57350 (CT spiral angiography) into three items with requesting restricted to specialists and remove the word “spiral” from the item descriptor for CT angiography items.

Recommendation 38: Remove the word “lifetime” from the Diagnostic Imaging Services Table (DIST) with regards to time period restrictions on imaging services for cancer patients.

 

Published: 04 Oct 2018