MBS explanatory notes: What GPs need to know

Eleanor Chew

3/05/2019 11:14:15 AM

Dr Eleanor Chew breaks down the changes to MBS explanatory notes for diagnostic imaging, including patient and practitioner benefits.

Examining an X-ray
A request must contain sufficient clinical information to assist the provider to accurately provide the diagnostic imaging service.

Changes have recently been made regarding the recommended information to be included in requests for diagnostic imaging providers.
As frequent requestors, this information is important to GPs.
These changes have come about following a recommendation by the Diagnostic Imaging Clinical Committee (DICC), one of the clinical committees established by the Medicare Benefits Schedule (MBS) Review Taskforce. (I am a member of the MBS Review Taskforce, but was not a member of the DICC.)
The DICC recognised that there is sometimes a lack of clear distinction in diagnostic imaging between a referral for an opinion and a request for a service, which results in confusion about when it is permissible for a radiologist to claim an attendance item. The previous legislation and accompanying MBS explanatory notes had established different minimal requirements for a referral and a request.
Consequently, one of the changes implemented in 2018 is the amendment to the explanatory notes in the General Medical Services Table (GMST) and the Diagnostic Imaging Services Table (DIST) to provide guidance on the information that should be contained in requests for diagnostic imaging services.
The purpose of the explanatory notes is to provide guidance to support the appropriate use of items listed on the MBS. They are not mandatory requirements.
Changes and their purpose
The changes have been made to explanatory note IN.0.1 in Category 5 of the MBS and include detail regarding what is required from a requestor in making a diagnostic imaging request:

  • A clear and legible request
  • Identity of the patient
  • Identity of the requestor
  • Clinical detail
  • MBS requirements
These changes have been implemented to support better requesting. Greater clarity of what is expected when making a request for a diagnostic imaging service may serve to increase clinician awareness of high-value tests, minimise radiation exposure, and promote greater recognition of item descriptor inclusions and exclusions.
What GPs need to know
GPs are frequent requestors of diagnostic imaging services, but may not regularly look to see what has changed in the explanatory notes so may not be aware of the change.
The change makes it clear that the onus is on the requestor (GP) to provide sufficient clinical detail and a clinical justification for each examination, while the onus is on the provider (radiologist) to determine the justification for medical radiation exposure. 
It is important to remember that this responsibility is not optional.

The legislation provides that a request must contain sufficient clinical information to assist the service provider to accurately provide the diagnostic imaging service and, where the requested service involves ionising radiation such as X-ray or computerised tomography (CT), make a decision whether to expose the patient to this radiation, consistent with the providers’ obligations under the International Commission of Radiological Protection’s doctrine of radiation protection.
So the next time you receive a request from your radiologist for more clinical information, or a call declining your request for a high-ionising radiation service, you will know why.
Benefits to practitioners
These changes provide clarity regarding the requirements of a request for services under Medicare and will improve the communication between the requestor and the provider. Our request forms are really referral letters to our radiologist colleagues, as we are seeking their expertise to answer a clinical question, eg is this colicky right upper quadrant pain due to gall stones? 
Our request forms should therefore contain, as is stated in the explanatory notes:
Sufficient information to enable the radiologist to confirm that the requested diagnostic imaging modality and examination are appropriate to that individual patient's presentation and circumstances, to answer the referrer's diagnostic question with the least number of diagnostic steps (with due regard for patient safety, radiation dose, local expertise and cost).
This is in accordance with the RACGP’s Standards for general practices (5th edition) (the Standards),  Criterion GP2.3 – Engaging with other services.
Benefits to patients
Patients will receive an optimal outcome from their diagnostic imaging service through better communication between them, their GP and their radiologist.
Again, as is stated in the explanatory notes, ‘Before requesting a diagnostic imaging service, the requesting practitioner must turn their mind to the clinical relevance of the request and determine that the service is necessary.’  This should serve to ensure that our patients are referred for the most appropriate diagnostic imaging for their needs.
‘The requestor should consider whether ... the benefits and risks to the patient or carer have been communicated and that there is information available to the patient about the tests requested.’
This is supported in the Standards, Criterion C1.3 – Informed patient decisions.
This updated information will result in quality communication between the GP and their diagnostic imaging service provider, which is optimal for good patient care.
Further information is available on the MBS Online website.

diagnostic imaging explanatory notes MBS review

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