6.           MBS Item Group 2: Ultrasound of the knee

6.1        Items considered in this section

The items listed in Table 6 are considered in this section.

Table 6: Item descriptor

Common MBS item descriptor

Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:

 meniscal and cruciate ligament tears

 assessment of chondral surface.

KNEE, 1 or both sides, ultrasound scan of, where:

(a)  the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and

(b)  the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,

and where the service is provided for the assessment of one or more of the following conditions or suspected conditions: abnormality of tendons or bursae about the knee; or meniscal cyst, popliteal fossa cyst, mass or pseudomas; or nerve entrapment, nerve or nerve sheath tumour; or injury of collateral ligaments.

 

Item

Specifier

Fee

55828

R

Fee: $109.10 Benefit: 75% = $81.85 85% = $92.75

55829

R NK

Fee: $54.55 Benefit: 75% = $40.95 85% = $46.40

55830

NR

Fee: $37.85 Benefit: 75% = $28.40 85% = $32.20

55831

NR NK

Fee: $18.95 Benefit: 75% = $14.25 85% = $16.15

 

6.2        Issues identified

Ultrasound is a low-clinical-utility examination in diagnosing the cause of symptomatic knee pain in the context of suspected meniscal, articular cartilage or cruciate ligament injury. It is an accurate means of diagnosing a suspected Baker’s cyst or to confirm a joint effusion or patellar tendon tear when this is clinically uncertain.

 

While the current descriptor excludes ultrasound imaging for meniscal and cruciate ligament tears, it includes the indication of collateral ligament injury.

 

6.3        Recommendation 3

Remove the indication of ‘injury of collateral ligaments’ from the current descriptor for items 55828, 55829, 55830 and 55831.

Table 7: Current and proposed item descriptors

Current item descriptor

Proposed new item descriptor

Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:

 meniscal and cruciate ligament tears

 assessment of chondral surface.

KNEE, 1 or both sides, ultrasound scan of, where:

(a)  the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and

(b)  the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,

and where the service is provided for the assessment of one or more of the following conditions or suspected conditions: abnormality of tendons or bursae about the knee; or meniscal cyst, popliteal fossa cyst, mass or pseudomass; or nerve entrapment, nerve or nerve sheath tumour; or injury of collateral ligaments.

Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:

 meniscal and cruciate ligament tears

 assessment of chondral surface.

KNEE, 1 or both sides, ultrasound scan of, where:

(a)  the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and

(b)  the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,

and where the service is provided for the assessment of one or more of the following conditions or suspected conditions: abnormality of tendons or bursae about the knee; or meniscal cyst, popliteal fossa cyst, mass or pseudomass; or nerve entrapment, nerve or nerve sheath tumour.

 

6.3.1        Rationale

The recommendation focused on improving the quality use of ultrasound imaging and was based on the following observations:

 Ultrasound is equally accurate to MRI in the assessment of collateral ligaments, quadriceps, patellar tendons and popliteal fossa, and will generally be more accessible than MRI.6

 Diagnosis of collateral ligament injury severity with imaging does not generally change treatment.

 The RACGP has not developed specific guidelines for use of ultrasound of the knee but do state that ultrasound is not recommended for evaluation of menisci or cruciate ligament injuries.8

6.4        Recommendations impact statement

Recommendation 3 is not likely to have an impact on patients.

The impact to providers is considered to be minimal.