Part 1Rules of interpretation

Part 1 Rules of interpretation

1 Interpretation of Table

(1) In this Table:

patient episode means:

(a) a pathology service or pathology services (other than a pathology service to which paragraph (1) (b) refers) provided for a single patient whose need for the service or services was determined under subsection 16A of the Act:

(i) on the same day; or

(ii) if more than 1 test is performed on the 1 specimen within 14 days — on the same or different days.

whether the services:

(iii) are requested by 1 or more practitioners; or

(iv) are described in a single item or in more than 1 item; or

(v) are rendered by 1 approved pathology practitioner or more than 1 approved pathology practitioner; or

(vi) are rendered on the same or different days; or

(b) a pathology service to which rule 4 refers that is provided in the circumstances set out in that rule that relates to the service.

recognised pathologist means a medical practitioner recognised as a specialist in pathology by a determination under section 3D or subsection 61 (3) of the Act.

serial examinations means a series of examinations requested on 1 occasion whether or not:

(a) the materials are received on different days by the approved pathology practitioner; or

(b) the examinations or cultures were requested on 1 or more request forms by the treating practitioner.

the Act means the Health Insurance Act 1973.

(2) In these Rules, a reference to a request to an approved pathology practitioner includes a reference to a request for a pathologist-determinable service to which subsection 16A (6) of the Act applies.

(3) A reference in this Table by number to an item that is not included in this Table is a reference to the item that has that number in the general medical services table or the diagnostic imaging services table, as the case requires.

(4) A reference to a Group in the Table includes every item in the Group.

2 Precedence of items

(1) If a service is described:

(a) in an item in general terms; and

(b) in another item in specific terms;

only the item that describes the service in specific terms applies to the service.

(2) Subject to subrule (3), if:

(a) subrule (1) does not apply; and

(b) a service is described in 2 or more items;

only the item that provides the lower or lowest fee for the service applies to the service.