Welcome back to Navigating the Maze, ClaimLogic’s ongoing series helping intensive care clinicians and billing teams master the complexities of Medicare Benefits Schedule (MBS) compliant billing. In Part 1, we introduced the five major groups of ICU item numbers. Here in Part 2, we explore the backbone of ICU billing: daily ICU management, monitoring, and organ support.
These items reflect the continuous, high-acuity care delivered in ICUs. When used correctly, they ensure appropriate reimbursement and compliance. When misused—or neglected—they can result in significant revenue leakage, rejections or audit risk.
🔹 Important Context – Who Can Bill and Where
Before billing any ICU daily management or monitoring item numbers, it’s important to understand the two essential MBS requirements that must be met for managing icu care:
1. Location – Must Be a Designated Intensive Care Unit
As per MBS Note TN.1.9:
Items 13870 to 13888 are only payable when the service is provided in a location that satisfies the MBS definition of an intensive care unit – requirements relate the ability to provide advanced organ support, monitoring as well as staffing both at senior, junior and nursing levels.
These items cannot be claimed in CCUs, wards, theatres, or recovery—even if the level of care is equivalent.
2. Practitioner – Must Be Exclusively Rostered to ICU
‘Immediately available’ means that the intensivist must be predominantly present in the ICU during normal working hours. Reasonable absences from the ICU would be acceptable to attend conferences, meetings and other commitments, which might involve absences of up to 2 hours during the working day, provided suitable cover is available. Outside normal working hours the specialist must be immediately contactable and, if required, available to return to the ICU within a reasonable time.
🔹 Daily ICU Management Item Numbers
13870 – ICU Management on the First Day
Management of a patient in an intensive care unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care, including all attendances, electrocardiographic monitoring, arterial sampling, and bladder catheterisation—management on the first day.
🔸 Claimable once per ICU admission – on the first day.
🔸 Includes all attendances by the treating ICU specialist (there is no item number for after hours attendances or callbacks).
🔸 Can not co-claim with consultation items (104, 105, 110, 116) or emergency attendances (160–164) on the same day.
🔸 Other specialists involved in the patient’s care may claim appropriate consultation items where justified.
🔸 Billing is by calendar day, not shift or time spent.
🔸 If a patient is in ICU for only a short duration and receives minimal management, the day should not be billed.
🔸 Cannot be claimed on the same day as 13899 (Goals of Care discussion) – this item implies the patient is not admitted to ICU.
🔗 View MBS Item 13870
13873 – ICU Management on Subsequent Days
Management of a patient in an intensive care unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care, including all attendances, electrocardiographic monitoring, arterial sampling, and bladder catheterisation—management on each day subsequent to the first.
🔸 Claimable once per calendar day after the first day during the ICU admission.
🔸 Same restrictions and inclusions apply as 13870.
🔸 Not claimable by multiple ICU specialists for the same patient/day.
🔗 View MBS Item 13873
🔹 Invasive Monitoring Item Numbers
13876 – Invasive Pressure Monitoring
Central venous pressure, Systemic arterial preussre, Pulmonary arterial pressure, Intra-cardiac pressure. Continuous monitoring by indwelling catheter, in an intensive care unit, managed by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care – once only for each type of pressure on any calendar day (up to a maximum of 4 pressures)
🔸 Claimable once per pressure per calendar day.
🔸 Up to 4 distinct pressures can be claimed each day (arterial, central venous, pulmonary arterial, cardiac intra-cavity)
🔸 Repeat readings of the same pressure do not qualify for multiple claims
🔸 Includes interpretation and adjustment of monitoring systems.
🔸 If monitoring is performed under anaesthesia in theatre, use 22012 (same 4-pressure limit applies).
🔸 If monitoring is performed outside of ICU by non-ICU role clinicians, 11600 may be appropriate (same 4-pressure limit applies).
🔗 View MBS Item 13876
13830 – Intracranial Pressure Monitoring
Intracranial pressure, monitoring of, by intraventricular or subdural catheter, subarachnoid bolt or similar, by a specialist or consultant physician—each day .
🔸 Claimable once per calendar day.
🔗 View MBS Item 13830
🔹 Ventilation
13882 – Ventilatory Support Management
Management on each day, in an intensive care unit, of invasive or non-invasive ventilatory support (where the only alternative to non-invasive ventilatory support would be invasive ventilatory support) of a patient, by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care.
🔸 Claimable once per calendar day.
🔸 Applies to invasive and non-invasive ventilation for respiratory failure.
🔸 High Flow Nasal Oxygen (HFNO) or established CPAP for OSA or similar indication is not considered non-invasive ventilation under MBS rules.
🔗 View MBS Item 13882
🔹 Renal Replacement Therapy
13885 – First Day of CRRT
Management on the first day, in an intensive care unit, of continuous renal replacement therapy (CRRT), by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care.
🔸 Claimable once per CRRT episode on the first day.
🔸 May be billed even if item 13100 (haemodialysis or peritoneal dialysis) was billed earlier the same day—provided clinical escalation to CRRT is justified and documented.
🔗 View MBS Item 13885
13888 – Subsequent Days of CRRT
Management on each day, subsequent to the first day, in an intensive care unit, of continuous renal replacement therapy (CRRT), by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care.
🔸 Claimable once per calendar day following the first.
🔸 Same rules apply regarding overlap with 13100.
🔗 View MBS Item 13888
🔹 Intra-Aortic Balloon Pump (IABP)
13848 – IABP Support
Counterpulsation by intra‑aortic balloon‑management, including associated consultations and monitoring of parameters by means of full haemodynamic assessment and management on several occasions on a day
🔸 Claimable once per calendar day and includes all related attendances.
🔗 View MBS Item 13848
🔹 ECMO
13834 – First Day of VA ECMO Management
Veno–arterial cardiopulmonary extracorporeal life support, management of—the first day
🔸 Claimable once per VA ECMO episode.
🔗 View MBS Item 13834
13835 – Subsequent VA ECMO Management
Veno–arterial cardiopulmonary extracorporeal life support, management of—each day after the first.
🔸 Claimable once per calendar day after the first during VA ECMO support.
🔗 View MBS Item 13835
13837 – First Day of VV ECMO Management
Veno-venous pulmonary extracorporeal life support, management of—the first day.
🔸 Claimable once per VV ECMO episode.
🔗 View MBS Item 13837
13838 – Subsequent VV ECMO Management
Veno-venous pulmonary extracorporeal life support, management of—each day after the first.
🔸 Claimable once per calendar day after the first during VV ECMO support.
🔗 View MBS Item 13838
Note: For complex configurations such as VAV ECMO, billing should occur under the VA ECMO item numbers (13834 and 13834) only, as these reflect the higher level of complexity. It is usually not appropriate to bill both VA and VV items concurrently for the same episode.
🔹 Mechanical Circulatory Support (VAD / Impella)
13851 – First Day of Management of Ventricular Assist Device
Ventricular assist device (excluding intravascular microaxial ventricular assist device inserted into the right ventricle), management of, for a patient admitted to an intensive care unit for implantation of the device or for complications arising from implantation or management of the device—first day.
🔸 Claimable once per episode.
🔸 Includes only left-sided microaxial devices; right-sided microaxial catheters are explicitly excluded.
🔸 The ICU admission must be directly related to implantation, complication or management of the device.
🔗 View MBS Item 13851
13854 – Subsequent Days of Management of Ventricular Assist Device
Ventricular assist device (excluding intravascular microaxial ventricular assist device inserted into the right ventricle), management of, for a patient admitted to an intensive care unit, including management of complications arising from implantation or management of the device—each day after the first day.
🔸 Claimable once per calendar day after the first during VAD/Impella support.
🔗 View MBS Item 13854
🔹 Special Claiming Rules and Edge Cases
🔸 First vs Subsequent Day Claiming
- First-day item numbers (e.g. 13870, 13834, 13837, 13851, 13885) will generally be rejected unless at least two calendar days have passed since the last claimable day of the previous episode. Although it could be argued that for example a discharge and a readmission to ICU the following day for an unrelated (new) indication should be classified as a first day of new admission for this new indication, in practice to avoid an almost guaranteed rejection, it is pragmatic practice to bill a subsequent day instead.
- Restarting support after a pause (e.g. CRRT) within the same admission usually falls under subsequent day billing.
- However, re-cannulation procedures (e.g. for ECMO) clearly indicate a new episode, and first-day billing is justified.
🔸 Transfers Between Hospitals
- Daily ICU item numbers can only be claimed by a single specialist per calendar day.
- In principle, treating teams should agree on who will claim the service if interhospital transfer occurs.
- In practice, this often follows a “first in, best dressed” approach.
- If the transfer occurs early in the day, the receiving team may claim; if late, the transferring team may be more appropriate.
🔸 On-Call Arrangements
Due to the per calendar day payment structure, issues may arise with after midnight attendances on the day of clinical handover to another specialist. Since only a single intensivist may bill item 13870 or 13873 for a given ICU day, it is essential that the group has an agreement in place to handle these situations fairly and consistently.
This limitation does not apply to procedures performed during the attendance, which can be billed by the attending intensivist. In resuscitation scenarios—particularly when the intensivist is involved prior to ICU admission in the emergency department, operating theatre, or ward—emergency attendance items (160–164) may be appropriate to bill.
✅ Summary
Daily ICU management and monitoring items form the foundation of compliant ICU billing. They reflect the continuous and resource-intensive care delivered in ICU and are subject to strict conditions of use.
By understanding:
- When first vs subsequent day claims apply,
- What support each item truly covers, and
- The responsibilities of the billing practitioner,
…clinicians can reduce audit risk and ensure that ICU services are fairly and accurately reimbursed.
ClaimLogic’s platform supports ICU management & practice by automatically validating these conditions and providing alerts and corrections when combinations are non-compliant—saving time and protecting revenue.
Let us help you streamline your billing.
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🔜 Next in our series: Procedural Item Numbers – CVCs, Lines, and More
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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 for actions taken based on the content of this article.
