August 2010 - Australian Optometry article
When is it appropriate to write an indefinite referral?
Optometrists can write indefinite referrals to ophthalmologists for the ongoing treatment of patients with chronic conditions.
An indefinite referral is appropriate where an ophthalmologist is involved in the continuing care and management of a patient with a specific chronic condition. If an indefinite referral already exists, the specialist does not need to request a new referral unless a new condition has developed. If the patient develops a new problem, it is appropriate for a new referral to be provided.
An initial attendance related to the new condition would then be claimed by the ophthalmologist. An example would be a patient with an indefinite referral for glaucoma who develops a pterygium requiring surgery.
Where an indefinite referral has not been provided before, the renewal of a referral for the same condition does not automatically indicate the start of a new course of treatment where the specialist can itemise another initial consultation.
If the condition requires continual management and treatment, the new referral facilitates the payment of benefits at the specialist or consultant referred rates, rather than the unreferred rates.
A patient's attendance following a new referral can initiate a new course of treatment for which Medicare benefits would be payable at the initial consultation rates. This is the case when:
- the referring optometrist deems it necessary for the patient's condition to be reviewed, and
- the patient is seen by the ophthalmologist outside the last referral period, and
- the patient was last seen by the ophthalmologist more than nine months earlier.
Referrals from optometrists are valid for 12 months, unless the referring optometrist specifically indicates the referral is for a different time period.
For more information:
- go to www.medicareaustralia.gov.au then For health professionals >Forms, publications and statistics > Information by program > Medicare > Indefinite referrals - when to write one
- call Medicare Australia on 132 150*
* Call charges apply.
Last updated: 7 July, 2011