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RACGP says GP-specific MBS item for ear toilet not required at present


Rosanne Barrett


9/04/2021 4:11:25 PM

It will soon be harder to claim item 41647, but time-based consultation items should sufficiently cover simpler methods for ear clearing.

A GP examining a patient's ear.
The RACGP has said a new GP-specific MBS descriptor for ear toilet is not needed at present.

Late last year the Otolaryngology, Head and Neck Surgery (OHNS) Implementation Liaison Group (ILG) accepted proposed changes to the Medicare Benefits Schedule (MBS) descriptor for ear toilet, which is currently defined as requiring an operating microscope and microinspection of tympanic membrane, with or without general anaesthesia.
 
The changes were originally recommended by the OHNS Clinical Committee, which advised ear toilet does not meet the existing criteria when a simpler method of wax removal would suffice. The ILG then invited the college to provide a new descriptor to address any possible gaps in access for patients, particularly those in rural and remote areas.

However, in a letter to the Department of Health (DoH) responding to the invitation, RACGP President Dr Karen Price said a new GP-specific descriptor is not required.
 
‘We understand that GPs will [still] be able to claim item 41647, provided the service is in line with the amended descriptor and explanatory note,’ she said.
 
‘We support patient rebates being available for GPs to perform microsuction where it is clinically appropriate, [and] as simpler methods of clearing the ear canal would be covered by standard time-based consultation items, we do not consider that a new GP-specific ear toilet item is needed at present.
 
The issue arose after the Clinical Committee, which is part of the MBS Review Taskforce, advised changing the item number’s description to ‘address inappropriate use for the removal of uncomplicated wax and debris’ in a report to the Federal Government.

‘The Taskforce recommends adding an explanatory note to item 41647 to state that the item is not for the removal of uncomplicated wax or debris if it can be achieved using a simpler method, such as topical eardrops or syringing,’ the recommendation stated.

RACGP Vice President Dr Bruce Willett told newsGP it can be tricky for GPs to know when they should claim rebates for ear toilet procedures.
 
‘GPs find themselves in a really difficult situation with this,’ he said.
 
‘We’re told by our ENT [ear nose and throat] colleagues that we should not be syringing ears as it is not safe and the risk of perforation is high, [and] that we should be using microscopes and doing it under direct vision so it is a lot safer.‘
 
In her letter to the DoH, Dr Price suggested an alternative to creating a new ear toilet item would be to consider creating an MBS item that provides a more suitable rebate for simpler ear clearing methods.
 
‘Doing so could discourage or reduce the need for GPs to refer patients for more complex methods of clearing the ear canal,’ she said.
 
‘The RACGP’s position is that GPs should be paid the same as other medical specialists for doing the same work.
 
‘This is particularly relevant in rural and remote areas where a GP may be the only provider offering a particular service.’
 
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Dr Graeme William Balch   14/04/2021 7:18:51 AM

Our clinic provides an ear toilet service to the far north community where we only have one ent covering both private and public. We struggle to meet demand seeing patients from plain obstructive debris associated with hearing aids right through to full on aggressive fungal disease , cholesteatoma , severe acute otitis media , etc . We have oversight from a visiting otologist who also cannot cope with the demand either and cannot see public patients. Financially skin work is more rewarding . Any restriction of the item number will result in the collapse of this service. I agree the item number should not be used for asymptomatic non obstructive wax except where it is for patients who have a past history of severe disease as maintenance care. Clinics ( both specialty and gp) operating under a business model and maximising their Medicare claiming are once again threatening the viability of ethical practice ( ecg and joint injection etc )