Goä no. 2381

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

extensive skin flap plastic surgery; Fee schedule; GOÄ 2381; GOÄ 2404; Item 2381 GOÄ; operational output; simple skin flap surgery; Skin flap plastics

General information
This section has been translated automatically.

No. 2381 GOÄ can be calculated in addition to No. 2404 GOÄ if simple wound closure - possibly after small, subcutaneous relief incisions - was not possible and flaps for wound closure had to be formed by extensive undermining. This procedure must be indicated in the documentation of the operation.
Argumentation: Excisions of larger tumors often require a subsequent skin flap plasty. The calculation of the No. 2381 GOÄ next to the No. 2404 GOÄ regularly meets with rejection of the PK and subsidies. Argumentation: "the skin flap plastic is compensated with the excision of the tumour" (Lit. GOÄ-Ratgeber Dt. Ärzteblatt of 16.05.2008). This argues as follows: "In the case of skin flap plasty for the excision of a tumour, the skin is first incised and then the skin is separated from the subcutaneous tissue down to the remaining stem of the flap in order to obtain one or more skin flaps. The detachment from the subcutaneous tissue is done so that the skin flap(s) can be rotated, swivelled or otherwise arranged. The Z-plasty, for example, represents a complex skin flap plasty. The undermining of one or both wound edges after excision of a skin tumour, which serves the tension-free adaptation of the wound edges, is not skin flap plastic surgery, but is part of the methodically necessary procedure after removal of a skin tumour".
Reason: According to § 4 paragraph 2a of the GOÄ, components or special versions of a service may not be invoiced separately. This also applies to methodically necessary individual steps of surgical services. The general provision on section L speaks of typical surgical services listed in section L. In addition, the provisions state: "another service according to the schedule of fees" or "the typical operational services listed in Section L". It is therefore only what is stated in the GOÄ as a service content, not a "medical event" connected with it. The service content of No. 2404 GOÄ is "Excision of a large tumour (e.g. ganglion)". The service does not specify that a skin flap plastic surgery that may be necessary in this context "is part of this service"! A skin flap is also not a "special execution" of an excision. Methodically necessary for a tumour excision is only the re-closure of the skin, but not the skin flap plastic. If the excision and skin flap plastic surgery are performed in one session, it is a "simultaneous operation", but not a single "cumulative" operation.
Evaluation relation: If the no. 2381 GOÄ were included in the no. 2404, the actual closure would make up the main part of the service according to the no. 2404 (370 out of 554 points). Therefore, the prescriber cannot have considered the simple skin flap plastic surgery according to No. 2381 GOÄ as a "typical operative performance" of No. 2404 GOÄ as an included and substantial part of the performance No. 2404 GOÄ.
Documentation: No. 2381 GOÄ but cannot be calculated for every tumor excision according to No. 2404 GOÄ. The prerequisite is that a skin flap plastic surgery has actually been performed. A "special execution" of the tumour excision can still be considered if a slight mobilisation of the wound edges (small, subcutaneous relief incisions) is required to enable a tension-free wound closure. This can then only be considered with a higher factor to No. 2404 GOÄ. However, if such a simple defect coverage is not possible and must be extensively undermined, forming flaps which can then be adapted ("mobilization plasty"), this is already a "simple skin flap plasty" - and additionally calculable with No. 2381 GOÄ. The fact that a mobilisation plastic is a simple skin flap plastic is not only obvious from a conceptual point of view, but also from the fact that the GOÄ-Ratgeber Dt. Ärzteblatt of 16.05.2008 defines a (quite complex) Z-plasty as "complex skin flap plastic". By this argumentation the terms "complex skin flap plastic" and "simple skin flap plastic" are clinically defined.
However, the treating physician must be responsible for drawing the line between "a minor mobilisation of the wound edges that cannot be calculated separately" and "a simple skin flap plastic that can be calculated separately". The documentation should make it clear that "simple defect coverage" with only slight mobilisation of the wound edges was not possible for surgical reasons.