Renal/urological (POAC)

All Pinnacle practices in the Te Whatu Ora Lakes area.

Patients with acute urological problems that can be managed safely in primary care e.g.: 

• acute indwelling catheter insertion for patient in acute urinary retention in the absence of red flags i.e. acute trauma – straddle injury/fractured pelvis, perineal haematoma 
• blocked catheter, which cannot be unblocked by flushing 
• uncomplicated pyelonephritis 
• renal colic with no red flags i.e.  AAA, temperature >38, pyelonephritis, peritonitis, biliary colic, testicular torsion, ovarian torsion, ectopic pregnancy. 
• Patients domiciled in Te Whatu Ora Lakes area.

Note: POAC funds a maximum of 3 catheter insertions in a 6-month period.  

• Investigations for torsion of testes/torsion of testicular or epididymal appendage – refer acutely to urology.
• Indwelling catheter claims for flushing of catheter resulting in blockage resolving.
• Complicated pyelonephritis – refer acutely to general medicine.
• Investigations for painless haematuria/palpable mass/suspected malignancy in renal tract or testes – Urgent scans through primary referred radiology via high suspicion of cancer pathway should be used.
• Severe epididymo-orchitis with systemic features or abscess – refer acutely to urology.
• Routine catheter changes, leaking catheter changes in patients with long term IDCs.
• TROC
• Mild uncomplicated pyelonephritis treated with oral antibiotics.
• Investigations of testes to diagnose or rule out hydrocele/varicocoele/epididymal cyst/hernia/haematoma/epididymo-orchitis. 
• Patients not domiciled in Te Whatu Ora Lakes area.

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. 

Note 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 procedure: $147 
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables. 

NB: POAC funds a maximum of 3 catheter insertions in a 6-month period unless a urology referral has occurred and is documented.  

GP/NP/CP follow up: $79 or RN follow up: $39 or

Rural GP/NP/CP follow up: $89 or RN follow up: $49 or

This funding is available to those practices that receive rural funding. 

Afterhours GP/NP/CP follow up: $99 or RN follow up $59

This funding can be claimed when care is provided after 5pm, on weekends or on public holidays.

A follow-up visit may be funded for management post ultrasound/CTU (based on treatment provided as evidenced in clinical notes).

This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a consultation.

IV medication invoice for IV antibiotics (once for pyelonephritis): $79 
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.

Rehydration: $158
IV rehydration only in adults, oral rehydration only in children. 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.

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.  

Note 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.