Multiple operation rules

Multiple operation rules

For surgeons and assistant surgeons, where there are several billable surgical items on an invoice the appropriate Multiple Operation Rule will apply. CESoft will apply the appropriate rule when you select a fund.

In most cases this is the MBS rule which pays 100% of the surgical item with the highest value, 50% of the second item and 25% for all subsequent items.  Surgical items are all items in Group T8  of the CMBS other than Subgroup 12 (amputations items 44325 - 44376) which are paid at 100% for each item. 

The AMA rules pay 100% of the item with the highest value, and 75% of all subsequent items. The exceptions here are for amputations, dislocations, and fractures which always pay at 100%, and for some spinal and neurosurgical items MZ731 to MZ871 (MBS 51011 to 51171) which also pay at 100%.

WorkCover NSW follows the AMA rules, and pay 150% of the derived fee for orthopaedic procedures

WorkCover Victoria follows the 100% rule for dislocations and fractures that require operative treatment, the 100:75 rule for orthopaedics (Group T8, subgroup 15 of the MBS, other than fractures and dislocations) and the 100:50:25 rule for other surgical items. NOTE: No benefit is payable for item 48415 when billed in combination with any shoulder surgery code (items 48900 – 48960).

CESoft also gives you the option to override the multiple operation rule for private billing. This should not be used for claims to funds as it will generate an incorrect fee.
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