When it comes to ECLIPSE, it can be hard to get your head around all the different processes and methods for managing different types of claims. To make things easier, this guide outlines the process for Anaesthetic ECLIPSE Billing.
Please note: The advice provided in this article is based on user experiences and previous advice from Medicare; for clarification regarding any of the requirements outlined here, please contact Medicare directly.
Before you begin
Before you begin, it's beneficial to know why anaesthetic services need to be billed in such a particular way.
The Relative Value Guide (RVG) structure is based on a unit system which reflects the complexity of the service and the time the service took. Under this structure, the Medicare Benefits Schedule (MBS) fee for an anaesthetic service in conjunction with a procedure comprises up to four unit components, represented by one or more MBS items. These unit numbers need to go on an invoice / ECLIPSE claim in a particular order to be paid.
Note that the requirement for a referral is dependent on the type of anaesthetic service performed.
Invoicing - No Referral Present
This will be the majority of all anaesthetic ECLIPSE claims.
For this situation, add the items to the one voucher in the following order:
- Pre-anaesthesia consult item (17610-17625)
- Procedure related item(s) (Basic Unit Value item), e.g. 20810 or 20140. A Medicare benefit is payable for one Basic Unit Value item only
- Time Unit item (23010 - 24136)
- Physical modifier where applicable (25000 - 25010)
- Age modifier where applicable (25015)
- In Hours Emergency Modifier where applicable - (25020 - note this item cannot be claimed with the After Hours Emergency Modifier 25025)
- Therapeutic/Diagnostic Service/s - where applicable (22001 - 22055, 22065 - 22075)
- Emergency After Hours Modifier (25025 - note: this item cannot be claimed with the Emergency Modifier 25020)
If you have a referral for your patient then the items need to be invoiced as per the steps below.
The items can be transmitted in the same ECLIPSE claim but need to be added to separate vouchers to avoid rejection.
Voucher 1: This voucher must contain referral information
1. Pre-anaesthesia consult item (17640 -17655)
Voucher 2: This voucher must not have any referral information
2. Procedure related item e.g. 20810 or 20140
3. Time Unit item (23010 - 24136)
4. Physical modifier where applicable (25000 - 25010)
5. Age modifier where applicable (25015)
6. Emergency Modifier where applicable - (25020 - note this item cannot be claimed with the After Hours Emergency Modifier 25025)
7. Therapeutic/Diagnostic Service(s) - where applicable (22001 - 22055, 22065 - 22075)
8. Emergency After Hours Modifier (25025 - note: this item cannot be claimed with the Emergency Modifier 25020)
Additional Requirements for Anaesthetic Accounts
All accounts must:
- Include account requirements listed in MBS explanatory note G7.1
- Show the name(s) of the medical practitioner(s) that performed the associated procedure(s)
- Have the appropriate time item
Accounts for after-hours emergency anaesthesia or perfusion items must include:
- The start, end and total time professional attention was provided to the patient during the anaesthetic
Accounts for assistance in the administration of anaesthesia must show:
- The name of the principal anaesthetist and proceduralist
- The start, end and total time the assistant anaesthetist provided professional attention to the patient
Clinical details must be lodged with any claims for MBS item 21965 or 21997 as the item descriptors for these items contain the phrase ‘where it can be demonstrated that there is a clinical need for anaesthesia’.
Cosmetic surgery and associated services do not attract Medicare benefits. Accounts for anaesthetic services associated with cosmetic surgery should be clearly identified.
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