Treatment of patients with acute urological problems that can be managed safely in primary care.
This service is part of the Primary Options for Acute Care (POAC) programme.
Your Pinnacle Services Contract applies to this service. By claiming for this service, you have indicated that you have read and agreed to the business rules set out here.
This is NOT a clinical guideline.
All Pinnacle practices in Taranaki region can claim for this service.
Patients with acute urological problems that can be managed safely in primary care e.g.:
NB: POAC funds a maximum of three catheter insertions in a 6-month period.
Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions.
Once the episode of care is completed and the patient is no longer acutely unwell, they exit the POAC programme.
Once the patient exits the POAC programme, the case requires a clinical outcome to be lodged. No payment can be made for any claims unless the outcome is completed.
Where treatment in the community is no longer clinically appropriate, the patient may be admitted to hospital during a POAC plan of care. Please indicate this in the clinical outcome.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim is unable to be funded by POAC, the patient may be liable to the practice for the fees incurred.
NB. POAC funds a maximum of 3 catheter insertions in a 6-month period unless a urology referral has occurred and is documented.
Please make your claim via Primary Options, select Renal/Urological and then attach the appropriate invoice(s).
Prices listed below are GST inclusive.
Acute urinary catheter insertion: $147
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables, it cannot be claimed along with any other claims.
IV medication: $87
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables. It cannot be claimed along with any other claims.
Practice observations: $1.00 per minute
Practice observations – maximum 3 hours and based on treatment provided as evidenced in clinical notes. This can be claimed provided no IV administration invoices are claimed. This invoice can only be claimed at the time of the initial consultation.
In-clinic observations can be claimed based on 3 x 10 minute baseline observations per hour.
RURAL practice observations: $1.00 per minute
Practice observations – maximum 3 hours and based on treatment provided as evidenced in clinical notes. This can be claimed provided no IV administration invoices are claimed. This invoice can only be claimed at the time of the initial consultation.
In-clinic observations can be claimed based on 3 x 10 minute baseline observations per hour.
URGENT CARE practice observations: $1.00 per minute
Practice observations – maximum 6 hours and based on treatment provided as evidenced in clinical notes. This can be claimed provided no IV administration invoices are claimed. This invoice can only be claimed at the time of the initial consultation.
In-clinic observations can be claimed based on 3 x 10 minute baseline observations per hour.
GP/NP follow up: $79 or RN follow up: $39
A follow-up visit may be funded (based on treatment provided as evidenced in clinical notes).
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day of the initial consult.
RURAL GP/NP follow up: $89 or RN follow up: $50
A follow-up visit may be funded (based on treatment provided as evidenced in clinical notes).
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day of the initial consult.
URGENT CARE GP/NP follow up: $100
A follow-up visit may be funded (based on treatment provided as evidenced in clinical notes).
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day of the initial consult.
GP/NP home visit: $126 or RN home visit: $79
This is limited to one per episode of care within 3 days of the initial consult and cannot be claimed on the day of the initial consult.
Mileage: $0.77 cents per kilometre
Can be claimed in conjunction with a home visit.
Funded via third party providers
A renal ultrasound is funded under this service for suspicion of renal colic/stones in pregnant women and women under 35 years OR if CTU is not available.
Radiology is only funded for same-day investigations (within a 24-hour period).
Patients who are not acutely unwell and do not require a same day scan are not funded under POAC and should be referred to primary referred radiology.
GP provided point of care ultrasound is excluded from POAC services – it is expected that patients will be charged for this service.
Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding otherwise the referral may be declined.
It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented, especially where the diagnosis is undetermined. It is important to state the time of consultations and interactions with the patient.
NB. If there is a suspicion of a blocked catheter - trial flushing, then document in the referral that you have done so. This will expedite the acceptance of your claim.
The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient.
The service is funded by Te Whatu Ora.
Primary options team, Pinnacle Midlands Health Network
infoprimaryoptions@pinnacle.health.nz
027 687 7312
Pinnacle has contracts with a number of radiology providers under Primary Options for Acute Care (POAC).
A web-based information portal supporting primary care clinicians to plan patient care through primary, community and secondary health care systems within the Midland Region.
Business rules for the Primary Options Acute Care programme (Taranaki), which supports primary care through funding specific clinical services.
Quick guides to assist practices with identifying eligibility criteria;invoices that can be claimed; managing claims and providing assistance with understanding remittance reports
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