Service text
„Digitaluntersuchung des Mastdarms und/oder der Prostata“Not alongside — per the Gebührenverzeichnis (2)
Numbers the fee schedule names together with this one in an exclusion sentence. Open a chip for the wording, in German, and where it stands; about a particular case the sentence says only what it says.
Number 11 values the digital examination of the rectum and/or the prostate at 60 points. That gives 3,50 € at the single rate and 8,04 € at the 2.3-fold rate, the usual span for this number. It carries no provision of its own; it is named only in the provision for Number 28, which excludes it alongside a man's cancer-screening examination.
The service text of Number 11
The service text names two organs joined by „und/oder“ — and/or: the rectum and the prostate. Examining one of the two, or both together, carries the same point count, 60 points; the Gebührenverzeichnis does not distinguish at this point between one organ examined and both.
Number 11 has no provision of its own. The only sentence in the Gebührenverzeichnis that names it stands under Number 28: „Neben der Leistung nach Nummer 28 sind die Leistungen nach den Nummern 1, 3, 5, 6, 7, 8, 11, 3500, 3511, 3650 und/oder 3652 nicht berechnungsfähig.“ — Alongside the service under Number 28, the services under Numbers 1, 3, 5, 6, 7, 8, 11, 3500, 3511, 3650 and/or 3652 are not billable. There, Number 11 is excluded alongside the examination of a man for the early detection of cancer — not in a provision of its own for Number 11.
Two further numbers describe a digital examination within their own service content, without naming Number 11. The service content of Number 6 includes: „- bei den Nieren und ableitenden Harnwegen: Palpation der Nierenlager und des Unterbauchs, Inspektion des äußeren Genitale sowie Digitaluntersuchung des Enddarms, bei Männern zusätzlich Digitaluntersuchung der Prostata, Prüfung der Bruchpforten sowie Inspektion und Palpation der Hoden und Nebenhoden;“ — for the kidneys and urinary tract: palpation of the renal beds and lower abdomen, inspection of the external genitals and digital examination of the rectum, for men additionally digital examination of the prostate, checking the hernial orifices and inspection and palpation of the testes and epididymides. The service content of Number 7 includes: „- bei dem weiblichen Genitaltrakt: bimanuelle Untersuchung der Gebärmutter und der Adnexe, Inspektion des äußeren Genitale, der Vagina und der Portio uteri, Digitaluntersuchung des Enddarms, gegebenenfalls Palpation der Nierenlager und des Unterbauchs.“ — for the female genital tract: bimanual examination of the uterus and adnexa, inspection of the external genitals, the vagina and the portio uteri, digital examination of the rectum, where applicable palpation of the renal beds and lower abdomen. Both sentences name the digital examination of the rectum as part of the respective organ-system examination, with Number 6 additionally naming the prostate for men.
Whether Number 11 is billable alongside Number 6 or Number 7, the Gebührenverzeichnis does not say. There is no sentence on this relationship — neither an exclusion nor an express permission. The only provision that names Number 11 at all concerns its relationship to Number 28.
The sentences below stand exactly like this in the Gebührenverzeichnis — one as a provision under Number 28, the rest as Allgemeine Bestimmungen to Abschnitt B. They are quoted here in German, word for word rather than summarized, because the German wording is what is legally binding. The English text after each dash is a working translation, not a substitute for the statutory wording.
- „Neben der Leistung nach Nummer 28 sind die Leistungen nach den Nummern 1, 3, 5, 6, 7, 8, 11, 3500, 3511, 3650 und/oder 3652 nicht berechnungsfähig.“ — Alongside the service under Number 28, the services under Numbers 1, 3, 5, 6, 7, 8, 11, 3500, 3511, 3650 and/or 3652 are not billable.
- „Als Behandlungsfall gilt für die Behandlung derselben Erkrankung der Zeitraum eines Monats nach der jeweils ersten Inanspruchnahme des Arztes.“ — For treatment of the same illness, the treatment case is the period of one month after the patient's first attendance.
- „Terminvereinbarungen sind nicht berechnungsfähig.“ — Arranging appointments is not billable.
- „Neben der Leistung nach Nummer 435 sind für die Dauer der stationären intensivmedizinischen Überwachung und Behandlung Leistungen nach den Abschnitten C III und M sowie die Leistungen nach den Nummern 1 bis 56, 61 bis 96, 200 bis 211, 247, 250 bis 268, 270 bis 286a, 288 bis 298, 401 bis 424, 427 bis 433, 483 bis 485, 488 bis 490, 500, 501, 505, 600 bis 609, 634 bis 648, 650 bis 657, 659 bis 661, 665 bis 672, 1529 bis 1532, 1728 bis 1733 und 3055 nicht berechnungsfähig. Diese Leistungen dürfen auch nicht anstelle der Leistung nach Nummer 435 berechnet werden.“ — Alongside the service under Number 435, for the duration of inpatient intensive-care monitoring and treatment, services under Abschnitte C III and M and under Numbers 1 to 56, 61 to 96, 200 to 211, 247, 250 to 268, 270 to 286a, 288 to 298, 401 to 424, 427 to 433, 483 to 485, 488 to 490, 500, 501, 505, 600 to 609, 634 to 648, 650 to 657, 659 to 661, 665 to 672, 1529 to 1532, 1728 to 1733 and 3055 are not billable. Nor may these services be billed instead of the service under Number 435.
The multiplier for Number 11
Number 11 stands in Abschnitt B, so it falls within the ordinary fee range: from the single rate up to the 3.5-fold rate, with the 2.3-fold rate as the span within which, under § 5 Abs. 2 Satz 4 GOÄ, a fee is as a rule assessed.
What the service text of Number 11 already describes itself — the digital examination of the rectum and/or the prostate — is left out of consideration under § 5 Abs. 2 Satz 3 GOÄ when a fee is assessed. An increase above the usual rate needs a justification beyond the bare fact that a digital examination was performed.
Above the 2.3-fold rate, § 12 Abs. 3 GOÄ applies: written, tied to the particular service, comprehensible and traceable for the person liable to pay, and to be explained further on request.
What the record has to carry for Number 11
§ 630f BGB requires the essential measures and their results in immediate temporal connection with the treatment. For Number 11, that includes the finding of the digital examination — which of the two organs was examined and what it showed.
Where the examination stands in connection with cancer screening under Number 28, the provision for Number 28 excludes billing Number 11 separately alongside it. Which of the two examinations actually took place, and under which number it was billed, can only be clarified from the record if disputed.
Whether a digital examination took place as part of an examination under Number 6 or Number 7, or was performed as a standalone Number 11, the Gebührenverzeichnis does not say — the record is the only place where that can be traced afterwards.
Frequently asked questions
What is the difference between Number 11 and the digital examination under Number 6 or 7?
Number 11 is its own number with its own service text: „Digitaluntersuchung des Mastdarms und/oder der Prostata“ — digital examination of the rectum and/or the prostate. Numbers 6 and 7, by contrast, name the digital examination of the rectum as one part of their respective service content, within the examination of the kidneys and urinary tract or of the female genital tract. Whether Number 11 is billable alongside them, the Gebührenverzeichnis does not say.
Alongside which services is Number 11 not billable?
It is expressly excluded only alongside Number 28: the provision for that number names Number 11 among the services that are not billable alongside it. For its relationship to other numbers, such as 6 or 7, the Gebührenverzeichnis contains no corresponding sentence.
What does Number 11 cost?
60 points times the point value of 5,82873 Cent give 3,50 € at the single rate; 2.3 times that is 8,04 €, and 3.5 times is 12,24 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.