Service text
„Punktion eines Gelenks“Not alongside — per the Gebührenverzeichnis (8)
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 300 is the puncture of a joint, valued at 120 points. That gives 6,99 € at the single rate and 16,09 € at the 2.3-fold rate, the usual span for this number. Set apart from Number 300 are the specifically named joints of Numbers 301 (elbow, knee or vertebral joint) and 302 (shoulder or hip joint), which carry a higher point count.
The service text of Number 300
The service text names a single, generally worded location. It does not distinguish by type of joint or reason for the puncture; what is covered is the act of puncturing a joint as such, regardless of the purpose it serves in the individual case.
Set apart from Number 300 are Numbers 301 and 302, which name individual joints specifically and carry a higher point count: 301 for the elbow, knee or vertebral joint at 160 points, 302 for the shoulder or hip joint at 250 points. For every other joint not named there, Number 300 remains the applicable one.
Under the general provision for Section C III, the content of the services for punctures includes the injections, instillations, irrigations and samples connected with them — for example of blood, cerebrospinal fluid or tissue. These accompanying steps are settled with the puncture fee and are not billed separately.
The sentences below stand exactly like this in the Gebührenverzeichnis — as Allgemeine Bestimmungen for Section C III, Section C I, and next to the numbers they name. 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.
- „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 services for punctures includes the injections, instillations, irrigations and samples connected with them, for example of blood, cerebrospinal fluid, tissue.
- „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.
- „Neben den Leistungen nach den Nummern 2189 bis 2196 sind die Leistungen nach den Nummern 300 bis 302 sowie 3300 nicht berechnungsfähig.“ — Alongside the services under Numbers 2189 to 2196, the services under Numbers 300 to 302 and 3300 are not billable.
- „Neben den Leistungen nach den Nummern 5050, 5060 und 5070 sind die Leistungen nach den Nummern 300 bis 302, 372, 373, 490, 491 und 5295 nicht berechnungsfähig.“ — Alongside the services under Numbers 5050, 5060 and 5070, the services under Numbers 300 to 302, 372, 373, 490, 491 and 5295 are 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 300
Number 300 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 a joint puncture, such a justification can only come from particular circumstances of performance, which have to be documented.
What the record has to carry for Number 300
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 300, that includes which joint was punctured and for what reason.
Because Numbers 300 to 302 stand side by side in the Gebührenverzeichnis and differ by the joint punctured, only the record can settle, if disputed, which joint was actually punctured and which of the three numbers applies.
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 puncturing a knee joint count as Number 300?
No. The knee joint is named specifically in Number 301 and valued at 160 points; Number 300 applies to the joints not named there.
Are irrigations or samples taken during the puncture billed separately?
No. Under the general provision for Section C III, the injections, instillations, irrigations and samples connected with the puncture belong to the content of the service and are settled with it.
What does Number 300 cost at the 2.3-fold rate?
120 points times the point value of 5,82873 Cent give 6,99 € at the single rate; 2.3 times that is 16,09 €, and 3.5 times is 24,48 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.