Billing Medicare items for ‘Unrelated’ services.

There are some items that have absolute restriction on billing together e.g. 721/723/732 and 23/36/44 in any combination. 

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

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 1 hour-long – e.g. item 44 + 2713.

There will always be instances when you will need to 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 needed to 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.

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