8.           MBS Item Group 4: CT of the knee

8.1        Items considered in this section

The items listed in Table 10 are considered in this section.

Table 10: Item descriptor

Common MBS item descriptor

COMPUTED TOMOGRAPHY – scan of extremities, 1 or more regions without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (Anaes.)

Item

Specifier

Fee

56619

R K

Fee: $220.00 Benefit: 75% = $165.00 85% = $187.00

56659

R NK

Fee: $112.10 Benefit: 75% = $84.10 85% = $95.30

Common MBS item descriptor

COMPUTED TOMOGRAPHY – scan of extremities, 1 or more regions with intravenous contrast medium and with any scans of extremities prior to intravenous contrast injection, when undertaken; only 1 benefit is payable whether 1 or more attendances are required to complete the service (Anaes.)

Item

Specifier

Fee

56625

R K

Fee: $334.65 Benefit: 75% = $251.00 85% = $284.50

56665

R NK

Fee: $167.40 Benefit: 75% = $125.55 85% = $142.30

8.2        Issues identified

Interpretation of the MBS data for knee CT is complicated by the item descriptors available for this test. Items 56619, 56625, 56659 and 56665 are used to claim for ‘CT scan of extremities’.

The proportion of knee CT of the total services claimed against the MBS items for CT of extremities requested by GPs has declined after the introduction of GP-requested knee MRI (28.5% vs 18.5%)7.

8.3        Recommendation 5

Separate the MBS items for the knee from the current CT items, which encompass all extremities.

Table 11: Current and proposed item descriptors

Current item descriptor

Proposed new item descriptor

COMPUTED TOMOGRAPHY - scan of extremities, excluding knee, 1 or more regions without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (Anaes.)

COMPUTED TOMOGRAPHY - scan of extremities the knee, 1 or more regions without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (Anaes.)

8.3.1        Rationale

The recommendation focuses on obtaining granularity of Medicare data. It was based on the following observations:

 There are no specific CT items for the knee. Therefore it is not possible to identify the number of CT scans performed specific for the knee.

 CT of the knee is most useful in patients who:

- require planning for operative stabilisation of complex fractures demonstrated by a plain radiograph series

- are suspected of having a bone tumour or infection relating to the knee.

 The appropriate use of CT imaging cannot be evaluated from current MBS data, for example whether patients undergoing knee CT had already undergone knee X-ray.

8.4        Recommendations impact statement

Recommendation 5 is not expected to have any impact on patients.

Providers will be required to use a different MBS items for CT of the knee and are expected to be aware of this recommendation.