MBS items for Practice Nurses

Immunisation
Health Assessments
The nurse role in chronic disease care
Diabetes Cycle of Care
Asthma Cycle of Care
Cervical Screening
Mental Health
Care Planning Items
Lifescripts
MBS Nurse Items

Immunisation

Division 1 nurses, and Division 2 nurses with appropriate qualification, may administer vaccines on behalf of a GP where directed by that GP. To comply with Victorian Drugs & Poisons regulations, the GP’s direction must include authority to take the vaccine/s from the fridge. The GP retains responsibility for the health, safety and clinical outcomes of the patient. The GP does not have to be present in the room but must be on the premises (unless the nurse has an Accredited Immunisation Provider certificate). Item 10993 can be used when a practice nurse gives vaccinations in the practice on behalf of a GP, providing the vaccines are registered under the Therapeutic Goods Act, are on the Australian Standard Vaccination Schedule, or are included in the Australian Immunisation Handbook. See MBS nurse items list below.

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Health Assessments

Health Assessment items are used for claims submitted to Medicare by a GP for assessments made by that GP. A nurse is not able to make an assessment. However, it is appropriate for the practice nurse to gather information which will ensure a full and accurate patient record on which to base the assessment. There is no need to state on the Medicare claim who did the information-gathering component of the assessment. The relevant GP items are: 700-702 for patients over 75 years; 704-706 for ATSI patients over 55 years; 710 for adult ATSI patients; 708 for child ATSI patients; 714-716 for Refugees and other Humanitarian Entrants; 718-719 for Intellectually Disabled patients.

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The nurse role in chronic disease care

Practice nurses can assist in chronic disease management (CDM) under the supervision of a medical practitioner. The doctor must ensure that the requirements of the particular item are met and claim only for the time in which they saw the patient, not the practice nurse time.

The nurse may be either Registered or Enrolled (Division 1 or 2) and must be registered with the relevant registration board of the State/territory in which they are employed. The nurse must have the minimum specified qualifications appropriate to the functions undertaken. Professional nursing standards require that a Registered Nurse must supervise an Enrolled Nurse. Supervision may be direct or indirect (e.g. by telephone, email or video link) but appropriate supervisory arrangements must be in place. [Adapted from : DoHA, Primary Care Division 2003]  

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Diabetes Cycle of Care

Providing that a doctor sees the patient with diabetes and assesses their condition, an appropriately trained and skilled practice nurse can recruit suitable patients, undertake checks such as blood pressure, BMI and feet examination, and review the patient’s diet, smoking and exercise. The nurse then reports back to the doctor who completes the remainder of the item requirements. The nurse can keep track of activities due, undertake recalls and reminders, ensure the correct item is claimed and record dates. Support material is available from the Division, and Resources and Links - Prevention and Chronic Disease. The relevant GP items are 2517-2526 & 2620-2635.

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Asthma Cycle of Care

GPs provide the majority of care for this item. However, an appropriately trained and skilled practice nurse can provide additional lifestyle information, reinforce the key messages conveyed by the doctor on asthma education, assist the patient with device use and undertake spirometry testing. S/he can ensure the patient’s record is up-to-date, including medication, keep track of checks due, undertake recalls and reminders, ensure the correct item is claimed and record dates. Support material is available from the Division, and Resources and Links - Prevention and Chronic Disease. The relevant GP items are 2664-77.

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Cervical Screening 

Practice nurses can take a cervical smear if they have undertaken appropriate training. Information of pap test provider courses can be found under Practice Nurses on the Links page. The doctor should review the pathology results. The relevant GP items are 2598-2616; see also MBS nurse items list below.

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Mental Health

A practice nurse cannot take part in delivery of a GP Mental Health Care Plan.

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Care Planning Items

Nurses can assist with the preparation and review of GP Management Plans and Team Care Arrangements by recruiting patients, booking appointments, managing recalls and reminders and ensuring the patient record is up to date and complete. The nurse can provide disease and lifestyle information, undertake checks, discuss suitable services with the patient, make contact with services, and draft the plan.

The doctor must discuss the service with the patient as part of obtaining consent, and must undertake an assessment of the patient that considers their current and future health care, and the patient’s goals. The doctor must supervise liaison with other members of the team and must review the final plan with the patient.

Where a nurse is providing a different kind of care or service to the patient in their own right (that is, independently of the services provided by the doctor and not under the supervision of the doctor), s/he may be counted as one of the members of the multidisciplinary care team and can collaborate in the development of the plan and contribute to its implementation.

CDM Care Planning is explained in detail in the MBS explanatory notes. Support material is available from the Division and at Resources and Links - Prevention and Chronic Disease. The relevant GP items are 721, 723, 725 & 727. For nurse care plan monitoring items see list below.

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Lifescripts

Lifescripts provides a framework for GPs, Practice Nurses and staff to assist patients to make healthier lifestyle choices. Lifescripts builds on the SNAP lifestyle risk factors - Smoking, Nutrition, Alcohol and Physical activity - and adds weight management as an additional risk factor. Implementing Lifescripts involves discussing risk factors with patients, setting lifestyle change goals, providing written lifestyle prescriptions, organising ongoing review of lifestyle risk factors, and referring patients to other services that support healthy lifestyle choices. For further information see ‘Lifescripts’ under Prevention and Chronic Disease Information at Resources and Links.

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MBS Nurse Items

For services provided by a practice nurse on behalf of a general practitioner:

• Item 10993: immunisation services provided by a practice nurse
• Item 10996: wound management services provided by a practice nurse
• Items 10994, 10995, 10998 and 10999: pap smear services and preventive checks provided by a practice nurse
• Item 10997: provision of monitoring and support for a person with a chronic disease by a practice nurse or registered Aboriginal Health Worker

Additional bulk billing payment can also be claimed where all of the conditions set out in paragraphs (a) to (d) of items 10990 & 10991 have been met.

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For Medicare Public Information phone 132 011.
For Medicare Claims Interpretation phone 9605 7964.

If further clarification is required, phone the Department of Health & Ageing EPC enquiries on 02 6289 8735, or email questions to: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Health Professionals intending to use these items should read the comprehensive information on each service which can be found in the MBS book, or at MBS Online website, found under Medicare at Resources and Links. Select ‘Search the MBS” and search by item number.

MBS Practice Nurse items, as at November 2007 can be found under Practice Nurses at Resources and Links.

Support material for nurses is available from impetus™ or can be found under Prevention and Chronic Disease Information on the Resources and Links page.