Update on Co-claiming MBS item 36812

ANZAUS recently sought clarification from the Department of Health and Aged Care as to whether it is appropriate to claim item 36812 concurrently with item 18375 or 18379.

The Urology Policy Team of the Department has advised that these items should NOT be claimed together. Therefore, in accordance with this directive from the Department, ANZAUS advises that members should NOT co-claim item 36812 with either item 18375 or 18379. The response from the Department was as follows:

We would not consider it appropriate to claim item 36812 (urethral dilatation) with item 18375 or 18379 (intravesical Botox).

The following clauses in the item descriptors indicate that they should not be claimed together:

18375 & 18379: “intravesical injection of, with cystoscopy”

Item 36812: “other than a service associated with any other urological endoscopic procedure on the lower urinary tract.”

Given that the lower urinary tract includes the bladder, a cystoscopy would constitute an endoscopic procedure on the lower urinary tract. Because this is a requirement component of the Botox items, it would restrict the co-claiming of item 36812.