Service text
„Injektion, intravenös“Not alongside — per the Gebührenverzeichnis (1)
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 253 is the injection given intravenously, valued at 70 points — unlike Number 252, which does not name that route. That gives 4,08 € at the single rate and 9,38 € at the 2.3-fold rate, the usual span for this number. Number 253 too: where several medicines are given one after another through the same cannula instead of as a mixture, it may not be billed more than once for that.
The service text of Number 253
The service text names a single route: intravenous. That sets Number 253 apart from its neighbours in the same section — Number 252 names subcutaneous, submucosal, intracutaneous or intramuscular, but not intravenous; Number 254 covers the intra-arterial injection, Number 258 the intra-aortic or intracardiac injection. Which route was used decides which of these numbers applies.
The quantity or type of medicine injected plays no role for the service text; it describes the intravenous act, not its content. For introducing a medicine into a parenteral catheter that is already in place, by contrast, the Gebührenverzeichnis carries its own number, 261 at 30 points — and the same provision that rules out multiple billing through an indwelling cannula names Numbers 252 to 258 and 261 in one breath.
Where several medicines are given one after another through the same cannula instead of as a mixture, the count stays at a single billing under Numbers 252 to 258 or 261 here as well. A wound dressing under Number 200 applied afterward counts as part of the injection, and a vessel puncture required in that connection belongs to Numbers 270 to 287, settled with their fee.
The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen for Section C II, which also govern Number 253. 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.
- „Die Leistungen nach den Nummern 252 bis 258 und 261 sind nicht mehrfach berechnungsfähig, wenn anstelle einer Mischung mehrere Arzneimittel bei liegender Kanüle im zeitlichen Zusammenhang nacheinander verabreicht werden.“ — Services under Numbers 252 to 258 and 261 may not be billed more than once where, instead of a mixture, several medicines are given one after another through the same cannula in immediate temporal connection.
- „Wundverbände nach Nummer 200, die im Zusammenhang mit einer operativen Leistung (auch Ätzung, Fremdkörperentfernung), Punktion, Infusion, Transfusion oder Injektion durchgeführt werden, sind Bestandteil dieser Leistung.“ — Wound dressings under Number 200 performed in connection with a surgical service (including cauterization, removal of a foreign body), puncture, infusion, transfusion or injection are part of that service.
- „Gegebenenfalls erforderliche Gefäßpunktionen sind Bestandteil der Leistungen nach den Nummern 270 bis 287 und mit den Gebühren abgegolten.“ — Vessel punctures required where applicable are part of the services under Numbers 270 to 287 and are settled with their fees.
- „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 253
Number 253 stands in 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.
Decisive under § 5 Abs. 2 Satz 1 are the difficulty and the time taken for the particular service and the circumstances of how it was performed; under Satz 2, the difficulty of the case may also be taken into account. Criteria already built into the service text are left out under Satz 3.
Above the 2.3-fold rate, § 12 Abs. 3 GOÄ requires a written justification tied to the particular service, comprehensible and traceable for the person liable to pay. For the intravenous injection, a technical service this brief, such a justification can only come from the circumstances of performance, which have to be documented.
What the record has to carry for Number 253
The treatment record is independent of the fee schedule — § 630f BGB requires it in immediate temporal connection with the treatment, regardless of how it is billed. For Number 253, that includes that the route was intravenous and with which medicine the injection was given.
Where several medicines are given one after another through the same cannula, the first provision prevents billing more than once — how many injections actually took place, and in what order, can only be clarified from the record if disputed, not from memory.
Above the 2.3-fold rate, the justification under § 12 Abs. 3 relates to the particular service; for a service description this brief, it only holds up if the special circumstances of performance were already recorded elsewhere.
Frequently asked questions
Does a subcutaneous injection count as Number 253?
No. The service text names only intravenous; the subcutaneous, submucosal, intracutaneous or intramuscular injection stands in the Gebührenverzeichnis as Number 252, at 40 points.
May Number 253 be billed once per medicine when several are injected one after another through the same indwelling cannula?
No, not where several medicines are given one after another through the same cannula in immediate temporal connection instead of as a mixture — the provision expressly rules out billing more than once for that case.
What does Number 253 cost at the 2.3-fold rate?
70 points times the point value of 5,82873 Cent give 4,08 € at the single rate; 2.3 times that is 9,38 €, and 3.5 times is 14,28 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.