Service text
„Injektion, intraartikulär oder perineural“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 255 is the injection given intra-articularly or perineurally, valued at 95 points. That gives 5,54 € at the single rate and 12,74 € at the 2.3-fold rate, the usual span for this number. The boundary that matters most for this number stands in Abschnitt C III: injections connected with a puncture belong to the content of the puncture — an injection given in connection with a joint puncture under Number 300 is part of that puncture, not a separate Number 255.
The service text of Number 255
Two routes stand side by side. That sets Number 255 apart from its neighbours in the same section — Number 256 covers the injection into the epidural space, Number 257 the injection into the subarachnoid space, each with its own, higher point count.
Number 255 differs from Number 253 only in the route: intravenous is covered there, intra-articular or perineural here. As with the other numbers in this section, the quantity or type of medicine given plays no role for the service text; it describes the act, not its content.
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. A wound dressing under Number 200 applied afterward counts as part of the injection.
The most important boundary leads into the neighbouring section. The Allgemeine Bestimmung to Abschnitt C III says that the content of the puncture services includes the injections connected with them. So where a joint is punctured under Number 300 and an injection is given in the same connection, the injection is part of the puncture; Number 255 stands for the injection into the joint without such a puncture.
The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen for Section C II, which also govern Number 255. 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.
- „Zum Inhalt der Leistungen für Punktionen gehören die damit im Zusammenhang stehenden Injektionen, Instillationen, Spülungen sowie Entnahmen z.B. von Blut, Liquor, Gewebe.“ — The content of the puncture services includes the injections, instillations, irrigations and withdrawals — e.g. of blood, cerebrospinal fluid, tissue — connected with them.
- „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 255
Number 255 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 an intra-articular or perineural 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 255
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 255, that includes which of the two routes was chosen, which joint or nerve was reached, and which medicine was injected.
Whether an injection into the joint was a stand-alone service or stood in connection with a puncture under Number 300 decides which number comes into question at all — and if disputed, that can only be clarified from the record, 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 an intravenous injection count as Number 255?
No. The service text names intra-articular or perineural; the intravenous injection stands in the Gebührenverzeichnis as Number 253, at 70 points.
Is Number 255 added alongside a joint puncture under Number 300?
No. The Allgemeine Bestimmung to Abschnitt C III counts the injections connected with a puncture as part of the puncture; the injection is then settled with the fee for Number 300.
What does Number 255 cost at the 2.3-fold rate?
95 points times the point value of 5,82873 Cent give 5,54 € at the single rate; 2.3 times that is 12,74 €, and 3.5 times is 19,38 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.