Service text
„Erörterung (Dauer mindestens 20 Minuten) der Auswirkungen einer Krankheit auf die Lebensgestaltung in unmittelbarem Zusammenhang mit der Feststellung oder erheblichen Verschlimmerung einer nachhaltig lebensverändernden oder lebensbedrohenden Erkrankung - gegebenenfalls einschließlich Planung eines operativen Eingriffs und Abwägung seiner Konsequenzen und Risiken -, einschließlich Beratung - gegebenenfalls unter Einbeziehung von Bezugspersonen -“Not alongside — per the Gebührenverzeichnis (29)
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 34 values the discussion of how an illness affects how a patient's life is shaped — and only in immediate connection with the identification or substantial worsening of a lastingly life-changing or life-threatening illness. 300 points give 17,49 € at the single rate and 40,22 € at the 2.3-fold rate. The service presupposes a minimum duration and includes the consultation itself.
The service text of Number 34
The discussion under Number 34 does not stand on its own: the service text ties it to the immediate connection with the identification or substantial worsening of a lastingly life-changing or life-threatening illness. Without that connection in time and substance, the wording describes something else.
„Gegebenenfalls einschließlich Planung eines operativen Eingriffs und Abwägung seiner Konsequenzen und Risiken“ — where applicable including planning a surgical procedure and weighing its consequences and risks — stands as an addition in the service text, not as a separate requirement: where a procedure is pending, planning it and weighing its consequences belongs to the discussion. Likewise the wording „einschließlich Beratung - gegebenenfalls unter Einbeziehung von Bezugspersonen -“ — including consultation, where applicable involving close relatives or other reference persons — includes the consultation itself and the presence of relatives, without requiring either.
The provisions limit what may stand alongside Number 34: not Numbers 1, 3, 4, 15 and/or 30; the provision gives no reason, the service text only says that the consultation is included. Within six months it is billable at most twice.
What counts as „lastingly life-changing“ or „life-threatening“, the wording does not define; it presupposes the illness and ties the service to its identification or substantial worsening. The Gebührenverzeichnis contains no definition of its own for this classification.
The sentences below stand exactly like this in the Gebührenverzeichnis — some as an Allgemeine Bestimmung to Abschnitt B, some directly under Number 34. They are quoted here in German, word for word rather than summarized, because the German wording is what is legally binding: the sentence that excludes two numbers from each other is exactly the sentence that matters, and a paraphrase of it would be a claim of its own. The English text after each dash is a working translation, not a substitute for the statutory wording.
- „Die Leistung nach Nummer 34 ist innerhalb von 6 Monaten höchstens zweimal berechnungsfähig.“ — The service under Number 34 is billable at most twice within six months.
- „Neben der Leistung nach Nummer 34 sind die Leistungen nach den Nummern 1, 3, 4, 15 und/oder 30 nicht berechnungsfähig.“ — Alongside the service under Number 34, services under Numbers 1, 3, 4, 15 and/or 30 are not billable.
- „Die Leistung nach Nummer 4 ist neben den Leistungen nach den Nummern 30, 34, 801, 806, 807, 816, 817 und/oder 835 nicht berechnungsfähig.“ — The service under Number 4 is not billable alongside services under Numbers 30, 34, 801, 806, 807, 816, 817 and/or 835.
- „Neben der Leistung nach Nummer 21 sind die Leistungen nach den Nummern 1, 3, 4, 22 und 34 nicht berechnungsfähig.“ — Alongside the service under Number 21, services under Numbers 1, 3, 4, 22 and 34 are not billable.
- „Neben der Leistung nach Nummer 22 sind die Leistungen nach Nummer 1, 3, 21 oder 34 nicht berechnungsfähig.“ — Alongside the service under Number 22, services under Number 1, 3, 21 or 34 are not billable.
- „Neben der Leistung nach Nummer 30 sind die Leistungen nach den Nummern 1, 3 und/oder 34 nicht berechnungsfähig.“ — Alongside the service under Number 30, services under Numbers 1, 3 and/or 34 are not billable.
- „Neben der Leistung nach Nummer 31 sind die Leistungen nach den Nummern 1, 3, 4, 30 und/oder 34 nicht berechnungsfähig.“ — Alongside the service under Number 31, services under Numbers 1, 3, 4, 30 and/or 34 are not billable.
- „Die Leistungen nach den Nummern 1, 3, 22, 30 und/oder 34 sind neben den Leistungen nach den Nummern 804 bis 812, 817, 835, 849, 861 bis 864, 870, 871, 886 sowie 887 nicht berechnungsfähig.“ — Services under Numbers 1, 3, 22, 30 and/or 34 may not be billed alongside services under Numbers 804 to 812, 817, 835, 849, 861 to 864, 870, 871, 886 or 887.
- „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.
- „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 Sections C III and M and services 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. These services may also not be billed in place of the service under Number 435.
The multiplier for Number 34
Number 34 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.
For this number, § 5 Abs. 2 Satz 3 GOÄ is the sentence a justification runs up against: criteria for assessment already accounted for in the service description are left out of consideration. That the discussion carries a minimum duration and stands in immediate connection with the identification or substantial worsening of the illness stands in the service text itself — it is already reflected in the point count, and does not by itself carry an increase.
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 34
The service text names a minimum duration, and § 12 Abs. 2 Nr. 2 GOÄ expressly requires the invoice to state „einschließlich einer in der Leistungsbeschreibung gegebenenfalls genannten Mindestdauer“ — including any minimum duration named in the service description. An invoice can only carry that statement if the duration was recorded during the conversation.
Because the service is tied to the identification or substantial worsening of a lastingly life-changing or life-threatening illness, and is billable at most twice within six months, the record also has to carry that connection: what occasion triggered the discussion, and when an earlier discussion took place.
Independently of that, § 630f BGB requires the essential measures and their results in immediate temporal connection with the treatment. For a discussion of this weight, that means recording not just that it took place, but what it was about and what decision followed from it.
Frequently asked questions
What is the difference between Number 34 and Number 3?
The service text. Number 3 values the thorough consultation exceeding the usual extent in general; Number 34 values the discussion of how an illness affects how a patient's life is shaped, tied to the identification or substantial worsening of a lastingly life-changing or life-threatening illness, with a minimum duration and the consultation itself included.
Alongside which services may Number 34 not be billed?
Alongside the service under Number 34, services under Numbers 1, 3, 4, 15 and/or 30 are not billable, and neither are services under Numbers 804 to 812, 817, 835, 849, 861 to 864, 870, 871, 886 and 887, which the Allgemeine Bestimmung for Numbers 1, 3, 22, 30 and/or 34 excludes jointly.
What does Number 34 cost?
300 points times the point value of 5,82873 Cent give a single standard fee of 17,49 €. The 2.3-fold rate is 40,22 €, the 3.5-fold rate 61,20 €.