ACFI Frequently Asked Questions – Complex Health Care – ACFI Item 12.12
1. When making an ACFI claim under ACFI 12.12a for arthritis and oedema related to the arthritis, does there need to be a diagnosis of both arthritis and oedema related to the arthritis?
Item 12.12a is claimable for care recipients who have arthritic joints with associated oedema. In making a claim for this item, evidence must be provided to support that the care recipient has both of these conditions, including the diagnosis and directive for treatment.
2. For ACFI 12.12a claims, does ‘tubular elasticised support bandages’ include elasticised support hosiery?
Tubular elasticised support bandages are tubular bandages that do not provide graduated compression.This may include support hosiery such as flight socks and elastic support stockings, provided the claim is supported with the relevant diagnosis and a directive recommending their use for the treatment of arthritic joints and associated oedema. The directive must comply with all requirements outlined in the ACFI User Guide.
3. Are there any tubular garments that are deemed appropriate for non-arthritic oedema under an ACFI 12.12b claim?
Tubular elasticised support bandages cannot be substituted for compression garments and/or compression bandages.
The conditions that ACFI 12.12b relate to are:
- non-arthritic oedema
- deep vein thrombosis
- chronic skin conditions.
Tubular compression garments and/or compression bandages are used to manage non-arthritic oedema and deep vein thrombosis as the need for graduated compression of the affected limb is essential. Quality medical grade garments designed to control swelling and assist with lymphatic drainage are essential.
For ACFI claims involving non-arthritic oedema or deep vein thrombosis, contemporaneous evidence would need to be provided demonstrating that it is necessary to apply compression garments which are:
- measured and selected correctly and
- appropriately applied and removed in accordance with the directive for the procedure.
4. Is there an approved compression garment list?
The department has not produced such a list. It is expected that the health professional providing the directive for treatment would have the clinical expertise within their scope of practice to identify the appropriate garments for treating these complex health care conditions.