Service text
„Symptombezogene Untersuchung“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 5 is the examination that follows up a symptom instead of working through an entire organ system — a two-word service text, 80 points, 4,66 € at the single rate and 10,72 € at the 2.3-fold rate. What matters about it is the boundary: it may not be billed alongside Numbers 6 to 8, and that is not a matter of interpretation.
The service text of Number 5
The Gebührenverzeichnis's service text for this number reads in full as above. The key word is the symptom: the number values that a particular complaint was investigated, not that an organ system was examined in full.
That is the boundary with Numbers 6, 7 and 8. Their service texts expressly require the complete physical examination of at least one listed organ system, or the complete-body status; for Numbers 6 and 7 the ordinance even lists out what that completeness consists of in detail.
Because the two paths exclude each other, choosing the right number is not a question of the fee but a question of what was actually examined — and that is a question for the record.
The sentences below stand exactly like this in the Gebührenverzeichnis — some as an Allgemeine Bestimmung to Abschnitt B, some directly under Number 5. 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 5 ist neben den Leistungen nach den Nummern 6 bis 8 nicht berechnungsfähig.“ — The service under Number 5 may not be billed alongside services under Numbers 6 to 8.
- „Die Leistungen nach den Nummern 1 und/oder 5 sind neben Leistungen nach den Abschnitten C bis O im Behandlungsfall nur einmal berechnungsfähig.“ — Services under Numbers 1 and/or 5 may be billed only once per treatment case alongside services under Abschnitte C to O.
- „Die Leistungen nach den Nummern 1, 3, 5, 6, 7 und/oder 8 können an demselben Tag nur dann mehr als einmal berechnet werden, wenn dies durch die Beschaffenheit des Krankheitsfalls geboten war. Bei mehrmaliger Berechnung ist die jeweilige Uhrzeit der Leistungserbringung in der Rechnung anzugeben. Bei den Leistungen nach den Nummern 1, 5, 6, 7 und/oder 8 ist eine mehrmalige Berechnung an demselben Tag auf Verlangen, bei der Leistung nach Nummer 3 generell zu begründen.“ — Services under Numbers 1, 3, 5, 6, 7 and/or 8 may be billed more than once on the same day only where the nature of the case required it. Where billed more than once, the time each service was performed must be stated on the invoice. For services under Numbers 1, 5, 6, 7 and/or 8, billing more than once on the same day must be justified on request; for the service under Number 3, always.
- „Neben einer Leistung nach Nummer 5, 6, 7 oder 8 sind die Leistungen nach den Nummern 600, 601, 1203, 1204, 1228, 1240, 1400, 1401 und 1414 nicht berechnungsfähig.“ — Alongside a service under Number 5, 6, 7 or 8, services under Numbers 600, 601, 1203, 1204, 1228, 1240, 1400, 1401 and 1414 may not be billed.
- „Anstelle oder neben der Visite im Krankenhaus sind die Leistungen nach den Nummern 1, 3, 4, 5, 6, 7, 8 und/oder 15 nicht berechnungsfähig.“ — Instead of or alongside a hospital visit, services under Numbers 1, 3, 4, 5, 6, 7, 8 and/or 15 may not be billed.
The multiplier for Number 5
Number 5 lies in Abschnitt B: single rate up to the 3.5-fold rate, with a usual span up to the 2.3-fold rate under § 5 Abs. 2 Satz 4 GOÄ.
The fee range is measured under § 5 Abs. 2 GOÄ by fair discretion, taking into account the difficulty and the time taken for the particular service and the circumstances of how it was performed. The difficulty can also lie in the difficulty of the case itself.
Exceeding the 2.3-fold rate is permitted under § 5 Abs. 2 Satz 4 GOÄ only where special features of these criteria justify it, and under § 12 Abs. 3 GOÄ it must be justified in writing.
What the record has to carry for Number 5
For a number defined by the word „symptombezogen“ — symptom-focused — the symptom is the part of the record that carries the service. If the chart says only „examined“, it shows neither which symptom was investigated nor that this was not a complete examination of an organ system.
§ 630f BGB requires the significant measures and their results in immediate temporal connection with the treatment. An examination is a measure, its finding the result; both belong in the same entry.
Whoever examines more than once on the same day needs, under the Allgemeine Bestimmung, the time on the invoice. It comes from the record, or from nowhere.
Frequently asked questions
May Number 5 be billed alongside Number 6 or 7?
No. The Allgemeine Bestimmung to Number 5 says that the service may not be billed alongside services under Numbers 6 to 8. Numbers 6, 7 and 8 also exclude each other in their own provisions.
What is the difference between Number 5 and Number 6?
The service text. Number 5 values the symptom-focused examination; Number 6 values the complete physical examination of at least one of the organ systems it lists — the ordinance spells out for Number 6 what that completeness consists of.
What does Number 5 cost at the usual rate?
80 points give 4,66 € at the single rate. 2.3 times that is 10,72 €, and 3.5 times is 16,32 €.