Service text
„Besuch eines Patienten auf einer Pflegestation (z.B. in Alten- oder Pflegeheimen - bei regelmäßiger Tätigkeit des Arztes auf der Pflegestation zu vorher vereinbarten Zeiten -“Not alongside — per the Gebührenverzeichnis (7)
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 48 is the visit to a patient on a nursing ward, where the physician works there regularly at pre-arranged times, 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 48 is Number 50, the visit including counselling and a symptom-related examination, at 320 points; the two numbers may not be billed alongside each other.
The service text of Number 48
The service text does not describe a single, occasional visit but a recurring form of activity: the physician attends the nursing ward regularly, at pre-arranged times. The visit to one particular patient on such an occasion is what Number 48 settles.
Set apart from Number 48 is Number 50, the visit including counselling and a symptom-related examination, at 320 points, which stands outside such regular nursing-ward activity. The two numbers rule each other out under the provision attached to Number 50.
Also set apart is Number 51, the visit to a further patient in the same household in immediate temporal connection with the service under Number 50; it, too, is not billable alongside Number 48.
The surcharges of Abschnitt B V also treat Number 48 differently from Number 50: the surcharges under letters F, G and H — for services in the evening, at night and on Saturdays, Sundays or public holidays — are not billable alongside Number 48. The surcharge K 2 for children up to the completed fourth year of life, by contrast, names Number 48 expressly.
The sentences below stand exactly like this in the Gebührenverzeichnis — as the provision under Number 48, as an Allgemeine Bestimmung of Section B, and next to the numbers naming Number 48. 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 Leistung nach Nummer 48 ist neben den Leistungen nach den Nummern 1, 50, 51 und/oder 52 nicht berechnungsfähig.“ — The service under Number 48 is not billable alongside the services under Numbers 1, 50, 51 and/or 52.
- „Besuchsgebühren nach den Nummern 48, 50 und/oder 51 sind für Besuche von Krankenhaus- und Belegärzten im Krankenhaus nicht berechnungsfähig.“ — Visit fees under Numbers 48, 50 and/or 51 are not billable for visits by hospital or attending physicians within the hospital.
- „Anstelle oder neben der Visite im Krankenhaus sind die Leistungen nach den Nummern 1, 3, 4, 5, 6, 7, 8, 15, 48, 50 und/oder 51 nicht berechnungsfähig.“ — Instead of, or alongside, the hospital ward round, the services under Numbers 1, 3, 4, 5, 6, 7, 8, 15, 48, 50 and/or 51 are not billable.
- „Neben der Leistung nach Nummer 50 sind die Leistungen nach den Nummern 1, 5, 48 und/oder 52 nicht berechnungsfähig.“ — Alongside the service under Number 50, the services under Numbers 1, 5, 48 and/or 52 are not billable.
- „Neben der Leistung nach Nummer 51 sind die Leistungen nach den Nummern 1, 5, 48 und/oder 52 nicht berechnungsfähig.“ — Alongside the service under Number 51, the services under Numbers 1, 5, 48 and/or 52 are not billable.
- „Neben den Leistungen nach den Nummern 100 und 101 sind die Leistungen nach den Nummern 48 bis 52 nicht berechnungsfähig.“ — Alongside the services under Numbers 100 and 101, the services under Numbers 48 to 52 are not billable.
- „Der Zuschlag nach Buchstabe F ist neben den Leistungen nach den Nummern 45, 46, 48 und 52 nicht berechnungsfähig.“ — The surcharge under letter F is not billable alongside the services under Numbers 45, 46, 48 and 52.
- „Der Zuschlag nach Buchstabe G ist neben den Leistungen nach den Nummern 45, 46, 48 und 52 nicht berechnungsfähig.“ — The surcharge under letter G is not billable alongside the services under Numbers 45, 46, 48 and 52.
- „Der Zuschlag nach Buchstabe H ist neben den Leistungen nach den Nummern 45, 46, 48 und 52 nicht berechnungsfähig.“ — The surcharge under letter H is not billable alongside the services under Numbers 45, 46, 48 and 52.
- „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 48
Number 48 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 visit to a nursing ward, such a justification can only come from particular circumstances of performance, which have to be documented.
What the record has to carry for Number 48
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 48, that includes that the visit took place as part of the physician's regular, pre-arranged activity at the nursing ward.
Because Number 48 is not billable alongside Numbers 50 and 51, only the record can settle, if disputed, which service was actually rendered and whether counselling or a symptom-related examination was part of the visit.
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
May Number 48 be billed alongside Number 50?
No. Alongside the service under Number 50, the services under Numbers 1, 5, 48 and/or 52 are not billable, and conversely Number 48 is also excluded alongside Number 50.
Does Number 48 also apply to visits by hospital physicians within the hospital?
No. Visit fees under Numbers 48, 50 and/or 51 are not billable for visits by hospital or attending physicians within the hospital.
What does Number 48 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.