(ii) Part 3 of the diagnostic imaging services table; or
(iii) Part 3 of the general medical services table; and
(b) in a reference immediately followed by a number — the item so numbered.
patient episode means:
(a) a pathology service or pathology services (other than a pathology service to which paragraph (b) refers) provided for a single patient whose need for the service or services was determined under section 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 relate 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.
(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 to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.
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.
(3) If an item is expressed to include a pathology service that is described in another item, the other item does not apply to the service in addition to the first-mentioned item, whether or not the services described in the 2 items are requested separately.
3 Circumstances in which services rendered following 2 requests to be taken to have been rendered following 1 request
(1) In subrule (2), service includes assay, estimation and test.
(2) Two or more pathology services (other than services to which, under rule 4, this rule does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:
(a) the services are listed in the same item; and
(b) the patient’s need for the services was determined under subsection 16A (1) of the Act on the same day even if the services are rendered by an approved pathology practitioner on more than one day.
4 Services to which rule 3 does not apply
(1) Rule 3 does not apply to a pathology service described in item 66500, 66503, 66506, 66509, 66512, 66515 or 66584 if:
(a) the service is rendered in relation to a single specimen taken on each of not more than 4 occasions in a period of 24 hours; and
(b) the service is rendered to a patient in a hospital unit where:
(i) the presence of 1 nurse is required for each group of not more than 4 patients; and
(ii) the condition of the patients is continuously observed in relevant respects; and
(c) in order to render the service, an approved pathology practitioner who is a recognised pathologist has to arrange for a member of the laboratory staff of the approved pathology authority concerned to undertake duties in respect of the service that are in addition to the usual duties of the staff member; and
(d) the account for the service is endorsed ‘Rule 3 Exemption’.
(2) Rule 3 does not apply to any of the following pathology services:
(a) estimation of prothrombin time (INR) for a patient undergoing anticoagulant therapy;
(b) quantitative estimation of lithium for a patient undergoing lithium therapy;
(c) a service described in item 65070 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy;
(d) a service described in item 65070 in relation to
clozaril, ticlopidine hydrochloride, methotrexate, gold, sulfasalazine or penicillamine therapy of a patient;
(e) a service described in item 66500 in relation to methotrexate therapy of a patient;
(f) quantitative estimation of urea, creatinine and electrolytes in relation to:
(i) cis-platinum therapy of a patient; or
(ii) chronic renal failure of a patient being treated in a dialysis program conducted by a recognised hospital;
(g) quantitative estimation of albumin and calcium in relation to therapy of a patient with vitamin D, its metabolites or analogues;
if:
(h) under a request for a service, other than a request for a service described in paragraph (a), no more than 6 tests are requested; and
(i) the tests are performed within 6 months of the request; and
(j) the account for the service is endorsed ‘Rule 3 Exemption’.
5 Item taken to refer only to the first service of a particular kind
(1) For an item in Group P1 (Haematology):
(a) if pathology services of a kind referred to in item 65090 or 65093 are rendered for a patient during a period when the patient is in hospital, the item applies only to the first pathology service of that kind rendered for the patient during the period; and
(i) tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out in relation to a patient episode; and
(iii) in response to a request made within 14 days of the patient episode, further tests (except tests mentioned in item 65099, 65102, 65105 or 65108) are carried out on the stored material;
(2) Items 65102 and 65108 apply only if a minimum of 6 units are issued for a patient’s care in any 1 day.
(3) For items 65099 and 65102:
compatibility tests by crossmatch means that, in addition to all the tests described in paragraphs (a) and (b) of the item, donor red cells from each unit must have been tested directly against the serum of the patient by 1 or more accepted crossmatching techniques.
Part Part 2 - Health Insurance (Pathology Services Table) Regulations 2000 - Rules of interpretation | Zoe