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Billing of diagnostic laparoscopic items 30390 and 30627

Posted: 13th of July, 2020

Change to the processing of Medicare claims for laparoscopy MBS items 30390 (diagnostic laparoscopy, on a person 10 years of age or over) and 30627 (diagnostic laparoscopy, on a person under 10 years of age).

The item descriptors for items 30390 and 30627 state that the services cannot be associated with another laparoscopic procedure. This restriction was applied to the item 30390 on 1 September 2015 and item 30627 was listed on the same date with this restriction. The item descriptors are:

30390

Laparoscopy, diagnostic, on a person 10 years of age or over, other than a service associated with another laparoscopic procedure (H) (Anaes.)

30627

Laparoscopy, diagnostic, other than a service associated with another laparoscopic procedure, on a person under 10 years of age (H) (Anaes.)

Utilisation data indicates there has been some inappropriate billing of items 30390 and 30627 with other laparoscopic procedures, for example the billing of items 30572 (laparoscopic appendicectomy) and 30390 for a single episode of care.

From 10 August 2020, if the item number of a separate laparoscopic service is co-claimed with item 30390 or 30627 the claim will be rejected by Medicare in accordance with the Health Insurance (General Medical Services Table) Regulations 2020.

Please note: If a diagnostic laparoscopy procedure is performed at a different time on the same day to another laparoscopic service, the procedures are considered to be un-associated services. In this situation the claim for benefits should be annotated to indicate that the two services were performed on separate occasions (see Explanatory Note TN.8.15 Diagnostic Laparoscopy – {Items 30390 and 30627}).

As you would be aware, under the Health Insurance Act 1973 (the Act) a health provider is legally responsible for services billed to Medicare under the provider number/s that have been issued in their name. In order to receive a benefit payment a professional service provided must be ‘clinically relevant’ and all requirements of the particular MBS items must be met.  To minimise the risk of incorrect or fraudulent claiming practices it is recommended that health providers regularly review the MBS and subscribe to receive MBS updates at www.mbsonline.gov.au.

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