What is an RVG Anaesthesia Service?

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The ASA's Relative Value Guide was incorporated into the Medicare schedule in the November 2001 edition. With this came a new set of rules for adding items to accounts. In particular, each account requires:


an Anaesthesia for ... item such as 'Anaesthesia for hip replacement'
a time item
optional modifiers such as the age or physical status modifiers


Additional procedures such as a preanaesthetic consultation or intravascular monitoring may be added to the account, although these do not technically form part of the RVG anaesthesia service.


The details of exactly what needs to appear on the account are described in detail elsewhere, such as in the documents produced by the ASA and the Health Insurance Commission.


Enter an Anaesthesia for … item


Each account for an anaesthetic service must have at least one basic item in the range 20100 to 21997. To enter these items on your accounts, use the standard methods for entering any MBS item. That is, type in an item number (into the A.Item field), choose an item from the MBS book, or select one of the options from the Quick Items list (you may need to set this up with the new RVG items).


Add any other Anaesthesia for … items which are relevant. The fee for all but one of these will be automatically reset to zero since only the anaesthesia item with the highest unit value will be used for the fee determination. This differs from the pre-RVG MBS system where the second item was discounted to 20% and subsequent items to 10% of their original value.


Item descriptions


The Health Insurance Commission (HIC) recommends that you abbreviate the item description that you put on your account so that only a brief one line phrase is shown. This can be done by creating your own description in the MBS book, or by editing the description directly on the account's Items page. If you require more than one description for a single item number, create a Subitem code in the MBS book.


The time item


You must enter the start and stop times of each anaesthetic service. Although the actual times are only required to appear on the account if you are claiming an after hours loading, Access Anaesthetics calculates the anaesthetic time and number of units from the start and stop times. If you don't know the times, enter estimated times which evaluate to the time you spent on the procedure.


When you enter the first Anaesthesia for.. item on the account, the time item is entered automatically. If you have not already entered the start and stop times, go back and enter these and a time item will be entered. If you subsequently change the start or stop times, the time item will be updated to reflect the change.


It is possible to create an account without a time item. This would happen if you perform procedures which do not form part of an RVG anaesthesia service. However, an account for an RVG anaesthesia service must have both an anaesthesia item and a time item, otherwise Medicare will reject the claim.


Because anaesthesia rebates are now calculated using actual, as opposed to estimated times, the prolonged anaesthesia rule no longer applies. The button which operates this function still remains in the system for backward compatibility. However, it will only perform the calculation correctly if a pre-November 2001 items file is attached to the system.


Entering modifiers


Modifiers can only be added to accounts which include an RVG anaesthesia service since they 'modify' the RVG anaesthesia service. The following notes should be considered.


The age modifier (25015) is for patients aged less than 12 months, or 70 years or greater.
The emergency modifier (25020) can be used for either in-hours or out-of-hours procedures.
The after hours emergency modifiers (25025, 25030, 25050) can only be used for after hours emergency procedures.
The emergency modifier and the after hours emergency modifiers cannot both be used on one account.
The modifiers for prone position, morbid obesity and 3rd trimester of pregnancy exist only in the ASA's RVG schedule and cannot be used on MBS type accounts.


What constitutes After hours?


The after hours period is time spent before 8am, after 8pm and at any time on weekends or public holidays. For an account to attract the 50% after hours modifier, at least half of the time for the procedure must be in the after hours period. Also, the procedure must be an emergency. Elective after hours procedures do not attract the modifier.


After entering the start and stop times on the account, click the  eligibility button to assess whether or not the times are eligible for the after hours emergency modifier.


This modifier is not added automatically to the system because the requirement for the procedure be of an emergency nature can only be manually specified.


NoteThe definition of after-hours is different in the ASA RVG - 6pm to 8am.


Anaesthetic 'Extras'


The MBS schedule has always, and still contains a set of items for monitoring, transfusions, cannulations and similar anaesthetic extras. These are mostly in the group T1 - Miscellaneous Therapeutic Procedures with item numbers between 13020 and 14224. Similar items have been included in the new RVG listing (20000-30000) which duplicate the original items. The latter items should be used only when performed in association with the administration of anaesthesia. This means, only in conjunction with an RVG type anaesthetic service. This would apply to most standard anaesthetic procedures. If a procedure is performed not in association with an RVG anaesthetic service, the original item numbers in group T1 should be used for the anaesthetic extras.


Ordering items on the account


The Health Insurance Commission has published their preferences for the order in which items should appear on RVG type accounts. Generally speaking, Access Anaesthetics follows this pattern if you use the Auto Order function. Under some circumstances, the order will be slightly different to the HIC recommendations, but the differences are usually cosmetic only, for example, the order of modifiers may be different. The main principle is that all the items related to one instance of an RVG anaesthesia service are listed together on the account.


If you would like the Auto Order function to operate automatically when items are entered, you can set this up in the system Options. Go to the Automatic Functions page and tick the checkbox which sets the auto order function to be done after the prolonged anaesthesia rule. Although the latter rule no longer applies, this check box needs to be ticked.