Service text
„Besuch eines weiteren Kranken in derselben häuslichen Gemeinschaft in unmittelbarem zeitlichen Zusammenhang mit der Leistung nach Nummer 50 - einschließlich Beratung und symptombezogener Untersuchung -“Not alongside — per the Gebührenverzeichnis (9)
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 51 is the visit to a further patient in the same household, in immediate temporal connection with the service under Number 50, valued at 250 points. That gives 14,57 € at the single rate and 33,52 € at the 2.3-fold rate. It does not stand on its own: it presupposes the preceding or concurrent visit under Number 50, and a series of provisions separates it from neighbouring numbers and from the surcharges under letters E to H.
The service text of Number 51
For a second or further patient in the same household who is attended while the visit under Number 50 is still under way, or immediately after it, the Gebührenverzeichnis provides Number 51. The phrase „in derselben häuslichen Gemeinschaft“ marks a spatial boundary: it concerns people who live together with the patient visited first, not a second visit at a different location.
Consultation and symptom-related examination are covered by the fee for Number 51 — they stand in the service text as expressly included and are not billed separately alongside it. Whatever conversation and examination take place with this further patient are therefore part of this same number, not of one of their own.
Number 51 excludes Number 45 or 46: it may not be billed instead of, or alongside, either of those two services. That sets the further visit in the same household apart from the other forms of visit the Gebührenverzeichnis names separately.
The sentences below stand exactly like this in the Gebührenverzeichnis — some as an Allgemeine Bestimmung to Abschnitt B, some directly under Number 51. 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 51 darf anstelle oder neben einer Leistung nach Nummer 45 oder 46 nicht berechnet werden.“ — The service under Number 51 may not be billed instead of, or alongside, a service under Number 45 or 46.
- „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 may not be billed.
- „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 may not be billed 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 may not be billed 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 may not be billed.
- „Die Zuschläge nach den Buchstaben E bis J sowie K 2 sind nur mit dem einfachen Gebührensatz berechnungsfähig. Abweichend hiervon sind die Zuschläge nach den Buchstaben E bis H neben der Leistung nach Nummer 51 nur mit dem halben Gebührensatz berechnungsfähig. Im Zusammenhang mit Leistungen nach den Nummern 45 bis 55 und 60 dürfen die Zuschläge unabhängig von der Anzahl und Kombination der erbrachten Leistungen je Inanspruchnahme des Arztes nur einmal berechnet werden. Im Zusammenhang mit Leistungen nach den Nummern 100 oder 101 dürfen die Zuschläge nach den Buchstaben F bis H unabhängig von der Anzahl und Kombination der erbrachten Leistungen je Inanspruchnahme des Arztes nur einmal berechnet werden. Neben den Zuschlägen nach den Buchstaben E bis J sowie K 2 dürfen die Zuschläge nach den Buchstaben A bis D sowie K 1 nicht berechnet werden.“ — The surcharges under letters E to J and K 2 may be billed only at the single fee rate. By way of exception, the surcharges under letters E to H may be billed alongside the service under Number 51 only at half the fee rate. In connection with services under Numbers 45 to 55 and 60, the surcharges may be billed only once per attendance by the physician, regardless of the number and combination of services performed. In connection with services under Numbers 100 or 101, the surcharges under letters F to H may be billed only once per attendance by the physician, regardless of the number and combination of services performed. The surcharges under letters A to D and K 1 may not be billed alongside the surcharges under letters E to J and K 2.
- „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.
The multiplier for Number 51
Number 51 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.
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. Because the service text of Number 51 already includes consultation and symptom-related examination, such a justification cannot rest on the mere fact of the visit — it has to state what, in particular, this further patient required.
§ 5 Abs. 2 GOÄ names the criteria that fee is measured against: the difficulty and the time taken for the particular service, and the circumstances of how it was performed. Criteria already accounted for in the service description — here, consultation and symptom-related examination as such — are left out of consideration.
What the record has to carry for Number 51
The treatment record is independent of the fee schedule — § 630f BGB requires it in immediate temporal connection with the treatment, whether billed privately or through statutory insurance. For Number 51, the fee itself additionally depends on a temporal connection: the one to the service under Number 50.
That a further patient in the same household was visited immediately afterwards has to be derivable from somewhere if it plays a role on the invoice or in a justification. The record is where that can be captured — with sequence and connection, not just the fact that two visits took place.
A written justification under § 12 Abs. 3 can only come from the treatment record, or from nothing. A conversation documented while the visit itself takes place supplies exactly the content that such a justification would later be built from.
Frequently asked questions
Does Number 51 require that Number 50 was billed first?
Yes. The service text requires immediate temporal connection with the service under Number 50 — Number 51 applies to a further patient in the same household, not to a stand-alone visit.
Is Number 1 billable alongside Number 51?
No. Alongside the service under Number 51, the services under Numbers 1, 5, 48 and/or 52 may not be billed.
What does Number 51 cost at the 2.3-fold rate?
250 points times the point value of 5,82873 Cent give 14,57 € at the single rate; 2.3 times that is 33,52 €, and 3.5 times is 51,00 €. Rounding is to the cent, under § 5 Abs. 1 Satz 4 GOÄ.