1.  The whole of this instrument

1 January 2016.

1 January 2016

30165

Lipectomy, wedge excision of abdominal apron that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non‑surgical) treatment; and

(b) the abdominal apron interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H) (Anaes.) (Assist.)

454.85

30168

Lipectomy, wedge excision of redundant non‑abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non‑surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 1 excision only

(H) (Anaes.) (Assist.)

454.85

30171

Lipectomy, wedge excision of redundant non‑abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non‑surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 2 excisions only

(H) (Anaes.) (Assist.)

691.75

30172

Lipectomy, wedge excision of redundant non‑abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non‑surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 3 or more excisions

(H) (Anaes.) (Assist.)

691.75

30176

Lipectomy, radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30177, 30179, 45530, 45564 or 45565 applies, if it can be demonstrated that there is an anterior abdominal wall defect that is a consequence of the surgical removal of large intra‑abdominal or pelvic tumours

(H) (Anaes.) (Assist.)

985.70

30177

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non‑surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H) (Anaes.) (Assist.)

985.70

30179

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar), not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if:

(a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non‑surgical) treatment; and

(b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H) (Anaes.) (Assist.)

1 213.15

15275

Radiation oncology treatment with IGRT imaging undertaken:

(a) to implement an IMRT dosimetry plan prepared in accordance with item 15565; and

(b) utilising an intensity‑modulated treatment delivery (fixed or dynamic gantry linear accelerator or non‑linear accelerator) mode, once only at each attendance at which treatment is given

182.90

15555

Simulation for IMRT, with or without intravenous contrast medium, if:

(a) treatment set‑up and technique specifications are in preparation for IMRT dose planning; and

(b) patient set‑up and immobilisation techniques are suitable for reliable CT image volume data acquisition and IMRT; and

(c) a high‑quality CT image volume dataset is acquired for the relevant region of interest to be planned and treated; and

(d) the image set is suitable for the generation of quality digitally reconstructed radiographic images

710.55

15565

Preparation of an IMRT dosimetry plan, which uses one or more CT image volume datasets, if:

(a) in preparing the IMRT dosimetry plan:

(i) the differential between target dose and normal tissue dose is maximised, based on a review and assessment by a radiation oncologist; and

(ii) all gross tumour targets, clinical targets, planning targets and organs at risk are rendered as volumes as defined in the prescription; and

(iii) organs at risk are nominated as planning dose goals or constraints and the prescription specifies the organs at risk as dose goals or constraints; and

(iv) dose calculations and dose volume histograms are generated in an inverse planned process, using a specialised calculation algorithm, with prescription and plan details approved and recorded in the plan; and

(v) a CT image volume dataset is used for the relevant region to be planned and treated; and

(vi) the CT images are suitable for the generation of quality digitally reconstructed radiographic images; and

(b) the final IMRT dosimetry plan is validated by the radiation therapist and the medical physicist, using robust quality assurance processes that include:

(i) determination of the accuracy of the dose fluence delivered by the multi‑leaf collimator and gantry position (static or dynamic); and

(ii) ensuring that the plan is deliverable, data transfer is acceptable and validation checks are completed on a linear accelerator; and

(iii) validating the accuracy of the derived IMRT dosimetry plan in a known dosimetric phantom; and

(iv) determining the accuracy of planned doses in comparison to delivered doses to designated points within the phantom or dosimetry device; and

(c) the final IMRT dosimetry plan is approved by the radiation oncologist prior to delivery

3 313.85

Subgroup 7—Radiation oncology treatment verification

15715

Radiation oncology treatment verification of planar or volumetric IGRT for IMRT, involving the use of at least 2 planar image views or projections or 1 volumetric image set to facilitate a 3‑dimensional adjustment to radiation treatment field positioning, if:

(a) the treatment technique is classified as IMRT; and

(b) the margins applied to volumes (clinical target volume or planning target volume) are tailored or reduced to minimise treatment related exposure of healthy or normal tissues; and

(c) the decisions made using acquired images are based on action algorithms and are given effect immediately prior to or during treatment delivery by qualified and trained staff considering complex competing factors and using software‑driven modelling programs; and

(d) the radiation treatment field positioning requires accuracy levels of less than 5mm (curative cases) or up to 10mm (palliative cases) to ensure accurate dose delivery to the target; and

(e) the image decisions and actions are documented in the patient’s record; and

(f) the radiation oncologist is responsible for supervising the process, including specifying the type and frequency of imaging, tolerance and action levels to be incorporated in the process, reviewing the trend analysis and any reports and relevant images during the treatment course and specifying action protocols as required; and

(g) when treatment adjustments are inadequate to satisfy treatment protocol requirements, replanning is required; and

(h) the imaging infrastructure (hardware and software) is linked to the treatment unit and networked to an image database, enabling both on‑line and off‑line reviews

76.60