Reimbursement of ECGs has proven to be a particularly contentious issue emerging from the Medicare Taskforce Review, the CSANZ ASM held in Adelaide last week heard.

Under the MBS items review, 188 cardiology related services were flagged of which, 117 underwent some level of revision, 65 required no change, and six services were recommended for removal from the schedule.

Updating delegates on the proposed item number changes that will affect cardiologists, Dr Rick Draper, Interim Director of Cardiology and Emeritus Director of Cardiology, Monash Medical Centre, said figures showed that in the year 2014/ 2015 98% of ECG paid benefits were for trace and report (item 11700) at a cost of $71.1 million.

When these figures were broken down by provider, GPs were found to have claimed for 38% of this item, followed by cardiologists at 34%, pathologists at 17% and 13% ‘other’.

The view of the Procedures and Rules Committee, an arm of the MBS review, was that it was appropriate to charge a 11700 (trace and report) only when a formal report has been made that was stored electronically and was readily available to other clinicians.

“i.e the current common practice of GPs and cardiologists taking a self referred ECG in their rooms and not providing a formal report separate to a description of the ECG in a letter does not entitle the provider to raise a 11700 item number in any event the interpretation of the ECG should be regarded as part of the consultation,”the committee said in its report.

However, the view of the CSANZ is that when a GP refers a patient to a cardiologist it is expected (implied) that they will perform an ECG. The interpretation of the ECG should be seen as distinct from the consultation but if it isn’t, then the consultation fee should be increased.

Furthermore, the description of the ECG by the cardiologist in the letter back to the GP should be considered as providing a report – and GPs, unlike cardiologists, should not be allowed to charge a 11700.

As a compromise, new item number 11704 has been suggested for an ECG taken in a cardiologists rooms in association with a consultation (110 or 116) with a description of the ECG in the letter back to the GP. The ECG must be retained and provided upon request (along with the report).

“Now this is not a recommendation of the cardiology committee (quite the opposite) but the GP taskforce lobbied to say they should also be able to charge 11704 because they are just as good as cardiologists at interpreting ECGs… this hasn’t been decided but I think GPs will win the day politically,” said Professor Draper, who was a member of the ECG working group.

In the discussion at the CSANZ ASM, Chair of the session Professor Michael Feneley said that from the outset it was clear that the opinion of the Procedures and Rules Committee’s was that GPs had been billing “almost entirely 11700 for probably as long as the item has been scheduled”.

“Clearly they’ve been breaking the rules the whole time… our view is that they should stop breaking the law,” he told delegates.

“We [cardiologists] should be considered differently from GPs…the compromise of 11704 was to satisfy us but when the GPs saw that they said that’s ridiculous, you can’t let them charge for the report but not let us charge for the report so the compromise was not consistent with what we espoused.”

“I think economically it’s the worst outcome because…one of the biggest savings that could have been made would be to stop GPs from charging the report..that would have saved a motza so a lot of the savings are now going to be squandered.”

“We should all be very deeply insulted [that cardiologists are treated the same as GPs] and I certainly will be making representations to the Minister about it on your behalf … this is a real slap down for our profession,” he added.

The likely fee for 11704 will be 75% of the fee for 11700 and was currently under review but was likely to be accepted, Professor Draper said.

ECG – A summary of the likely changes

1. 1170 no longer allowable for GPs, physicians, cardiologists who take ECGs in their rooms. Appropriate charge is 11702 or 11704.

2. Pathology services can still charge 11700

3. 11701 (ECG report only) can only be charged by a cardiologist if a GP sends an ECG to that cardiologist with a specific request for a report of that ECG.

4. Private hospitals no longer able to charge for 11700 for in-patient ECGs. They can charge 11701 if there is a referral request for an ECG and the ECG is formally reported and available on request with the training retained.