Appendix C Summary for consumers

This table describes the medical service, recommendations of the Clinical Experts and why the recommendation has been made.

Recommendation 1: Thyroidectomy items 30296 and 30309
Item What it does Committee recommendation What would be differentWhy

30296 and 30309

These items cover total and subtotal thyroidectomies, which is the surgical removal of all or part of the thyroid gland.

Consolidate item 30309 under item 30296, leaving the descriptor for item 30296 unchanged and adding clearer explanatory notes.

Procedures previously performed under item 30309 would now be performed as a total thyroidectomy under item 30296.

To improve clinical quality and provide better guidance for thyroidectomies explaining when they should be used.

Recommendation 2: Thyroidectomy item 30306
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30306

Total hemithyroidectomy, which is the removal of one of the lobes (and part of the isthmus) of the thyroid gland.

Update the explanatory notes to provide clearer guidance on the appropriate use of hemithyroidectomies in line with best clinical practice.

Providers are encouraged to consider best clinical practice standards and where possible, use item 30306 instead of 30310.

To align the use of total hemithyroidectomies with best clinical practice and is supported by the American Thyroid Association’s Management Guidelines.

Recommendation 3: Thyroidectomy items 30308 and 30310
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30308 and 30310

These items cover partial thyroid gland removal including bilateral subtotal thyroidectomies and unilateral subtotal thyroidectomies or the equivalent partial thyroidectomy.

Consolidate items 30308 and 30310 into one item number.

Update the explanatory notes to provide clinicians with better guidance on the use of these items.

These items would be consolidated into one item with a proposed descriptor of ‘Partial or subtotal thyroidectomy (Anaes.) (Assist.)’

As explanatory notes are currently not provided, this would better guide providers on the appropriate use of these item numbers.

This recommendation focuses on modernising and simplifying the item numbers to reflect best clinical practice for patients.

Recommendation 4: Thyroidectomy item 30297
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30297

This item covers a thyroidectomy (surgical removal of the thyroid gland) following previous thyroid surgery.

Add explanatory notes to this item number to provide better guidance for providers.

Explanatory notes would be provided to ensure best practice guidelines are followed in using this item number.

To improve clinical quality and provide better guidance for thyroidectomies explaining when it’s appropriate to be used.

Recommendation 5: Parathyroid items 30315, 30317-8 and 30320
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30315, 30317-8 and 30320

These items cover removal of the parathyroid gland to treat an overactive gland( hyperparathyroidism).

Change item descriptors for all four items to promote best practice and limit inappropriate co-claiming.

Change item number 30318 to 30316 to make the order of item numbers more intuitive.

Updated item descriptors would be clearer and reflect current modern use of the items and address any intended or unintended misuse.

This recommendation aims to simplify these item numbers to reflect best clinical practice for ease of use by practitioners and address potential misuse in co-claiming.

Recommendation 6: Synacthen stimulation test item 30097
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30097

This test checks the function of the adrenal gland, to see whether a patient is producing enough steroid hormone (cortisol).

Change the item descriptor to require a basal cortisol quantitation prior to a Synacthen stimulation test and add clearer explanatory notes.

Low-value testing would be addressed by requiring the use of basal cortisol measurements prior to performing a Synacthen stimulation test.

Growth and service volume of this item showed a likely indication of over-testing. The additional requirement to undertake a basal cortisol quantitation along with clearer rules describing when this test is appropriate will address any over-use and provide better clinical guidance.

Recommendation 7: Thyroglossal cyst items 30313 and 30314
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30313 and 30314

Removal of thyroglossal cysts( a cyst in the neck close to the thyroid gland).

Delete 30313 from the MBS and direct providers to instead use item 30314 and update the item descriptor for 30314.

Patients will receive a more effective and up-to-date treatment which has a lower cyst recurrence rate.

Item 30313 is obsolete and doesn’t reflect best practices. The use of item 30314 improves clinical quality and provides a better quality of service to patients.

Recommendation 8: Tumour removal items 30321, 30323-4 and 36500
ItemWhat it doesCommittee recommendationWhat would be differentWhy

30321, 30323-4 and 36500

Removal adrenal gland tumours and other rare tumours located in the abdomen that produce hormones.

Consolidate item 30321 into 30323 and item 36500 into 30324.

Update item descriptors for items 30323 and 30324 to provide better clinical guidance.

Billing would be simplified for providers; patients would see little if any change in treatment.

The Committee believes this is still a clinically relevant treatment and sees no concerns with consolidating the items to simplify the MBS and provide consistent billing and treatment to patients.

Recommendation 9: Administration of thyrotropin alfa-rch item 12201
ItemWhat it doesCommittee recommendationWhat would be differentWhy

12201

Administration, by a specialist or consultant physician in the practice of his or her specialty, of thyrotopin alfa-rch in the management of thyroid cancer.

Change the item descriptor to make the nuclear scan (item 61426) optional rather than obligatory.

Providers would have the option to perform the associated nuclear scan if deemed appropriate as part of this service to patients.

The Committee recommends to the Nuclear Medicine Clinical Committee that the associated nuclear scan is not always clinically required and should be optional instead of mandatory for this service. This is in line with best practice and recommendations 66 and 67 of the 2015 American Thyroid Association’s Management Guidelines.






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