Quick Overview

A multi-discipline approach – explained:

• Multi-discipline approach with a team of eating disorder specialists;
  • Identified as essential in the care of eating disorders and implemented through MBS items as a holistic treatment plan.
  • Eating disorder specialists can be found through the Butterfly Foundation who have registration screening requirements. A list has been compiled on our website, however, please contact the Butterfly Foundation directly for updated information.
  • Eating disorders are mental health disorders that present with physical disorders.

• To access higher rebates;
  • GP’s providing Eating Disorder Treatment Management Plans must have undertaken appropriate mental health training recognised through the Mental Health Standards Collaboration (see Education and Training for Clinical Staff drop-down).

• The EDE-Q is a form of the EDE;
  • They generate two types of data: (1) behavioral, and (2) severity of psychopathology.
  • The EDE provides in depth details for the assessment process and diagnosis of eating disorders (see Assessment drop-down).

• Assessment;
  • Allow a long appointment (refer to EDE, see above note).
  • Scoff Questionnaire has been recommended as a pre-assessment tool to establish if a long appointment should be made for a full assessment (see Assessment drop-down)

Responsibility/roles:

• Diagnosis is the responsibility of the General Practitioner (item 90250-90253), Psychiatrist (item PSY1) or Paediatrician (PAED1).
• Allied Health professionals are not eligible to make the decision about a patient’s eligibility however;
  • they may be sought to contribute assessment information and conduct EDE-Q assessments for consideration when assessing eligibility.
• A psychiatrist or paediatrician appointment is required in addition to the GP review to access sessions 21-40.
  • Consider early referral in the course of the treatment.
• At or before the end of each 10-session course;
  • the mental health professionals are expected to provide a written progress report to the GP/Psychiatrist/Paediatrician which may be inclusive of recommendations for the next course of treatment.
• Practitioners should have regard to the relevant diagnostic criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Management/Assessment process:

• Use SCOFF as an initial tool to gauge if a longer appointment should be made for a full assessment (see Assessment drop-down)
• Allow a long appointment for assessment, explain the process of the assessment.
• The EDE – Q automated provides an automated score result. PDF available for printing off and giving to client.
• Discuss the EDE-Q results and developing a plan with patient, agree on goals and referrals to allied health professionals. Debrief and ensure patient is okay before leaving.
• Provide psychoeducation, including a plan for crisis intervention.
• Explain review and follow up plan procedure.
• Consider making an early psychiatrist/paediatrician referral for ongoing treatment (for sessions 21-40).

Criteria not met – but has an eating disorder:

• Better Access Mental Health Care Plan (10 sessions/calendar year) and Enhanced Primary Care Plans:
• Better Access Mental Health professionals include:
  • Focused Psychological services: Psychiatrists, GP’s, clinical psychologists, psychologists, mental health social workers, mental health occupational therapists.
  • Dietitians: With a referral from a GP, dietitians are eligible to provide up to 20 sessions of at least 20 minutes.

(Comorbidities or pre-existing conditions):

• Chronic disease management plan (CDMP) must be included in the eating disorder plan.
• Ensure the records reflect the CDMP as very separate to the eating disorder.
• Mental Health Treatment Plan can be used before or after and EDP (still not exceeding 40 sessions), however not at the same time.
• If simultaneous treatment (other than eating disorder) is required, this can be included in the EDP however, these will be included within the Medicare scheme EDP 40 sessions.

Treatment sessions – eligibility per year:

• Clients are entitled to a maximum of 40 eating disorder psychological treatment sessions in a rolling and/or calendar year.
  • A person cannot exceed 40 psychological treatment sessions from;
    • 1st of January to 31st December AND from the start date of the EDP to 12 months later (e.g. 2nd March 2020 to 1st March 2021).
  • A course of psychological treatment is 10 sessions, with a maximum of 4 courses of treatment.
  • Ongoing reviews are required by the GP and a Psychiatrist or Paediatrician once each course of treatment has been completed.
  • To check how many sessions, you or your client is eligible for, you can contact Medicare on;
    • Clinicians: 132 150; www.mbsonline.gov.au; OR use the Health Professionals Online System (HPOS) to check if a service is payable or not on a service date.
    • Consumers: 132 011; www.mbsonline.gov.au; OR access your My Health Record or Medicare online account.
    • For further information visit the MBS drop-down.

For further information

Frequently Asked Questions – a joint response from Butterfly, NEDC & ANZAED is available under FAQ drop-down.

Resources

Additional resources available under the Resources drop-down.

Preparation for Assessment

• Separate SCOFF Questionnaire
• Eating Disorders Screening Identification Referral Guide

EDE – Q Assessment tool

• EDE-Q (automated)

EDP – Plan

• GP InsideOut Eating Disorders Plan
• Eating Disorders Care Plan
• GP Eating Disorders Plan (EDP) Best Practice (30/01/2020)
• GP Eating Disorders Plan (EDP) MD (30/01/2020)

EDR – Review

• GP Care Plan Review Template

DSM-5 Diagnostic criteria for Eating Disorders

• DSM-5 Diagnostic criteria for Eating Disorders (PDF)

ED – Examination

• Eating Disorder Examination (PDF)

MBS Online

• For current information visit the MBS website.

InsideOut MBS Eating Disorder Items – for Health Professionals

Eating Disorders (Advanced Notification; Factsheet; FAQ; Quick Reference Guide)

Item specific – GPs and other Medical Practitioners

MBS Book

• Items specific to GP Eating Disorder Treatment Plan
  • 90250 At least 20 minutes for general practitioner with mental health training; up to 40 minutes for GP without mental health training
  • 90251 At least 40 minutes for general practitioner without mental health training
  • 90252 Between 20 and 40 minutes for GP with mental health training
  • 90253 At least 40 minutes for GP with mental health training

MBS Online – complete MBS schedule (downloads)

The Gold Coast Health eating disorder team of senior clinicians assess and provide targeted interventions for children and adults with an eating disorder.

Providing consultation and liaison the eating disorder team undertake assessment and specialist targeted interventions to consumers with eating disorders. Ongoing care is provided by the community case management Continuing Care Team.

GP Guide for referrals to the Gold Coast Community Mental Health – Adult Eating Disorder Program (AEDP)

Butterfly Foundation – list of Gold Coast professionals – please note, Gold Coast Primary Health Network cannot recommend professional providers. This list has been supplied by the Butterfly Foundation who have a screening process to ensure those listed have met criteria for working with Eating Disorders.

TELEHEALTH – list of Australia wide services

• health direct
• Telehealth rural/remote standard

• National Eating Disorders Collaboration (NEDC)
• National Eating Disorders Collaboration – Professional resources for GPs
• MBS (online factsheets and notifications)
• INSIDEOUT
• Butterfly Foundation
• Others – including relevant literature links
  • National Eating Disorders Collaboration – Literature: Professional resource GP
  • National Eating Disorders Collaboration – Literature: Eating disorders in Australia (PDF)
  • National Eating Disorders Collaboration – Strategic Communication Framework
  • Academy of Eating Disorders – A guide to medical care guidelines
• Eating Disorders Australia GP Information Kit (2012) – as supported by Qld Health

• NEDC – Free online professional development (5 module video series)
• NEDC video handout

Information to be added as it becomes available.

Butterfly Foundation, NEDC & ANZAED joint response: MBS Eating Disorder Items FAQs