Twelve-lead electrocardiography, trace and clinical note, by a medical…

There are four 12-lead electrocardiography items:

·         Item 11704 for a trace and formal report service performed by a specialist or consultant physician.

·         Item 11705 for a formal report service performed by a specialist or consultant physician, where the specialist reports on a trace.

·         Item 11707 for a trace service performed by a medical practitioner, including general practitioners for the purpose of forwarding to a specialist or consultant physician for a formal report.

·         Item 11714 for trace and clinical note service performed by any medical practitioner, including general practitioners, specialists and consultant physicians.

Hospital Treatment

Items 11704, 11707 and 11714 do not apply where a patient is receiving services as part of an episode of hospital treatment or hospital-substitute treatment. Item 11705 can be performed out-of-hospital or as hospital treatment or hospital-substitute treatment.

Requested service

a) Items 11704 and 11705 are requested services which require the rendering specialist or consultant physician to produce a written formal report which must be provided to the requesting practitioner. The rendering specialist or consultant physician cannot perform the service unless it has been requested by another medical practitioner.

b) As a requested service, it is generally not expected that items 11704 or 11705 would involve any clinical work beyond performing the formal report (and the trace for item 11704). The MBS Review Taskforce recommended that an attendance should not be co-claimed with a diagnostic cardiac investigation in these circumstances. Item 11704 cannot be claimed if the rendering specialist or consultant physician has performed an attendance on the same patient on the same day.

Generally, it is expected that item 11705 should not be co-claimed with an attendance, but in exceptional clinical circumstances an attendance can be performed i.e. an admitted patient requires a formal report (on a trace) to be provided by a cardiologist and the result of this reporting determines that an urgent attendance (life threatening) is required by the cardiologist to guide immediate treatment (particularly when there is only one cardiologist rostered on the shift).

Financial relationship

For services provided under items 11704 and 11705, the rendering specialist or consultant physician and the requesting practitioner cannot have a financial relationship. Definition of ‘financial relationship’: is where the requesting practitioner is a member of a group of practitioners of which the providing practitioners is a member (both the requestor and provider potentially financially benefit from the MBS service provided). The need for a request should be informed by a clinical decision only.

Item 11705

Only applicable for an ECG that has not been previously reported on.

Item 11707

Item 11707 is a trace only service for the purpose of forwarding to a specialist or consultant physician for a formal report and can be performed by any medical practitioner, including general practitioners.

Item 11714

Item 11714 is a trace and clinical note service. The trace and clinical note will ensure the service:

• has used the ECG to inform clinical decision making during an attendance (or immediately following an attendance);
• details the clinical indication for the service in the clinical note;
• includes the interpretation in the context of the indication for the service in the clinical note; and
• does not require a formal report.

The clinical note must include:

1. comments on the significance of:

1. the trace findings; and 
2. the relationship of the trace findings to clinical decision making for the patient in the clinical context; and

       b. an interpretation that is not based solely on measurements or diagnoses automatically generated from the trace.

Item 11714 allows medical practitioners, including general practitioners, specialist and consultant physicians to perform an electrocardiography trace and interpret the results (in the form of producing a written clinical note) where they consider it necessary for the management or treatment of the patient. No request is required for this service. There is no limitation on the claiming of an attendance with item 11714, as the Taskforce agreed that performance of an electrocardiography was part of routine assessment for patients presenting to medical practitioners, including general practitioners, specialist and consultant physicians for management of their cardiac condition.