Lipoma item numbers – March 2017

Lipoma item numbers

 

Lipoma item numbers have been in disarray since the new tranche of skin numbers was introduced last year. The problem is that when \”mucosa\” was intentionally separated from the skin items, the term \”and subcutaneous tissues\” was inadvertently removed at the same time. This left us with only the large lipoma number 31345 for lesions deep to fascia or greater than 5 cm diameter and two numbers left over in the multiple skin section. eg 31220 for 4 to 10 lesions less than 1cm in diameter and 31225 for more than 10 lesions that are less than 1cm in diameter. This leaves a significant gap in services.

We asked that the new benign skin numbers include \”and subcutaneous tissue\”. In addition to the lipoma problem, true sebaceous cysts with no skin connection, are now excluded from surgery except in the limited circumstances that they happen to fit into a 4-10 category (rare)

We raised the issue last year with the Health department and they  suggested the use of 30075.  I countered saying that this was an inappropriate use of the number:

30075: DIAGNOSTIC BIOPSY OF LYMPH GLAND, MUSCLE OR OTHER DEEP TISSUE OR ORGAN, as an independent procedure, where the biopsy specimen is sent for pathological examination.

The department replied:

In relation to the lipoma issue you have raised, the Department has noted your concern in relation to those lipomas particularly those greater than 1cm in diameter but less than 5 cm in diameter as well as the clinical scenario of multiple lesions.  I also note your concern about items 30074/5 as not being optimal items, if clinically relevant, for the management of multiple lipomas with this diameter range as well as the issue of complex dissection of lipomas in challenging anatomical locations of this diameter size..

I have been advised that the most appropriate forum to review the lipoma issue is the MBS Review Taskforce and although you previously expressed concern that this process may potentially take some time, it is proposed that the Plastic and Reconstructive Clinical Committee of the Review will commence it work in the early part of 2017 as part of the 4th tranche of MBS items being reviewed as part of Taskforce process. It is currently proposed that this committee will look at 214 MBS items

 

This means that until the review, there is no way to bill for a lipoma that doesn\’t fit into the 31345 category or the numbers 31220 and 31225.

It has now become apparent that our services review will be pushed out to next year.

The AMA has taken up this negotiation for us and we await resolution. In the meantime, I suggest that if a member uses 30075, they restrict it to lesions suspicious for malignancy and keep good notes on why they thought the lesion was suspicious.

 

Regards,

Dan Kennedy

Chair Therapeutic Procedures Committee