1777 – Review of MBS items for clinically indicated gross and histologic examination of placentas in perinatal deaths

Amend MBS item.

This application proposes amendments be made to increase the complexity of some placental examinations from complexity level 4 to complexity level 5 or 6 on the Pathology Services Table. 

Most placental examinations performed in public hospitals around Australia are currently claimed under MBS Item 72823 at complexity level 4. This fee is based on a single specimen from a gastrointestinal biopsy with a relative time unit (RTU) of 5 minutes. However, the time and expertise required to perform a detailed placental examination are significantly greater. 

The average examination time for one placenta, including gross examination and measurements, sampling for ancillary studies, dissection, tissue processing, staining, microscopy and reporting, is estimated to be a minimum of 30 mins and, in cases of a complex placenta such as associated with a neonatal death or stillbirth, would increase to 45-60 mins. 

As a result of the current complexity level, many stillbirth/neonatal autopsies are currently not conducted and placental examinations are being delayed and/or not performed by pathologists with appropriate expertise.

Type: Investigative technology

Placental examinations occur following delivery and are performed as gross and microscopic examinations of the placenta, umbilical cord, and fetal membranes by a trained pathologist. Where a placental examination is clinically indicated, this enables a detailed investigation and evaluation of abnormalities and infections to aide in guiding clinical management and, where relevant, improve outcomes for both the mother and baby. Placental examinations provide helpful information in the majority of cases (estimated 69.5-95.7%), and are important in identifying and evaluating possible causes of perinatal death – of the 3,004 perinatal (stillbirth and neonatal) deaths in Australia in 2020, 1,043 (37.2%) underwent an autopsy, including an examination of the placenta.

The Perinatal Society of Australia & New Zealand’s Clinical Practice Guidelines recommends that:

1. Perinatal post-mortem: Placentas should be sent for examination by perinatal/paediatric pathologist regardless of whether consent for an autopsy has been gained following stillbirths, neonatal deaths in the delivery room or birth of high-risk infants.
2. Investigations of neonatal death: Detailed macroscopic examination of the placenta & cord with findings documented in the medical record by obstetric staff; Histopathology exam of fresh & unfixed placenta, cord & membranes

• MSAC consultation: Closed Friday 14 June 2024

• PASC meeting: Expedited – bypassing PASC
• ESC meeting: Expedited – bypassing ESC
• MSAC meeting: 1–2 August 2024