8. Restriction of items8. Restriction of items

8. Restriction of items

Restriction on items 11704, 11707, 11714, 11716, 11717, 11723 and 11735 —location of service

(1) Items 11704, 11707, 11714, 11716, 11717, 11723 or 11735 do not apply to a service if the patient is an admitted patient.

Restriction on items 11704 and 11705—financial relationship

(2) Items 11704 or 11705 do not apply to a service if the medical practitioner who renders the service has a financial relationship with the requesting practitioner.

Restriction on items 11729 and 11730—patient limitations

(3) Items 11729 or 11730 do not apply to a service unless:

(a) the patient’s body habitus, or other physical condition, is suitable for exercise stress testing or pharmacological induced stress testing; and

(b) the patient can complete the exercise sufficiently or respond adequately to pharmacological induced stress, to take the required measurements/

(4) Item 11729 does not apply to a service performed on a patient who:

(a) is asymptomatic and has a normal cardiac examination; or

(b) has a known cardiac disease but the absence of symptom evolution suggests the disease has not progressed and the service is used for monitoring; or

(c) has an abnormal resting electrocardiography result which would prevent the interpretation of results.

(5) Item 11730 does not apply to a service performed on a patient who is asymptomatic and has a normal cardiac examination.

Restriction on items 11729 and 11730—personnel limitations

(6) Items 11729 or 11730 do not apply to a service unless one of the persons, as described in subparagraphs b(iv) and (v) of the descriptors of those items (column 2 of the table at Schedule 1), is a medical practitioner.

Restriction on items 11704 and 11705—services performed on the same day as an attendance

(7) Item 11704 does not apply to a service if the specialist or consultant physician who performs the service has performed a service to which an attendance applies for the same patient on the same day.

(8) Item 11705 does not apply to a service if the specialist or consultant physician who performs the service has performed a service to which an attendance applies for the same patient on the same day, unless exceptional circumstances exist.

(9) For the purpose of subsection 8(8), exceptional circumstances means there has been a significant change in the patient’s clinical condition or care circumstances that necessitates the performance of the attendance.

Restriction on items 11716, 11717, 11723, 11729 or 11735 —requested services performed on the same day as an attendance