A 2713 by any other name does not smell as sweet, according to the AskMBS Advisory service.
The Department of Health has clarified that GPs should not claim general attendance items when it is possible to claim a mental health-specific item.
The July issue of AskMBS Advisory sought to answer questions on how to bill a mother who presents for breastfeeding difficulties but reveals to the GP over the course of the consult that she’s also suffering from symptoms of postnatal depression.
Most of the 40-minute consult, in this scenario, is taken up with a discussion of the patient’s mental health.
One of the queries that AskMBS addressed was whether an Item 44 ($113.30) could be charged, rather than co-billing an Item 23 ($39.75) and an Item 2713 ($75.80).
“It is a fundamental principle of Medicare that the item that best describes the service is the item that should be claimed for that service,” the service said.
“It would not be appropriate to claim a general attendance item for [sic] mental health treatment service if it were possible to claim a dedicated mental health treatment item.”
In this specific scenario, the GP doesn’t end up any worse off financially by billing the two items – in fact, they earn a whole $2.25 more.
But, as Associate Professor Louise Stone was quick to point out, this would be the exception rather than the rule.
Medicare has made it COMPULSORY that we use MH item numbers for pts with MH problems. There is no MH item number for >20 mins. This means if you see me for 40 mins with a physical health issue you get $113 back from Medicare. MH? $76. This is outrageous https://t.co/TmQoQmsRIX
— Louise stone (@GPswampwarrior) August 10, 2022
If Professor Stone, a GP with special interest in mental health, were to follow the advice set out by AskMBS, she would have to charge an Item 2713 for an hour with a patient attending for mental health, but an Item 44 for a physical health consult of the same length.
Implications for practice viability aside, at least Professor Ian Hickie might just get his wish for more accurate data on the mental health load in general practice.
It’s been a big week for discussions of mental health in general practice; the latest entry in the saga is another Insight+ article, this time from Queensland GP and former United Nations Medical Director Dr Jillann Farmer.
“We need to take a long, hard look at why a GP spending 40 + minutes on assessing and designing a management plan for a patient under a Mental Health Care Plan has a scheduled fee of $141.00, ($3.33 per minute for 45 minutes, or 35 minutes, just $96.25) and a psychiatrist undertaking an item 291 assessment and management plan of over 45 minutes has a scheduled fee of $485.70 ($10.79 per minute), almost 3.5 times the GP fee,” Dr Farmer wrote.
It’s worth mentioning here that the advice from AskMBS isn’t necessary meaningful.
For a start, Medicare is law, and the DoH can’t give legal advice.
There’s also precedent in case law; in the 2018 case of Nithianantha v Commonwealth of Australia, the Professional Services Review was able to argue that a piece of AskMBS advice was incorrect, meaning it cannot be relied on in court.
Medicare compliance and claiming expert Dr Margaret Faux, a lawyer by trade, said she regularly saw pieces of AskMBS advice that were either incorrect, confusing or unhelpful.
Dr Faux said she’d seen the unreliability of AskMBS firsthand, when two doctors sent in the same question a few weeks apart, only slightly changing the wording.
“When they both got their respective responses, they sent them to me,” she told The Medical Republic.
“The two responses to the same question were the exact opposite of each other.”
