ACFI Frequently Asked Questions – Complex Health Care – ACFI Item 12.12
1. What are the medical diagnoses evidence requirements when there is an ACFI 12.12 claim involving oedema?
To satisfy a claim for ACFI 12.12, the health professional must identify the care recipient’s care needs in the directive. There must also be a medical diagnosis that identifies the underlying health condition that requires on-going care related to oedema.
2. 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. This must include the diagnosis and the directive for treatment.
3. Arthritis and oedema related to the arthritis - ACFI 12.12a: does ‘tubular elasticised support bandages’ include elasticised support hosiery?
Tubular elasticised support bandages are tubular bandages that do not provide graduated compression. Support hosiery such as flight socks and elastic support stockings can be included in an ACFI claim provided there is a relevant diagnosis and a directive recommending their use for the treatment of arthritic joints and associated oedema. The directive must comply with the requirements of the ACFI User Guide.
To ensure the integrity of the garments provides the correct on-going support for the care recipient, compression stockings, socks and/or bandages should be replaced regularly according to the care management plan or directive.
4. Non- arthritic oedema or deep vein thrombosis - ACFI 12.12b: are there any tubular garments that are deemed appropriate?
Tubular elasticised support bandages cannot be substituted for compression garments and/or compression bandages when making a claim under ACFI 12.12b.
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 (refer to the Best Practice for the Management of Lymphoedema guidelines).
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.
5. Is there an approved compression garment list?
The department does not produce such a list. It is expected that the health professional providing the directive for treatment has the clinical expertise within their scope of practice to identify the appropriate garments for treating these complex health care conditions.
If providers are seeking guidance for selecting compression garments, standards for compression garments can be found in the Best Practice for the Management of Lymphoedema Guidelines. These Guidelines cover parameters such as testing methods, yarn specification, compression gradient and durability.
6. What does a directive need to contain to support a 12.12b claim?
As per page 38 of the ACFI User Guide, a directive for ACFI 12.12b must:
- be given by a Health Professional acting in their scope of practice;
- be given by a medical practitioner or registered nurse or allied health professional, if specifically required by the item;
- direct the manner in which the care is to be provided, the qualifications of any person involved in providing the care, and the frequency of treatment; and
- identify the associated management and /or treatment plan.
In respect of the last dot point, identifying ‘the associated management and/or treatment plan’ needs to include the following information:
- aim of the compression therapy including- a reason why graduated compression is required as opposed to non-graduated e.g. tubigrip;
- type/description of the bandage/hosiery/garment;
- objective measurements e.g. calf size, ankle size, Doppler ankle brachial pressure index, etc;
- level of compression required;
- application directions (e.g. frequency of application, qualifications of any person in providing the care, fitting requirements); and
- review / evaluation details.
For more information on best practice management of lymphoedema and venous leg ulcers visit:
- Best Practice for the Management of Lymphoedema; and
- Australian and New Zealand Clinical Practice Guideline for Prevention and Management of Venous Leg Ulcers.