Health Insurance (1991-1992 Pathology Services Table)

Statutory Rules 1991 No. 3531

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Health Insurance (1991-1992 Pathology

Services Table) Regulations

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 20 November 1991.

BILL HAYDEN

Governor-General

By His Excellency’s Command,

B. HOWE

Minister of State for Health, Housing and Community Services

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Citation

1. These Regulations may be cited as the Health Insurance (1991-1992 Pathology Services Table) Regulations.

Commencement

2. These Regulations commence on 1 December 1991.

Repeal

3. Statutory Rule 1990 No. 343 is repealed.

Pathology services table

4. The table of pathology services in the Schedule is prescribed for the purposes of subsection 4A (2) of the Health Insurance Act 1973.

SCHEDULE Regulation 4

TABLE OF PATHOLOGY SERVICES

RULES OF INTERPRETATION

1. (1) In this table, unless the contrary intention appears:

“recognised pathologist” means a medical practitioner recognised as a specialist in pathology under a determination under subsection 61 (3) of the Act ;

“the Act” means the Health Insurance Act 1973.

(2) In these Rules, a reference to a request to an approved pathology practitioner includes a reference to a request for a pathologist-determinable service to which subsection 16A (6) of the Act applies.

(3) In rules 6, 7 and 8, “patient episode” means:

(a) a single pathology service; or

(b) 2 or more pathology services, whether listed in 1 or more than 1 item, the patient’s need for which was determined under subsection 16A (1) of the Act on the same day.

2. (1) If a service is described:

(a) in an item in general terms; and

(b) in another item in specific terms;

only the item that describes the service in specific terms applies to the service.

(2) If:

(a) a service is described in 2 or more items; and

(b) subrule (1) does not apply;

only the item that provides the lower or lowest fee for the service applies to the service.

3. (1) In subrule (2), “service” includes an assay, estimation and test.

SCHEDULE—continued

(2) 2 or more pathology services provided for a patient following 2 or more requests are taken to have been provided following a single request if:

(a) the services are listed in the same item; and

(b) the patient’s need for the services was determined under subsection 16A (1) of the Act on the same day.

4. If:

(a) a pathology service to which an item of the table applies is provided for a patient in accordance with a request; and

(b) another pathology service is provided for the patient in accordance with the request; and

(i) applies to the other service ; and

(ii) is referred to in the item mentioned in paragraph (a);

the other service is treated as if it were part of the service referred to in paragraph (a).

Example:

Dr Proctor requests an extended blood grouping test (covered by item 65019) and the test includes a basic blood grouping test (covered by item 65017). Item 65017 is referred to in item 65019. Benefit is payable under item 65019 for the extended blood grouping test but benefit is not payable separately under item 65017 for the basic blood grouping test.

5. (1) In paragraphs (2) (c) and (d), “prescribed laboratory” means a laboratory operated by:

(a) the Commonwealth; or

(b) a State; or

(d) the Northern Territory; or

(e) the Australian Capital Territory; or

(f) an Australian tertiary education institution.

(2) An item including the symbol “(SP)” does not apply to a pathology service provided by, or on behalf of, an approved pathology practitioner who is a recognised pathologist if:

(a) the service is provided upon a request made in the course of an out-patient service at a recognised hospital; or

(b) the service is provided upon a request made for a patient who is a private patient in a recognised hospital when the request was made; or

SCHEDULE—continued

(d) a member of the staff of a recognised hospital, or prescribed laboratory, participates in the service in the course of the member’s employment with the hospital or laboratory.

(3) An item including the symbol “(OP)” does not apply to a pathology service:

(a) to which an item that includes the symbol “(SP)” applies; or

(b) to which subsection 16A (7) of the Act applies.

6. For the purposes of items 65001 to 66200 (inclusive):

(a) if pathology services of a kind referred to in item 65017, 65018, 65019 or 65020 are provided for a patient during a period when the patient is in hospital, the item applies only to the first pathology service of that kind provided for the patient during that period; and

(b) tests (except the tests mentioned in items 65023 and 65024) carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request is made within 14 days of that previous patient episode.

7. For the purposes of items 66201 to 69200 (inclusive):

(a) if a pathology service involving the measurement of a substance in urine requires a 24 hour urine collection, or calculation of a substance/ creatinine ratio, the service is treated as including any estimation of creatinine in other fluids necessary for the calculation; and

(b) tests carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request is made within 14 days of that previous patient episode.

8. For the purposes of items 69201 to 71000 (inclusive):

(a) “serial examinations or cultures” means examinations or cultures requested on 1 occasion whether or not:

(i) the materials are received on different days by the approved pathology practitioner; or

(ii) the examinations or cultures were requested on 1 or more request forms by the treating practitioner; and

(b) tests carried out on material stored from a previous patient episode in response to a later request are treated as part of that previous patient episode if the second request occurs within 14 days of that previous patient episode.

SCHEDULE—continued

9. For the purposes of items 71001 to 72800 (inclusive):

(a) in items 71025, 71026, 71027, 71028, 71029, 71030, 71031 and 71032, the estimation of a single antibody includes qualitative and quantitative assays for that antibody; and

10. For the purposes of items 72801 to 73040 (inclusive):

(a) “biopsy material” means all tissue received by the approved pathology practitioner from an operation, or a group of operations, performed on a patient at the same time, other than a bone marrow biopsy; and

(b) if:

(i) a pathology service that is the examination of biopsy material is provided under any of those items; and

(ii) a further pathology service mentioned in any of those items is also provided using that biopsy material;

those pathology services are treated as 1 pathology service.

11. For the purposes of items 73041 to 73280 (inclusive), “serial examinations” means examinations requested on 1 occasion whether or not:

(a) the materials are received on different days by the approved pathology practitioner; or

(b) the examinations were requested on 1 or more request forms by the treating practitioner.

12. The abbreviations at the end of the table may be used to identify particular pathology services or groups of pathology services.