Bone health

Endocrinology item changes revealed by MBS Review Taskforce

Numerous changes to endocrinology-related MBS items have been revealed in the release of a series of MBS Review Taskforce reports.

Changes to MBS items recommended by the Taskforce’s Endocrinology Clinical Committee include revision of items for procedures such as thyroidectomy and parathyroidectomy.

The committee also recommends amending the item descriptor for a Synacthen Stimulation Test  to require a basal cortisol quantitation prior to performing the test.

Restrictions on vitamin D testing are recommended by the Taskforce’s Diagnostic Medicine Clinical Committee, which advises that testing be limited to once every three months in patients with a confirmed vitamin D deficiency and bone disease.

It also recommends that testing should be limited to once every 12 months for MBS item 66833 (25-hydroxyvitamin D).

Other recommendations in the Taskforce’s reports include:

  • Removing the thyroid antibodies (anti-thyroglobulin Ab, thyroid microsome Ab and TSH receptor Ab) from the suite of tests currently covered under items 71165–71168 and creating new distinct thyroid antibodies items.
  • Limit testing of collagen breakdown or formation products in patients with proven low bone mineral density to two tests every 12 months.
  • Splitting of items covering tests for catecholamines used in the diagnosis of phaecochromocytoma and paraganglioma.
  • Re-wording of items for thyroid ultrasound to clarify appropriate and inappropriate indications.

The Taskforce’s Pathology Clinical Committee for Endocrine Tests previously released recommendations that TSH should not be used as a screening test in asymptomatic patients. It also recommended that the item descriptor and explanatory notes for TFTs should be amended to enable pathologist-determinable (or requested) testing of TFTs when the most recently performed TSH is abnormal.

In its report, the Committee recommended adding a new item for TFTs to include all three tests: TSH, free thyroxine and free T3, as this is clinically valuable and provides additional information in a subgroup of patients with markedly suppressed TSH.

On blood glucose tests the committee recommended deletion of the obsolete MBS item 66545 for OGTT and revision of the item descriptor and explanatory notes of OGTT item 66542 to allow testing for patients when HbA1c measurement is unreliable. The HbA1c testing item 66841 would be amended to include specific indications for asymptomatic patients tested for diabetes mellitus in the explanatory notes.

“The maximum number of permissible tests under item 66841 should be increased to two per year to reflect current guidelines,” the committee said.

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