Is ADHD a billable diagnosis

Profitability bonus

The profitability bonus (32001) rewards you when you perform or arrange laboratory services economically. The GOP 32001 is remunerated differently depending on the specialist group (see profitability bonus GOP 32001 per specialist group). In general, the following applies: The amount is higher for specialist groups that initiate or carry out extensive laboratory diagnostics.

In order to determine the level of the profitability bonus (WiBo), your average laboratory costs per treatment case (individual case value) are compared with the costs of your group of doctors.

  • An average individual case value (iFW) of the doctor is determined. This is calculated from the costs of all laboratory costs of the doctor’s practice (Sections 32.2 and 32.3) that have been brought in, obtained and transferred as an order service, divided by the number of treatment cases with at least one insured, basic and / or consulting flat rate.
  • The doctor's average individual case value (iFW) is compared with the limiting case values ​​of his group of doctors.
  • The limit values ​​for each group of doctors are defined in (see limit values ​​for profitability bonus).
  • There are two values ​​for each specialist group: a lower limiting case value - up to which doctors receive the full bonus - and an upper limiting case value - from which doctors receive no bonus. If the laboratory costs in practice are between the two values, the bonus is paid out on a pro-rata basis.

The identification numbers (32004 - 32024)

For certain examination indications, individual laboratory services are excluded from the control through the profitability bonus (see laboratory identification numbers profitability bonus and laboratory identification numbers (explanations KBV)). As a result, their costs are not included in the calculation of the individual case value. There is a ring of digits for each identification number. These numbers define which services are deducted from the laboratory costs of the practice for selected indications.

Laboratory services with identification numbers

  • are only indicated on the own treatment case,
  • exempt certain services from being counted towards the individual case value
  • can also be specified in selective contractual cases (identification with pseudo-GOP 88192 or 88194 for general practitioners with NäPa).

If necessary, you can enter several identification numbers for a patient.

Enter pseudo cases for selective patients with code 88192

If you participate in selective contracts, this can affect the size of your individual laboratory budget. For those insured in selective contracts, cases are not billed via the KV, while special laboratory services (Chapter 32.3) are still arranged and billed via the KV system. When comparing the laboratory services and the laboratory budget, the selective contract cases must be included separately.

For each selective patient for whom you do not bill any services via the KV, you should therefore create a so-called pseudo case and give it the code number 88192. The cases marked in this way are added to the calculation of the limited number of case points for the special laboratory.

With the laboratory compendium there is a practical manual of the National Association of Statutory Health Insurance Physicians (KBV), which supports both doctors who commission laboratory services and doctors who perform and bill laboratory services. It can be downloaded free of charge as a PDF document from the KBV homepage.