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 MBS explanatory notes for the MBS items dealing with diagnostic imaging for DVT

Item

What it does

Committee recommendation

What would be different

Why

55244, 55221

Duplex scanning for suspected lower limb deep vein thrombosis

The Committee recommends that Reference to the RANZCR Choosing Wisely recommendations be made in the explanatory notes to MBS item descriptors for DVT ultrasound.

Current clinical evidence suggests that duplex compression ultrasound should not be requested for suspected lower limb deep venous thrombosis in ambulatory outpatients unless the Wells Score (deep venous thrombosis risk assessment score) is greater than 2, OR if less than 2, D dimer assay is positive.

To prompt consideration to clinical guidelines.

 

To promote best clinical practice in accordance to current evidence.


Recommendation 2 Co-claiming duplex scanning for DVT and chronic venous disease

Item

What it does

Committee recommendation

What would be different

Why

55244, 55221, 55246, 55222

Duplex scanning for acute and chronic venous disease.

It is inappropriate to claim ultrasound items for both acute DVT and chronic venous disease on the same leg in the same patient on the same day.

The only exception to the above recommendation is a patient being actively prepared with ultrasound for superficial varicose vein ablation (by whatever method), where the deep venous system of the same leg has to also be scanned on the same day to exclude fresh DVT.

In addition the multiple services rules for diagnostic ultrasound apply and should be adhered to.

Acute DVT and chronic venous disease items would not be able to be co-claimed on the same leg of the same patient on the same day by the same provider, except where a patient is being actively prepared with ultrasound for superficial varicose vein ablation (by whatever method), where the deep venous system of the same leg has to also be scanned on the same day to exclude fresh DVT.

To promote best clinical practice - routine co-claiming of these two items is not appropriate clinical practice.

 

Recommendation 3 Redundant items for DVT imaging

Item

What it does

Committee recommendation

What would be different

Why

It is recommended that a mechanism is identified to reduce the number of NK (services performed on old equipment), which duplicate regular items and lengthen the Diagnostic Imaging Services Table (DIST), as a class solution. The Committee will separately consult on recommendations about capital sensitivity.

 


Recommendation 4 MBS explanatory notes for the MBS items dealing with diagnostic imaging for PE

Item

What it does

Committee recommendation

What would be different

Why

57351, 57356, 61328, 61340, 61348

Ventilation perfusion (V/Q) scans and CTPA for the diagnosis of pulmonary embolism.

Current clinical evidence suggests that diagnostic testing for suspected pulmonary embolism (PE) should not be requested unless indicated by Wells Score (or Charlotte Rule) followed by PE Rule-out Criteria (in patients not pregnant). Low risk patients in whom diagnostic testing is indicated should have PE excluded by a negative D dimer, not imaging.

To reflect this, the Committee recommends that Reference to the RANZCR Choosing Wisely recommendations be made in the explanatory notes used for PE diagnostic imaging items.

Updating explanatory notes will prompt consideration to be given to clinical guidelines.

 

To promote best clinical practice in accordance to current evidence.