Billing Medicare items for ‘Unrelated’ services.

Some items have absolute restrictions on billing, e.g. 721/723/732 and 23/36/44 in any combination. 

However, in any combination, some items can be billed together, e.g. 23/36/44 and 2717/2715/2712/2713/2700/2701.

I have encountered GPs being audited for billing those combinations consistently several times per session. Especially when the numbers were 36/44 + Mental Health. As a result, several consultations per session were supposedly one hour-long – e.g. item 44 + 2713.

There will always be instances when you must bill for ‘unrelated’ services. Reading the Medicare letters, I could see that billing of ‘unrelated’ items must follow two rules:

  1. The services must be provided for different body systems, e.g. mental health and blood pressure.
  2. There must be a reason why services must be provided on the same occasion. E.g. acute tonsillitis and Mental Health Consultation when the patient was in some sort of distress.  Neither of those problems could be left for later.