First Report from the Ear Nose and Throat (ent) Surgery Clinical Committee Tonsillectomy, Adenoidectomy & Insertion of Grommets



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Medicare Benefits Schedule Review Taskforce

First Report from the

Ear Nose and Throat (ENT) Surgery Clinical Committee - Tonsillectomy, Adenoidectomy & Insertion of Grommets

August 2016

Important note

The views and recommendations in this review report from the clinical committee have been released for the purpose of seeking the views of stakeholders.

This report does not constitute the final position on these items which is subject to:

Stakeholder feedback;

Then

Consideration by the MBS Review Taskforce;



Then if endorsed

Consideration by the Minister for Health; and

Government.

Stakeholders should provide comment on the recommendations via the online consultation tool.



Confidentiality of comments:

If you want your feedback to remain confidential please mark it as such. It is important to be aware that confidential feedback may still be subject to access under freedom of information law.


Table of Contents


1.Executive Summary 5

2.About the Medicare Benefits Schedule (MBS) Review 9

3.About the ENT Committee 12

4.MBS Item Group 1 – ENT Therapeutic Procedures 13

5.Adenoidectomy 15

6.Insertion of grommets 20

7.Tonsillectomy 25

8.Cauterisation 27

9.New item for Stroboscopy 32

10.MBS items which require no change 34

11.Items requiring no change 35

12.MBS Item Group 2 – Obsolete Items 35

13.Obsolete items 35

14.MBS Item Group 3 – Generic issues 37

15.Generic Issues 39

16.Recommendations Impact Statement 40

17.References 41

1.Acronyms and Abbreviations 42

18.Glossary 43

20.MBS items, Descriptors and Explanatory Notes 44

21.Summary for consumers 69

22.Stroboscopy Review 77

23.Data for items requiring no change 89


List of Tables




1.Executive Summary


The Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce) is undertaking a program of work that considers how more than 5,700 items on the MBS can be aligned with contemporary clinical evidence and practice and improves health outcomes for patients. The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe.

The Taskforce is committed to providing recommendations to the Minister that will allow the MBS to deliver on each of these four key goals:

Affordable and universal access

Best practice health services

Value for the individual patient

Value for the health system.

The Taskforce has endorsed a methodology whereby the necessary clinical review of MBS items is undertaken by Clinical Committees and Working Groups. The Taskforce has asked the Clinical Committees to undertake the following tasks:


  1. Consider whether there are MBS items that are obsolete and should be removed from the MBS.

  2. Consider identified priority reviews of selected MBS services.

  3. Develop a program of work to consider the balance of MBS services within its remit and items assigned to the Committee.

  4. Advise the Taskforce on relevant general MBS issues identified by the Committee in the course of its deliberations.

The recommendations from the Clinical Committees are released for stakeholder consultation. The Clinical Committees will consider feedback from stakeholders and then provide recommendations to the Taskforce in a Review Report. The Taskforce will consider the Review Report from Clinical Committees and stakeholder feedback before making recommendations to the Minister for consideration by Government.

The Ear, Nose and Throat (ENT) Surgery Clinical Committee (the Committee) was established in 2015 to undertake a review of relevant MBS items. Phase one of this review relied upon the clinical expertise of the members who sought advice from colleagues as necessary, as well as independent, targeted rapid evidence reviews of certain services.


1.1Areas of responsibility of the Ear, Nose and Throat Surgery Clinical Committee


The Taskforce identified 196 MBS items for review by the Committee (see Appendix A for full descriptions).

Otolaryngology and Audiology Diagnostic Procedures

11300 to 11339 (16 items)

General Surgery Items

30244 to 30259 (9 items) – procedures on the styloid process, parotid gland and associated structures, submandibular gland and associated structures

30265 to 30294 (12 items) – procedures on the salivary glands, tongue, intraoral tumours, branchial cysts and cervical esphagostomy

31400 to 31412 (5 items) – removal of tumours of the upper aerodigestive tract

Ear Nose and Throat Procedures

41500-41816, 41822, 41825, 41834- 41886, 41904, 41907, 41910 (145 items)

Audiology

82300 to 82332 (9 items) – services by audiologists on request from ENT specialists

Phase one of the review prioritised the items relating to tonsillectomy, adenoidectomy, insertion of grommets and identification of obsolete items. The remaining items are likely to be reviewed during phase two of the ENT review.


1.2Items referred to other Clinical Committees for review


Gastroenterologists are the main providers of items 41819 to 41820 and 41828 to 41832 for dilatation of stricture of upper gastro-intestinal tract and balloon dilatation of oesophagus (5 items). Therefore, these items were referred to the Gastroenterology Clinical Committee for review.

Thoracic medicine physicians are the main providers of items 41889 to 41898 and item 41905 for bronchoscopy (5 items). These items were referred to the Thoracic Medicine Clinical Committee for review.


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