GOÄ 28B III — Spezielle Beratungen und Untersuchungen280 points

GOÄ Number 28: the cancer-screening examination of a man, its points and its fee

Fee

37,54 €280 points × 5,82873 Cent × 2,3

The point count stands as written in the Gebührenverzeichnis; the point value stands in § 5 Abs. 1 Satz 3 GOÄ. The amounts are computed from these and rounded to the cent, as § 5 Abs. 1 Satz 4 requires. Which multiplier is appropriate in an individual case is set by § 5 Abs. 2 according to difficulty, time taken and the circumstances of performance — the practice decides that, not this table.

Service text

„Untersuchung eines Mannes zur Früherkennung von Krebserkrankungen des Rektums, der Prostata, des äußeren Genitales und der Haut - einschließlich Erhebung der Anamnese, Urinuntersuchung auf Eiweiß, Zucker und Erythrozyten sowie Untersuchung auf Blut im Stuhl, einschließlich Beratung -“

Not alongside — per the Gebührenverzeichnis (12)

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 28 is the examination of a man for the early detection of cancer of the rectum, the prostate, the external genitals and the skin, valued at 280 points. That gives 16,32 € at the single rate and 37,54 € at the 2.3-fold rate, the usual span for this number. Also worth noting: the provision for Number 28 excludes billing the digital examination of the rectum and/or the prostate (Number 11) and the tests for blood in the stool and in the urine (Numbers 3500, 3511, 3650, 3652) alongside it — the rectum and the prostate are areas the examination covers, while the stool and urine tests stand in the service text itself.

The service text of Number 28

Four areas stand side by side: the rectum, the prostate, the external genitals and the skin. What the number covers is a man's cancer-screening examination in these four areas — not a general physical examination, and not the screening examination of a child or of an adult regardless of sex.

The service text lists the individual components: taking the history, testing the urine for protein, sugar and erythrocytes, and testing for blood in the stool, plus counselling. All four are settled with the 280 points of Number 28.

Not named is a woman's examination — that is Number 27, at 320 points, covering the breast, the genitals, the rectum and the skin, together with a smear collection for cytological examination that is absent from the service text of Number 28. Nor is this the general health check-up for an adult under Number 29, which takes a complete whole-body status regardless of sex.

The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen and directly under Number 28. 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.

„Mit der Gebühr sind die Kosten für Untersuchungsmaterialien abgegolten.“ — The fee settles the costs of examination materials.
„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.“ — A treatment case, for the treatment of the same illness, is the period of one month following the first time the doctor is consulted.
„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 28

Number 28 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. What the service text of Number 28 already names itself — taking the history, the urine test, the stool test, counselling — is 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.

What the record has to carry for Number 28

The treatment record is independent of the fee schedule — § 630f BGB requires it in immediate temporal connection with the treatment. For Number 28, that includes which of the four named areas were examined and which of the included components were actually carried out.

Because the digital examination under Number 11 and the stool and urine tests under Numbers 3500, 3511, 3650 and 3652 are not billable alongside Number 28, which of these examinations actually took place as part of the screening can only be clarified from the record if disputed, not from memory.

Above the 2.3-fold rate, the justification under § 12 Abs. 3 GOÄ relates to the particular service; for a service description this comprehensive, it only holds up if the special circumstances of performance were already recorded elsewhere.

Frequently asked questions

Is the digital examination of the rectum and/or the prostate billable separately alongside Number 28?

No. The provision for Number 28 expressly excludes Number 11 (digital examination of the rectum and/or the prostate) alongside it; the rectum and the prostate are two of the four areas the service text of Number 28 names.

What does Number 28 cost at the 2.3-fold rate?

280 points times the point value of 5,82873 Cent give 16,32 € at the single rate; 2.3 times that is 37,54 €, and 3.5 times is 57,12 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.

How does Number 28 differ from Number 27?

Number 28 is a man's examination — the rectum, the prostate, the external genitals and the skin; its provision additionally excludes Number 11. Number 27 is a woman's examination — the breast, the genitals, the rectum and the skin — and names the smear collection for cytological examination in its service text, which is absent from Number 28.