Education Guide - Billing abandoned or discontinued surgery
Information about billing abandoned or discontinued surgical procedures, assistance at surgery and anaesthesia.
We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.
Abandoned or discontinued surgery is where a patient’s operative procedure is commenced, but is stopped before completion. This could be due to medical reasons, equipment failure or other reasons.
Commenced means the patient is:
- in the procedure room, or on the bed or operation table where the procedure will take place
- anaesthetised, or the operative site is anaesthetised for the procedure
- positioned, or the operative site is prepared with antiseptic or draping.
Surgical item 30001
Item 30001 applies when you’ve abandoned an operative procedure for one or more items in Category 3, Group T8.
Item 30001 is a derived fee item. It applies half of the schedule fee for the T8 item it is billed with. You need to list item 30001 below the abandoned T8 item so we can calculate the correct schedule fee.
If you perform multiple operations, you need to bill item 30001 under each abandoned T8 item. The multiple operation rule applies to abandoned procedures.
Read more about the multiple operation rule on our Education guide for billing multiple MBS items.
You need to provide an individual charge for each T8 item number billed. If you submit claims for abandoned surgery via an electronic channel, you will also need to supply an individual charge for item 30001. The minimum charge amount accepted is $1.00. To calculate the total charge for the abandoned service, we'll add the charge for item 30001 to the charge for the surgical item that's claimed above it.
We’ll reject electronic claims that aren’t itemised in the correct order.
Billing for abandoned procedures
This table outlines billing scenarios for abandoned surgery.
|Scenario||MBS item billing||Item notes|
|Abandoned before a T8 item commenced||Bill only the proposed T8 item for the procedure with the highest schedule fee, followed by item 30001.||Include a note against the procedure item saying it was abandoned.|
|Abandoned after a T8 item commenced but before any T8 item was completed||Bill all T8 items for the planned procedures and follow each item with item 30001.||Include a note against each procedure item billed saying it was abandoned.|
|One or more T8 items completed, and one or more T8 items abandoned||
Bill any T8 items for completed procedures. Don’t follow them with item 30001.
Bill all T8 items for additional planned procedures. Follow each with item 30001.
|Include a note against each procedure item billed to advise if it was completed or abandoned.|
Assistance at an abandoned surgery - items 51300 and 51303
The service still attracts a benefit if you assisted at an abandoned surgery for an item or items that include the word ‘Assist’.
If the total schedule fee is above the threshold in item 51303, bill this item. Otherwise, 51300 applies.
When billing, include a note saying assistance at abandoned surgery and list the surgical item or items.
To select the right assistance item number, you need to calculate the correct surgeon’s fee.
To do this:
- Only include item numbers with ‘Assist’ in the item description.
- If the procedure was abandoned before surgery commenced, use only the item with the highest schedule fee.
- Use 100% of the schedule fee for completed item numbers.
- Use 50% of the schedule fee for abandoned item numbers.
- Apply the multiple operation rule.
Assistance at a multiple operation with some items completed and some abandoned.
- Item A (Assist) - $300 @100% (completed) and @100% (multi op) = $300
- Item B - (Assist isn’t in the item description ) $250 = $0
- Item C (Assist) - $200 @ 50% (abandoned) and @50% (multi op) = $50
- Item D (Assist) - $150 @50% (abandoned) and @25% (multi op) = $18.75
- Total fee = $368.75.
You bill assistant item 51300. This is because the total fee for the surgery is under the threshold described in the item description.
Assistance at abandoned operation after the procedure commenced, but due to equipment failure none of the item numbers commenced.
- Item E (Assist) - $2,000 @50% = $1,000
- Item F (Assist) - because the procedure was abandoned before an item number commenced, you only apply the item with the highest schedule fee = $0
- Total fee = $1,000.
You can bill item 21990 if:
- a procedure is abandoned before surgery commences
- the patient was anaesthetised
- the surgical item has ‘Anaes.’ in the item description.
If the surgery has commenced, bill the relevant initiation of management of anaesthesia item.
When billing item 21990 this must be claimed with a time unit value item (23010 – 24136) that reflects the total time of the anaesthesia. If other anaesthetic modifier items apply they’ll need to be processed in the same claim (items 25000 – 25020).
You may also bill it with a therapeutic and diagnostic imaging service item (22002 – 22075).
When claiming for item 21990 you’ll need toinclude a note listing the surgical item or items that were abandoned.
Read more about:
Contact us for Medicare provider enquiries.
Provide your feedback on our education resources.
Page last updated: 15 April 2021
This information was printed 8 June 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/education-guide-billing-abandoned-or-discontinued-surgery/46561. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.