An MBS review takes a softly softly approach to the use of PE rule out criteria before referring patients for imaging.

The report from the Diagnostic Imaging Clinical Committee on pulmonary embolism and deep vein thrombosis found use of MBS items for PE imaging was ‘reasonable and compatible with clinically appropriate imaging use’.

The items were CT (57351 and 57356), lung perfusion (61328), lung ventilation (61340) and a combined lung perfusion and ventilation study (61348).

The report recommended the introduction of a MBS explanatory note that doctors referring patients with suspected PE become familiar with RANZCR Choosing Wisely advice:

Don’t request any diagnostic testing for suspected pulmonary embolism (PE) unless indicated by Wells Score (or Charlotte Rule) followed by PE Rule-out Criteria (in patients not pregnant). Low risk patients in whom diagnostic testing is indicated should have PE excluded by a negative D dimer, not imaging.

However the Committee advised against replacing imaging tests with PE-rule out tools or incorporating them into MBS item descriptors.

The report made a similar recommendation for DVT ultrasound and also recommended against co-claiming duplex scanning for both DVT and chronic venous disease.

The report is open for consultation until Friday 21 July.