April 2010 - Cataract surgery—Medicare Benefits Schedule (MBS) item numbers explained
There is no single item number that can be used by optometrists after cataract surgery. It is recommended you carry out all the clinical assessments relevant to the patient’s attendance and then assign the appropriate item number.
- If the patient has recently had cataract surgery and has completed their aftercare, their first visit with you is normally to check refractive status. In this circumstance the attendance where a prescription for spectacles or contact lenses is written does attract a Medicare benefit.
- If the patient has no symptoms or signs of post-surgical complications and has vision at a level that is as expected, and has come to see you to have their spectacles updated, it is likely all required assessments could be done within 15 minutes. In this situation, you could claim Item 10916 where the attendance was the first in a course of attention and Item 10918 where the attendance was the second or subsequent in a course of attention.
- If the consultation exceeds 15 minutes, the service could be claimed as Item 10918 if the attendance is subsequent to the previous course of attention, or claimed as Item 10900, 10905 or 10907 if the attendance is the first in a course of attention and the patient is eligible for, and requires a comprehensive consultation.
- If the patient presents with symptoms or signs of a post-surgical complication, it is likely that a comprehensive range of testing will be required, including a retinal examination, tonometry and subjective refraction. In this case, Item 10913 could be used. If there was a significant change of visual function, such as a reduction in vision of two lines or more, Item 10912 could be used.
Note: if the visit falls in the aftercare period, a Medicare benefit is not payable. The MBS item numbers that apply to cataract surgery include all professional attendances necessary for the post-operative treatment of the patient, whether provided by a medical practitioner or an optometrist. The amount and duration of the aftercare may vary but includes all attendances until recovery from the operation.
When claiming a service under Medicare, it is necessary to establish that it was a 'clinically relevant service'. This means the service performed would be generally accepted in the optometrical profession as being necessary for the appropriate treatment of the patient.
When trying to determine the appropriate item number to claim, refer to section O.6 of the Optometrical Benefits Schedule available at Department of Health and Ageing
For more information call Medicare Australia on 132 150*.
* Call charges apply.
Last updated: 5 March, 2012