Q&A Session – 30 September 2025
Q: If I provided anaesthesia for a percutaneous tracheostomy and performed a bronchoscopy, why was it rejected?
🔍 Scope: This issue relates to how anaesthetic services are defined under the Medicare framework and how they interact with procedural items.
🩺 Key principle:
- A fundamental rule in the MBS is that the person performing a procedure and the person providing the anaesthetic cannot be the same practitioner.
🚫 Why the claim was rejected:
- Any Therapeutic Procedure (Category 3) item that is classified as a Surgical Operation (Subgroup T8) cannot be claimed by the same doctor who is billing an Anaesthesia (Relative Value Guide – RVG) item.
- In this scenario, providing anaesthesia for a percutaneous tracheostomy and personally performing a bronchoscopy breaches this separation-of-roles rule.
📝 Practical nuance:
- The claim can be annotated to clarify that the bronchoscopy was not the surgical procedure to which the anaesthetic related.
- However, in practice payment is often still problematic, as Services Australia validation rules may continue to link the procedural and anaesthetic services to the same practitioner.
⚠️ Important compliance point: Combining anaesthesia and Category 3 surgical procedures under the same provider is a common cause of rejections.
More info: 👉 Read our related blog Navigating the Maze: Part 3: Common Items for ICU Procedures Explained and watch the full Q&A video for further discussion:
Disclaimer
This blog is provided for educational and general informational purposes only and does not constitute legal, medical, or financial advice. While every effort has been made to ensure accuracy, billing requirements under the Medicare Benefits Schedule (MBS) are complex and subject to change. Clinicians should always consult the official MBS, relevant hospital policies, or seek independent professional advice before making billing decisions. While we use reasonable effort to ensure that our overview articles are accurate, current and complete, we do not represent, warrant, or guarantee (to the maximum extent permitted by law) their accuracy, currency, or completeness or imply that they are applicable to your individual situation. ClaimLogic accepts no liability arising from actions taken based on the content of this article.
