Q&A Session – 21 October 2025
Q: If I am the admitting VMO for an ICU patient, who is the referring doctor?
- 🔍 Scope: This question relates to MBS referral requirements that apply to a small fraction of items claimed in ICU — in a setting, particularly in smaller hospitals, where intensivists may act as the primary admitting doctor.
🏥 The clinical scenario
- In most ICUs, patients are admitted under another specialist (e.g. physician or surgeon), with ICU providing supportive or consultative care.
- In these instances conventionally the referring doctor for ICU services is usually the admitting specialist.
- However, in smaller hospitals, patients may be:
- Admitted directly from the Emergency Department (ED) under the ICU specialist (e.g. admitting doctor),
- With another specialist only taking over care after ICU discharge.
- This is where the confusion around the admitting vs referring doctor often arises.
📄 Who is the referring doctor in this situation?
- ✅ If a referred service is performed while the patient is admitted under the intensivist (admitting doctor):
- The referring doctor can be the ED specialist who initially assessed the patient and requested the service.
- The referring doctor may also be another medical specialist in the hospital who requested the referred service.
- 🚫 The intensivist cannot refer to themselves.
🧾 Do ICU services ever require a referring doctor?
- ❌ Most ICU item numbers are non-referred services
- This means no referring doctor is required for admission, daily management, procedures or routine ICU care.
- ⚠️ Items that do require a referral:
- 🩻 Non self-determined Diagnostic imaging items (require a referral or diagnostic imaging request)
- 👨⚕️ Specialist consultation items
🔎 Practical application in ICU
- 🩻 Diagnostic imaging:
- Only relevant if the intensivist is performing imaging on the request of another practitioner.
- In reality, most imaging in ICU is self-determined as part of ongoing patient management → non-referred / non-requested.
- 👨⚕️ Specialist consultations:
- Typically relevant after ICU discharge, e.g.:
- TPN services
- Tracheostomy outreach
- In these cases, a referral is required, and the referring doctor is:
- The specialist who has taken over care on the ward
- If the Intensivist remains the admitting doctor after ICU discharge, the referring doctor would likely be the ED specialist
- Typically relevant after ICU discharge, e.g.:
⚠️ Important compliance points
- A referral is almost never required for ICU patients, but there are certain rare exceptions.
- If a referring doctor is required, details do not always need to be included in the claim submission, but:
- 📌 Referral must exist,
- 📌 It must be appropriately documented,
- 📌 It must be available if audited.
- Of routinely used ICU attendance items, only specialist/physician consultation items are referred services.
- 🚫 The following attendances are non-referred services:
- Emergency attendance items (160–164)
- Goals of care planning (13899)
🧩 Practical takeaway
- ⚠️ Admitting VMO does not always equal referring doctor
- In ICU, most services are non-referred, but when a referral is required:
- It must come from an independent practitioner (other than the Intensivist),
- And be clearly documented, even if not submitted.
More info: 👉 Visit our Learning Center 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.
