from April 1st, 1995
Article 1
Changes to the form agreement ( Annex 2 BMV-Ä)
1. Numbers 2.13, 2.14 and 2.18 are changed as follows:
" 2.13 Model 13: Therapeutic Products Ordinance (measures of Physical Therapy / Podiatry Therapy) (Status: 1.2017)
2.14Model 14: Ordinance on Therapeutic Products (Measures of Voice, Speech and Speech Therapy (Status: 1.2017) < /p>
2.18Model 18: Therapeutic Products Ordinance (Occupational Therapy Measures) (Status: 1.2017) “
Article 2
< p> Changes to the V Explanations of the printout1st sentence 3 in the explanatory part " 3 unable to work since" for pattern 1 changes as follows:
"A backdating of the beginning incapacity for work on day prior to the start of treatment is only permitted in exceptional cases and only after careful examination and generally only for up to three days. "
2. Number 7 of the form explanations for sample 2 changes as follows:
"7. In addition to prescription for hospital treatment, certificate of incapacity for work (sample 1) must be issued if necessary, even if the start of the incapacity for work coincides with the day of hospital admission. "
3. The explanations of the form for sample 13 change like follows:
" Sample 13: Therapeutic Products Ordinance
Measures of physical therapy and podiatry therapy 1
The guideline of the Federal Joint Committee on the prescription of medicinal products in contract medical care (Therapeutic Products Directive / HeilM-RL) must be observed.
When filling out the fields, please note the following:
1 First prescription; 2 follow-up ordinance; 3 Ordinance outside of the normal case
Only one box may be ticked when marking regulation as an initial ordinance, subsequent ordinance or ordinance outside of the normal case. Checking several boxes is not permitted.
1 First prescription
Every rule begins with an initial prescription. from April 1st, 1995 Article 1 Changes to the form agreement ( Annex 2 BMV-Ä) 1. Numbers 2.13, 2.14 and 2.18 are changed as follows: " 2.13 Model 13: Therapeutic Products Ordinance (measures of Physical Therapy / Podiatry Therapy) (Status: 1.2017) 2.14Model 14: Ordinance on Therapeutic Products (Measures of Voice, Speech and Speech Therapy (Status: 1.2017) < /p> 2.18Model 18: Therapeutic Products Ordinance (Occupational Therapy Measures) (Status: 1.2017) “ Article 2
1st sentence 3 in the explanatory part " 3 unable to work since" for pattern 1 changes as follows:
"A backdating of the beginning incapacity for work on day prior to the start of treatment is only permitted in exceptional cases and only after careful examination and generally only for up to three days. "
2. Number 7 of the form explanations for sample 2 changes as follows:
"7. In addition to prescription for hospital treatment, certificate of incapacity for work (sample 1) must be issued if necessary, even if the start of the incapacity for work coincides with the day of hospital admission. "
3. The explanations of the form for sample 13 change like follows:
" Sample 13: Therapeutic Products Ordinance
Measures of physical therapy and podiatry therapy 1
The guideline of the Federal Joint Committee on the prescription of medicinal products in contract medical care (Therapeutic Products Directive / HeilM-RL) must be observed.
When filling out the fields, please note the following:
1 First prescription; 2 follow-up ordinance; 3 Ordinance outside of the normal case
Only one box may be ticked when marking regulation as an initial ordinance, subsequent ordinance or ordinance outside of the normal case. Checking several boxes is not permitted.
1 First prescription
Every rule begins with an initial prescription.In this case, the “first prescription” box must be ticked by the contract doctor. Before the first prescription, an initial diagnosis by the contract doctor is necessary. During the initial diagnosis, diagnostic measures based on the disorder are to be carried out, initiated and, if necessary, documented (see field 12 )
2 Follow-up ordinance
After an initial prescription, every prescription for the treatment of the same disease and the same normal case is considered follow-up ordinance. In this case the “Follow-up ordinance” box must be ticked by the contract doctor. This also applies if the main symptoms change during treatment and different physical therapy measures are used. If new normal case begins, an initial ordinance must be issued again (cf. § 7 HeilM-RL). Even before follow-up prescriptions, it is necessary to collect the current findings depending on the disorder (see explanations for field 1 ).
3 Regulation outside of the normal case
If, as rule, the total amount of prescriptions determined in accordance with the remedies catalog cannot complete the treatment, further prescriptions are possible (prescriptions outside the normal range, especially long-term prescriptions). In this case, the “Prescription outside the normal” box must be ticked by the contract doctor. Such prescriptions require special justification with prognostic assessment (see field 15 Medical justification). Even before prescription outside of the normal case, new disorder-related collection of the current findings is required (see explanations for field 1 ).
Prescriptions due to "long-term need for therapeutic agents" can, according to § 8a Para 8 of the Therapeutic Products Directive can be immediately identified as "Ordinance outside of the normal case" without having to go through the normal case beforehand.
Special feature of the prescription of podiatry therapy measures
The box “Regulation outside of the normal case” should not be ticked if podiatry therapy measures are prescribed. For podiatry measures, no prescriptions outside of the normal case are provided, as there are no restrictions on the total amount of prescriptions.
4 Group therapy
The “Group Therapy” box must be ticked by the contract doctor if individual therapy is not medically required.In this case, the “first prescription” box must be ticked by the contract doctor. Before the first prescription, an initial diagnosis by the contract doctor is necessary. During the initial diagnosis, diagnostic measures based on the disorder are to be carried out, initiated and, if necessary, documented (see field 12 )
2 Follow-up ordinance
After an initial prescription, every prescription for the treatment of the same disease and the same normal case is considered follow-up ordinance. In this case the “Follow-up ordinance” box must be ticked by the contract doctor. This also applies if the main symptoms change during treatment and different physical therapy measures are used. If new normal case begins, an initial ordinance must be issued again (cf. § 7 HeilM-RL). Even before follow-up prescriptions, it is necessary to collect the current findings depending on the disorder (see explanations for field 1 ).
3 Regulation outside of the normal case
If, as rule, the total amount of prescriptions determined in accordance with the remedies catalog cannot complete the treatment, further prescriptions are possible (prescriptions outside the normal range, especially long-term prescriptions). In this case, the “Prescription outside the normal” box must be ticked by the contract doctor. Such prescriptions require special justification with prognostic assessment (see field 15 Medical justification). Even before prescription outside of the normal case, new disorder-related collection of the current findings is required (see explanations for field 1 ).
Prescriptions due to "long-term need for therapeutic agents" can, according to § 8a Para 8 of the Therapeutic Products Directive can be immediately identified as "Ordinance outside of the normal case" without having to go through the normal case beforehand.
Special feature of the prescription of podiatry therapy measures
The box “Regulation outside of the normal case” should not be ticked if podiatry therapy measures are prescribed. For podiatry measures, no prescriptions outside of the normal case are provided, as there are no restrictions on the total amount of prescriptions.
4 Group therapy
The “Group Therapy” box must be ticked by the contract doctor if individual therapy is not medically required.Group therapy should be prescribed for effects that are desired in terms of group dynamics or in the interests of economic efficiency.
Special features when prescribing podiatry measures
Podiatry treatment is carried out exclusively as individual therapy. Group therapy cannot be prescribed.
5 Start of treatment at the latest. on
The field "Treatment start latest. am “is only to be filled in by the contract doctor if the treatment is not to be started within 14 calendar days (for physical therapy) and 28 calendar days (for podiatry therapy) after the prescription has been issued. The information must only be given in six digits in the format DDMMYY (e.g. 010217).
6 Home visit
The box “Home visit - Yes “Must be ticked by the contract doctor if the patient cannot visit the therapist for medical reasons or if the home visit is absolutely necessary for medical reasons. In other cases, the box "Home visit - No" must be ticked.
7 Therapy report
Upon request, the contract doctor can Request contract doctor for therapy report from the service provider. This is to be indicated on the Therapeutic Products Ordinance by ticking the box "Therapy Report - Yes". In other cases the box “Therapy report - No” must be ticked.
8 Prescription amount
In the case of an initial or subsequent prescription The indication of the prescription amount must not exceed the value according to the selected diagnosis code, possibly in connection with the selected remedy in accordance with the remedy catalog (HeilM-RL Part 2). Not every damage / malfunction requires treatment with the maximum prescription amount per prescription.
Special feature of prescriptions outside the normal case (physical therapy)
In the case of prescription outside of the normal case, the prescription amount is dependent to be based on the treatment frequency so that the treatment covers period of up to 12 weeks ad medical examination is guaranteed (see § 8 Paragraph 1 Clause 4 HeilM-RL).
9 Remedies in accordance with the catalog
On the remedies ordinance, the measures of physical therapy and podiatry therapy in accordance with the remedies catalog must be specified. In the case of the prescription of "standardized combination of medicinal products", it is possible to specify the medicinal products subsumed under "D1" in the medicinal product catalog.Group therapy should be prescribed for effects that are desired in terms of group dynamics or in the interests of economic efficiency.
Special features when prescribing podiatry measures
Podiatry treatment is carried out exclusively as individual therapy. Group therapy cannot be prescribed.
5 Start of treatment at the latest. on
The field "Treatment start latest. am “is only to be filled in by the contract doctor if the treatment is not to be started within 14 calendar days (for physical therapy) and 28 calendar days (for podiatry therapy) after the prescription has been issued. The information must only be given in six digits in the format DDMMYY (e.g. 010217).
6 Home visit
The box “Home visit - Yes “Must be ticked by the contract doctor if the patient cannot visit the therapist for medical reasons or if the home visit is absolutely necessary for medical reasons. In other cases, the box "Home visit - No" must be ticked.
7 Therapy report
Upon request, the contract doctor can Request contract doctor for therapy report from the service provider. This is to be indicated on the Therapeutic Products Ordinance by ticking the box "Therapy Report - Yes". In other cases the box “Therapy report - No” must be ticked.
8 Prescription amount
In the case of an initial or subsequent prescription The indication of the prescription amount must not exceed the value according to the selected diagnosis code, possibly in connection with the selected remedy in accordance with the remedy catalog (HeilM-RL Part 2). Not every damage / malfunction requires treatment with the maximum prescription amount per prescription.
Special feature of prescriptions outside the normal case (physical therapy)
In the case of prescription outside of the normal case, the prescription amount is dependent to be based on the treatment frequency so that the treatment covers period of up to 12 weeks ad medical examination is guaranteed (see § 8 Paragraph 1 Clause 4 HeilM-RL).
9 Remedies in accordance with the catalog
On the remedies ordinance, the measures of physical therapy and podiatry therapy in accordance with the remedies catalog must be specified. In the case of the prescription of "standardized combination of medicinal products", it is possible to specify the medicinal products subsumed under "D1" in the medicinal product catalog.
Special feature of prescribing manual lymph drainage
As far as manual lymph drainage (LY1 to LY3) is to be prescribed as cure in accordance with the remedies catalog, the field “Remedies in accordance with the catalog "In addition to the remedy" Manual lymphatic drainage ", the minutes should also be 30, 45 or 60 minutes. Alternatively, it is also possible to specify the remedy together with the number of minutes in abbreviated form according to the remedy catalog (MLD-30, MLD-45 or MLD-60). If compression bandage (lymphological compression bandage) is required in connection with manual lymphatic drainage, this must also be stated in the same line (e.g. "MLD-45 with compression bandage"), provided that no aids for compression therapy are available. Any compression bandages required are to be prescribed separately as bandages.
10 Number per week
In the "Number per week" field is the contract doctor should provide frequency recommendation. A recommendation on the frequency of treatment is to be given depending on the severity and severity of disease (functional / structural damage, impairment of activities taking into account the individual context factors) as well as the therapy goal aimed at with this regulation.
Special feature of the Regulation of measures of podiatry therapy
For the diagnosis group DF (diabetic foot syndrome), the contract doctor can recommend frequency of "every 4 to 6 weeks" for measures of podiatry therapy.
11 Indication code
The complete indication code must be entered in this field. In the Therapeutic Products Ordinance, this is composed of the name of the diagnosis group and the letter of the primary main symptom according to the catalog of medicinal products (e.g. ZN2a or DFa).
12 Diagnosis with Key symptoms, any essential findings
Therapy-relevant findings must be stated on the Ordinance on Therapeutic Products. These can result from the initial diagnostics or from new disorder-dependent assessment of the findings.
13 ICD-10 code
The therapy-relevant ICD-10-GM-Code1 must be stated on the therapeutic products ordinance; this can be deviated from in justified exceptional cases. In order to assert special prescription requirements or long-term need for therapeutic products, the ICD-10-GM code must be stated in the form in accordance with the specifications in Appendix 2 of the Therapeutic Products Directive or in Appendix 1 to Appendix 2 of the framework requirements according to Section 106b Para.
Special feature of prescribing manual lymph drainage
As far as manual lymph drainage (LY1 to LY3) is to be prescribed as cure in accordance with the remedies catalog, the field “Remedies in accordance with the catalog "In addition to the remedy" Manual lymphatic drainage ", the minutes should also be 30, 45 or 60 minutes. Alternatively, it is also possible to specify the remedy together with the number of minutes in abbreviated form according to the remedy catalog (MLD-30, MLD-45 or MLD-60). If compression bandage (lymphological compression bandage) is required in connection with manual lymphatic drainage, this must also be stated in the same line (e.g. "MLD-45 with compression bandage"), provided that no aids for compression therapy are available. Any compression bandages required are to be prescribed separately as bandages.
10 Number per week
In the "Number per week" field is the contract doctor should provide frequency recommendation. A recommendation on the frequency of treatment is to be given depending on the severity and severity of disease (functional / structural damage, impairment of activities taking into account the individual context factors) as well as the therapy goal aimed at with this regulation.
Special feature of the Regulation of measures of podiatry therapy
For the diagnosis group DF (diabetic foot syndrome), the contract doctor can recommend frequency of "every 4 to 6 weeks" for measures of podiatry therapy.
11 Indication code
The complete indication code must be entered in this field. In the Therapeutic Products Ordinance, this is composed of the name of the diagnosis group and the letter of the primary main symptom according to the catalog of medicinal products (e.g. ZN2a or DFa).
12 Diagnosis with Key symptoms, any essential findings
Therapy-relevant findings must be stated on the Ordinance on Therapeutic Products. These can result from the initial diagnostics or from new disorder-dependent assessment of the findings.
13 ICD-10 code
The therapy-relevant ICD-10-GM-Code1 must be stated on the therapeutic products ordinance; this can be deviated from in justified exceptional cases. In order to assert special prescription requirements or long-term need for therapeutic products, the ICD-10-GM code must be stated in the form in accordance with the specifications in Appendix 2 of the Therapeutic Products Directive or in Appendix 1 to Appendix 2 of the framework requirements according to Section 106b Para.2 SGB V for the performance audit of medically prescribed services of November 30, 2015 (special prescription requirements) defined diagnosis lists.
The specification of an additional ICD-10-GM code is only necessary if special prescription requirement is claimed for which the specification of second ICD-10-GM code is prerequisite (according to Appendix 1 to Appendix 2 of the framework specifications according to Section 106b, Paragraph 2 of the Social Code Book V for the performance audit of medically prescribed services from November 30, 2015) >
14 If applicable, specification of the therapy goals
The contract doctor only has to specify the therapy goals if they are not based on the information given by Diagnosis and the main symptoms result.
15 Medical justification for prescriptions outside the normal case (if applicable, supplementary sheet)
This field is only to be filled in the case of regulation outside the normal In this field, the contract doctor must provide special reason with prognostic assessment. If necessary, supplementary sheet should be used (see also explanations for field 3 ). “
4. The explanations on the form for sample 14 change as follows:
"Sample 14: Therapeutic Products Ordinance (Measures of Voice, Speech and Speech Therapy)
The guidelines of the Federal Joint Committee on the Ordinance of Medicinal Products in Contract Medical Care (Therapeutic Products Guideline / HeilM-RL) must be observed.
Please note the following when filling in the fields:
1 first prescription; 2 follow-up ordinance; 3 Ordinance outside of the normal case
Only one box may be ticked when marking regulation as an initial ordinance, subsequent ordinance or ordinance outside of the normal case. Checking several boxes is not permitted.
1 First prescription
Every rule begins with an initial prescription. In this case, the “first prescription” box must be ticked by the contract doctor. Before the first prescription, an initial diagnosis by the contract doctor is necessary. In the initial diagnosis, diagnostic measures depending on the disorder are to be carried out, initiated and, if necessary, documented (see field 13 ).
2 Follow-up ordinance
After an initial prescription, every prescription for the treatment of the same disease and the same normal case is considered follow-up ordinance. In this case the “Follow-up ordinance” box must be ticked by the contract doctor.2 SGB V for the performance audit of medically prescribed services of November 30, 2015 (special prescription requirements) defined diagnosis lists.
The specification of an additional ICD-10-GM code is only necessary if special prescription requirement is claimed for which the specification of second ICD-10-GM code is prerequisite (according to Appendix 1 to Appendix 2 of the framework specifications according to Section 106b, Paragraph 2 of the Social Code Book V for the performance audit of medically prescribed services from November 30, 2015) >
14 If applicable, specification of the therapy goals
The contract doctor only has to specify the therapy goals if they are not based on the information given by Diagnosis and the main symptoms result.
15 Medical justification for prescriptions outside the normal case (if applicable, supplementary sheet)
This field is only to be filled in the case of regulation outside the normal In this field, the contract doctor must provide special reason with prognostic assessment. If necessary, supplementary sheet should be used (see also explanations for field 3 ). “
4. The explanations on the form for sample 14 change as follows:
"Sample 14: Therapeutic Products Ordinance (Measures of Voice, Speech and Speech Therapy)
The guidelines of the Federal Joint Committee on the Ordinance of Medicinal Products in Contract Medical Care (Therapeutic Products Guideline / HeilM-RL) must be observed.
Please note the following when filling in the fields:
1 first prescription; 2 follow-up ordinance; 3 Ordinance outside of the normal case
Only one box may be ticked when marking regulation as an initial ordinance, subsequent ordinance or ordinance outside of the normal case. Checking several boxes is not permitted.
1 First prescription
Every rule begins with an initial prescription. In this case, the “first prescription” box must be ticked by the contract doctor. Before the first prescription, an initial diagnosis by the contract doctor is necessary. In the initial diagnosis, diagnostic measures depending on the disorder are to be carried out, initiated and, if necessary, documented (see field 13 ).
2 Follow-up ordinance
After an initial prescription, every prescription for the treatment of the same disease and the same normal case is considered follow-up ordinance. In this case the “Follow-up ordinance” box must be ticked by the contract doctor.This also applies if the main symptoms change during treatment and different measures of voice, speech and speech therapy are used. If new normal case begins, an initial ordinance must be issued again (cf. § 7 HeilM-RL). Even before follow-up prescriptions, it is necessary to collect the current findings depending on the disorder (see explanations for field 1 ).
3 Regulation outside of the normal case
If the total amount of prescriptions determined in accordance with the therapeutic product catalog cannot normally be used to complete the treatment, further prescriptions are possible (prescriptions outside the normal range, especially long-term prescriptions). In this case, the “Prescription outside the normal” box must be ticked by the contract doctor. Such ordinances require special justification with prognostic assessment (see field 17 ). Even before prescribing outside of the normal case, new disorder-dependent collection of the current findings is required (see explanations for field 1 ).
Prescriptions based on "long-term need for medicinal products" can be 8a (8) of the Therapeutic Products Directive can be directly identified as “Ordinance outside the normal case” without the normal case having to be run through beforehand.
4 Group therapy
The "Group therapy" box must be ticked by the contract doctor if individual therapy is not medically required. Group therapy should be prescribed for effects that are desired in terms of group dynamics or in the interests of economic efficiency.
5 Start of treatment at the latest. on
The field "Treatment start latest. on “is only to be completed by the contract doctor if treatment is not to be started within 14 calendar days of the prescription being issued. The information must only be given in six digits in the format DDMMYY (e.g. 010217).
6 House visit
The box " Home visit - Yes "must be ticked by the contract doctor if the patient cannot visit the therapist for medical reasons or if the home visit is absolutely necessary for medical reasons. In other cases, the box "Home visit - No" must be ticked.
7 Therapy report
Upon request, the contract doctor can Request contract doctor for therapy report from the service provider. This is to be indicated on the Therapeutic Products Ordinance by ticking the box "Therapy Report - Yes".This also applies if the main symptoms change during treatment and different measures of voice, speech and speech therapy are used. If new normal case begins, an initial ordinance must be issued again (cf. § 7 HeilM-RL). Even before follow-up prescriptions, it is necessary to collect the current findings depending on the disorder (see explanations for field 1 ).
3 Regulation outside of the normal case
If the total amount of prescriptions determined in accordance with the therapeutic product catalog cannot normally be used to complete the treatment, further prescriptions are possible (prescriptions outside the normal range, especially long-term prescriptions). In this case, the “Prescription outside the normal” box must be ticked by the contract doctor. Such ordinances require special justification with prognostic assessment (see field 17 ). Even before prescribing outside of the normal case, new disorder-dependent collection of the current findings is required (see explanations for field 1 ).
Prescriptions based on "long-term need for medicinal products" can be 8a (8) of the Therapeutic Products Directive can be directly identified as “Ordinance outside the normal case” without the normal case having to be run through beforehand.
4 Group therapy
The "Group therapy" box must be ticked by the contract doctor if individual therapy is not medically required. Group therapy should be prescribed for effects that are desired in terms of group dynamics or in the interests of economic efficiency.
5 Start of treatment at the latest. on
The field "Treatment start latest. on “is only to be completed by the contract doctor if treatment is not to be started within 14 calendar days of the prescription being issued. The information must only be given in six digits in the format DDMMYY (e.g. 010217).
6 House visit
The box " Home visit - Yes "must be ticked by the contract doctor if the patient cannot visit the therapist for medical reasons or if the home visit is absolutely necessary for medical reasons. In other cases, the box "Home visit - No" must be ticked.
7 Therapy report
Upon request, the contract doctor can Request contract doctor for therapy report from the service provider. This is to be indicated on the Therapeutic Products Ordinance by ticking the box "Therapy Report - Yes".In other cases, the box “Therapy report - No” must be ticked.
8 Voice therapy, speech therapy and speech therapy
The contract doctor / The contract doctor prescribes voice therapy, speech therapy and / or speech therapy by ticking the appropriate box. At least one remedy must be prescribed.
9 Duration of therapy per session
The duration of therapy is in accordance with the remedy catalog depending on the medical indication (specific disorder) as well as the patient's resilience to be filled in with the minutes of 30, 45 or 60 minutes.
Special feature of the prescription outside the normal case
In the case of prescription outside of the normal case As rule, the amount of the prescription is to be calculated depending on the treatment frequency so that the treatment covers period of up to 12 weeks and medical examination is guaranteed (see Section 8 (1) sentence 4 HeilM-RL).
10 Prescription amount
In the case of an initial or subsequent prescription, the indication of the prescription amount may correspond to the value according to the selected diagnosis code, if necessary in connection with the selected remedy in accordance with the remedies catalog (HeilM-RL Part 2) do not exceed. Not every damage / dysfunction requires treatment with the maximum prescribed amount per prescription.
11 Therapy frequency
In the field "Therapy frequency" is the contract doctor should provide frequency recommendation A recommendation for the frequency of treatment is to be given depending on the severity and severity of disease (functional / structural damage, impairment of activities taking into account the individual context factors) as well as the therapeutic goal aimed at with this regulation.
Special feature of the Prescription of voice therapy for aphonia
For diagnosis group ST3 (Psychogenic Disorders of the Voice - Aphonia), the contract doctor can prescribe several units per day.
12 Indication code
The complete indication code must be entered in this field. When prescribing voice, speech and / or speech therapy, this only consists of the designation of the diagnosis group in accordance with the remedy catalog (e.g. SC2 or RE1).
13 Diagnosis with key symptoms, disorder-specific findings (e.g. speech, language, voice status, hearing aids)
Therapy-relevant findings are to be stated on the medication ordinance. These can result from the initial diagnostics or from new disorder-dependent assessment of the findings (see explanations for field 1 ).In other cases, the box “Therapy report - No” must be ticked.
8 Voice therapy, speech therapy and speech therapy
The contract doctor / The contract doctor prescribes voice therapy, speech therapy and / or speech therapy by ticking the appropriate box. At least one remedy must be prescribed.
9 Duration of therapy per session
The duration of therapy is in accordance with the remedy catalog depending on the medical indication (specific disorder) as well as the patient's resilience to be filled in with the minutes of 30, 45 or 60 minutes.
Special feature of the prescription outside the normal case
In the case of prescription outside of the normal case As rule, the amount of the prescription is to be calculated depending on the treatment frequency so that the treatment covers period of up to 12 weeks and medical examination is guaranteed (see Section 8 (1) sentence 4 HeilM-RL).
10 Prescription amount
In the case of an initial or subsequent prescription, the indication of the prescription amount may correspond to the value according to the selected diagnosis code, if necessary in connection with the selected remedy in accordance with the remedies catalog (HeilM-RL Part 2) do not exceed. Not every damage / dysfunction requires treatment with the maximum prescribed amount per prescription.
11 Therapy frequency
In the field "Therapy frequency" is the contract doctor should provide frequency recommendation A recommendation for the frequency of treatment is to be given depending on the severity and severity of disease (functional / structural damage, impairment of activities taking into account the individual context factors) as well as the therapeutic goal aimed at with this regulation.
Special feature of the Prescription of voice therapy for aphonia
For diagnosis group ST3 (Psychogenic Disorders of the Voice - Aphonia), the contract doctor can prescribe several units per day.
12 Indication code
The complete indication code must be entered in this field. When prescribing voice, speech and / or speech therapy, this only consists of the designation of the diagnosis group in accordance with the remedy catalog (e.g. SC2 or RE1).
13 Diagnosis with key symptoms, disorder-specific findings (e.g. speech, language, voice status, hearing aids)
Therapy-relevant findings are to be stated on the medication ordinance. These can result from the initial diagnostics or from new disorder-dependent assessment of the findings (see explanations for field 1 ).
14ICD-10-Code
The therapy-relevant ICD-10-GM code must be specified on the therapeutic products ordinance can be deviated from in justified exceptional cases. In order to assert special prescription requirements or long-term need for therapeutic products, the ICD-10-GM code must be stated in the form in accordance with Annex 2 of the Therapeutic Products Directive or in Annex 1 to Annex 2 of the framework according to Section 106b, Paragraph 2 SGB V for the performance audit of medically prescribed services dated November 30, 2015 (special prescription requirements) defined diagnosis lists.
The specification of an additional ICD-10-GM code is only necessary if special prescription requirement is to be claimed , for which the specification of second ICD-10-GM code is prerequisite (in accordance with Appendix 1 to Appendix 2 of the framework specifications according to Section 106b, Paragraph 2 of SGB V for the performance audit of medically prescribed services from November 30, 2015).
15 If necessary Neurological, pediatric peculiarities (e.g. psycho-intellectual findings)
In this field, the contract doctor can specify neurological and pediatric peculiarities that are necessary for measure of voice, speech and language therapy are of relevance.
16 If applicable Specification of the therapy goals
The contract doctor only has to state the therapy goals if they are not derived from the diagnosis and the main symptoms.
17 Medical justification for prescriptions outside the normal case (supplementary sheet)
This field only needs to be filled in for prescriptions outside the normal case. In this field, the contract doctor must provide special reason with prognostic assessment. A supplementary sheet should be used if necessary (see also explanations for field class = "numberBullet"> 3 ).
18 Tone audiogram / eardrum findings / Laryngological findings
In these fields, the contract doctor can enter therapy-relevant findings from the medical diagnosis. "
5. The explanations on the form for sample 18 change as follows:
"Sample 18: Therapeutic Products Ordinance (Occupational Therapy Measures)
The guidelines of the Federal Joint Committee on the Ordinance of Medicinal Products in Contract Medical Care (Therapeutic Products Directive / HeilM-RL) must be observed .
14ICD-10-Code
The therapy-relevant ICD-10-GM code must be specified on the therapeutic products ordinance can be deviated from in justified exceptional cases. In order to assert special prescription requirements or long-term need for therapeutic products, the ICD-10-GM code must be stated in the form in accordance with Annex 2 of the Therapeutic Products Directive or in Annex 1 to Annex 2 of the framework according to Section 106b, Paragraph 2 SGB V for the performance audit of medically prescribed services dated November 30, 2015 (special prescription requirements) defined diagnosis lists.
The specification of an additional ICD-10-GM code is only necessary if special prescription requirement is to be claimed , for which the specification of second ICD-10-GM code is prerequisite (in accordance with Appendix 1 to Appendix 2 of the framework specifications according to Section 106b, Paragraph 2 of SGB V for the performance audit of medically prescribed services from November 30, 2015).
15 If necessary Neurological, pediatric peculiarities (e.g. psycho-intellectual findings)
In this field, the contract doctor can specify neurological and pediatric peculiarities that are necessary for measure of voice, speech and language therapy are of relevance.
16 If applicable Specification of the therapy goals
The contract doctor only has to state the therapy goals if they are not derived from the diagnosis and the main symptoms.
17 Medical justification for prescriptions outside the normal case (supplementary sheet)
This field only needs to be filled in for prescriptions outside the normal case. In this field, the contract doctor must provide special reason with prognostic assessment. A supplementary sheet should be used if necessary (see also explanations for field class = "numberBullet"> 3 ).
18 Tone audiogram / eardrum findings / Laryngological findings
In these fields, the contract doctor can enter therapy-relevant findings from the medical diagnosis. "
5. The explanations on the form for sample 18 change as follows:
"Sample 18: Therapeutic Products Ordinance (Occupational Therapy Measures)
The guidelines of the Federal Joint Committee on the Ordinance of Medicinal Products in Contract Medical Care (Therapeutic Products Directive / HeilM-RL) must be observed .
When filling in the fields, please note the following:
1 First prescription; 2 Follow-up ordinance; 3 Ordinance outside of the normal case
Only one box may be ticked when marking regulation as an initial ordinance, subsequent ordinance or ordinance outside the normal case . Checking several boxes is not permitted.
1 First prescription
Every rule begins with an initial prescription. In this case, the “first prescription” box must be ticked by the contract doctor. Before the first prescription, an initial diagnosis by the contract doctor is necessary. During the initial diagnosis, diagnostic measures based on the disorder are to be carried out, initiated and, if necessary, documented (see field 12 ).
2 Follow-up Ordinance
After an initial prescription, every prescription for the treatment of the same disease and the same applies Usually as follow-up ordinance. In this case, the box “Follow-up prescription must be ticked by the contract doctor. This also applies if the main symptoms change during treatment and different physical therapy measures are used. If new normal case begins, an initial ordinance must be issued again (cf. § 7 HeilM-RL). Even before follow-up prescriptions, it is necessary to collect the current findings depending on the disorder (see explanations for field 1 ).
3 Regulation outside of the normal case
If, as rule, the total amount of prescriptions determined in accordance with the remedies catalog cannot complete the treatment, further prescriptions are possible (prescriptions outside the normal range, especially long-term prescriptions). In this case, the “Prescription outside the normal” box must be ticked by the contract doctor. Such ordinances require special justification with prognostic assessment (see field 16 ). Even before prescription outside of the normal case, new disorder-related collection of the current findings is required (see explanations for field 1 ).
Prescriptions due to "long-term need for therapeutic agents" can be made according to § 8a para. 8 of the Therapeutic Products Directive can be directly identified as “Ordinance outside of the normal case” without the normal case having to be run through beforehand.
When filling in the fields, please note the following:
1 First prescription; 2 Follow-up ordinance; 3 Ordinance outside of the normal case
Only one box may be ticked when marking regulation as an initial ordinance, subsequent ordinance or ordinance outside the normal case . Checking several boxes is not permitted.
1 First prescription
Every rule begins with an initial prescription. In this case, the “first prescription” box must be ticked by the contract doctor. Before the first prescription, an initial diagnosis by the contract doctor is necessary. During the initial diagnosis, diagnostic measures based on the disorder are to be carried out, initiated and, if necessary, documented (see field 12 ).
2 Follow-up Ordinance
After an initial prescription, every prescription for the treatment of the same disease and the same applies Usually as follow-up ordinance. In this case, the box “Follow-up prescription must be ticked by the contract doctor. This also applies if the main symptoms change during treatment and different physical therapy measures are used. If new normal case begins, an initial ordinance must be issued again (cf. § 7 HeilM-RL). Even before follow-up prescriptions, it is necessary to collect the current findings depending on the disorder (see explanations for field 1 ).
3 Regulation outside of the normal case
If, as rule, the total amount of prescriptions determined in accordance with the remedies catalog cannot complete the treatment, further prescriptions are possible (prescriptions outside the normal range, especially long-term prescriptions). In this case, the “Prescription outside the normal” box must be ticked by the contract doctor. Such ordinances require special justification with prognostic assessment (see field 16 ). Even before prescription outside of the normal case, new disorder-related collection of the current findings is required (see explanations for field 1 ).
Prescriptions due to "long-term need for therapeutic agents" can be made according to § 8a para. 8 of the Therapeutic Products Directive can be directly identified as “Ordinance outside of the normal case” without the normal case having to be run through beforehand.
4Groupentherapie
The "Group Therapy" box must be ticked by the contract doctor if individual therapy is not medically necessary is required. Group therapy should be prescribed for effects that are desired in terms of group dynamics or in the interests of economic efficiency.
5 Start of treatment at the latest. on
The field "Treatment start latest. on “is only to be completed by the contract doctor if treatment is not to be started within 14 calendar days of the prescription being issued. The information must only be given in six digits in the format DDMMYY (e.g. 010217).
6 Home visit
The box “Home visit - Yes “Must be ticked by the contract doctor if the patient cannot visit the therapist for medical reasons or if the home visit is absolutely necessary for medical reasons. In other cases, the box "Home visit - No" must be ticked.
7 Therapy report
Upon request, the contract doctor can Request contract doctor for therapy report from the service provider. This is to be indicated on the Therapeutic Products Ordinance by ticking the box "Therapy Report - Yes". In other cases the box “Therapy report - No” must be ticked.
8 Prescription amount
In the case of an initial or subsequent prescription The indication of the prescription amount must not exceed the value according to the selected diagnosis code, possibly in connection with the selected remedy in accordance with the remedy catalog (HeilM-RL Part 2). Not every damage / malfunction requires treatment with the maximum prescribed amount per prescription. If several "priority remedies" are prescribed at the same time when prescribing occupational therapy, the sum of the individual prescribed remedies must not exceed the maximum amount prescribed for each prescription in accordance with the remedies catalog.
Special feature of prescriptions outside of the normal case
In the case of prescription outside of the normal case, the prescription amount is to be calculated depending on the treatment frequency so that the treatment covers period of up to 12 weeks and medical examination is guaranteed (see § 8 Paragraph 1 Clause 4 HeilM-RL ).
9 Remedies in accordance with the catalog
On the remedies ordinance, the occupational therapy measures must be specified in accordance with the remedies catalog. There is the possibility of prescribing several "priority remedies" at the same time (see also the explanations for field 8 ).
4Groupentherapie
The "Group Therapy" box must be ticked by the contract doctor if individual therapy is not medically necessary is required. Group therapy should be prescribed for effects that are desired in terms of group dynamics or in the interests of economic efficiency.
5 Start of treatment at the latest. on
The field "Treatment start latest. on “is only to be completed by the contract doctor if treatment is not to be started within 14 calendar days of the prescription being issued. The information must only be given in six digits in the format DDMMYY (e.g. 010217).
6 Home visit
The box “Home visit - Yes “Must be ticked by the contract doctor if the patient cannot visit the therapist for medical reasons or if the home visit is absolutely necessary for medical reasons. In other cases, the box "Home visit - No" must be ticked.
7 Therapy report
Upon request, the contract doctor can Request contract doctor for therapy report from the service provider. This is to be indicated on the Therapeutic Products Ordinance by ticking the box "Therapy Report - Yes". In other cases the box “Therapy report - No” must be ticked.
8 Prescription amount
In the case of an initial or subsequent prescription The indication of the prescription amount must not exceed the value according to the selected diagnosis code, possibly in connection with the selected remedy in accordance with the remedy catalog (HeilM-RL Part 2). Not every damage / malfunction requires treatment with the maximum prescribed amount per prescription. If several "priority remedies" are prescribed at the same time when prescribing occupational therapy, the sum of the individual prescribed remedies must not exceed the maximum amount prescribed for each prescription in accordance with the remedies catalog.
Special feature of prescriptions outside of the normal case
In the case of prescription outside of the normal case, the prescription amount is to be calculated depending on the treatment frequency so that the treatment covers period of up to 12 weeks and medical examination is guaranteed (see § 8 Paragraph 1 Clause 4 HeilM-RL ).
9 Remedies in accordance with the catalog
On the remedies ordinance, the occupational therapy measures must be specified in accordance with the remedies catalog. There is the possibility of prescribing several "priority remedies" at the same time (see also the explanations for field 8 ).
10 Number per week
In the "Number per week" field, the contract doctor must provide frequency recommendation. A recommendation on the frequency of treatment is to be given depending on the severity and severity of disease (functional / structural damage, impairment of activities taking into account the individual context factors) as well as the therapy goal aimed at with this regulation.
11 Indication code
The complete indication code must be entered in this field. When prescribing occupational therapy, this only consists of the designation of the diagnosis group in accordance with the catalog of medicinal products (e.g. SB1 or PS2).
12 Diagnosis with key symptoms, if necessary essential findings
Therapy-relevant findings must be stated on the Ordinance on Therapeutic Products. These can result from the initial diagnostics or from new disorder-dependent assessment of the findings.
13 ICD-10 code
The therapy-relevant ICD-10– GM code must be stated on the prescription form; deviations from this can be made in justified exceptional cases. In order to assert special prescription requirements or long-term need for medicinal products, the ICD-10-GM code must be stated in the form in accordance with the specifications in Appendix 2 of the Therapeutic Products Directive (long-term medicinal products requirement) or in Appendix 1 to Appendix 2 of the framework specifications according to § 106b para. 2 SGB V for the performance audit of medically prescribed services dated November 30, 2015 (special prescription requirements) defined diagnosis lists.
The specification of an additional ICD-10-GM code is only necessary if special prescription is required should be asserted for which the specification of second ICD-10-GM code is prerequisite (in accordance with Appendix 1 to Appendix 2 of the framework requirements according to Section 106b (2) SGB V for the performance audit of medically prescribed services of November 30, 2015).
14 If necessary, neurological / psychiatric, pediatric, orthopedic features
In this field, the contracted doctor tin / the contracted physician specify neurological or psychiatric, pediatric or orthopedic features that are relevant as additional information for the therapy.
15 If necessary, specification of the therapy goals
The contract doctor must only specify the therapy goals if they are not derived from the diagnosis and the main symptoms.
16 Medical justification for prescriptions outside the normal case (possibly
10 Number per week
In the "Number per week" field, the contract doctor must provide frequency recommendation. A recommendation on the frequency of treatment is to be given depending on the severity and severity of disease (functional / structural damage, impairment of activities taking into account the individual context factors) as well as the therapy goal aimed at with this regulation.
11 Indication code
The complete indication code must be entered in this field. When prescribing occupational therapy, this only consists of the designation of the diagnosis group in accordance with the catalog of medicinal products (e.g. SB1 or PS2).
12 Diagnosis with key symptoms, if necessary essential findings
Therapy-relevant findings must be stated on the Ordinance on Therapeutic Products. These can result from the initial diagnostics or from new disorder-dependent assessment of the findings.
13 ICD-10 code
The therapy-relevant ICD-10– GM code must be stated on the prescription form; deviations from this can be made in justified exceptional cases. In order to assert special prescription requirements or long-term need for medicinal products, the ICD-10-GM code must be stated in the form in accordance with the specifications in Appendix 2 of the Therapeutic Products Directive (long-term medicinal products requirement) or in Appendix 1 to Appendix 2 of the framework specifications according to § 106b para. 2 SGB V for the performance audit of medically prescribed services dated November 30, 2015 (special prescription requirements) defined diagnosis lists.
The specification of an additional ICD-10-GM code is only necessary if special prescription is required should be asserted for which the specification of second ICD-10-GM code is prerequisite (in accordance with Appendix 1 to Appendix 2 of the framework requirements according to Section 106b (2) SGB V for the performance audit of medically prescribed services of November 30, 2015).
14 If necessary, neurological / psychiatric, pediatric, orthopedic features
In this field, the contracted doctor tin / the contracted physician specify neurological or psychiatric, pediatric or orthopedic features that are relevant as additional information for the therapy.
15 If necessary, specification of the therapy goals
The contract doctor must only specify the therapy goals if they are not derived from the diagnosis and the main symptoms.
16 Medical justification for prescriptions outside the normal case (possiblySupplement)
This field is only to be filled in for regulation outside of the normal case. In this field, the contract doctor must provide special reason with prognostic assessment. If necessary, supplementary sheet must be used (see also explanations for field 3 ). “
Article 3 Coming into force
The change of the form explanations for samples 1 and 2 come into force on July 1st, 2016.
The changed samples 13, 14 and 18 as well as the associated form explanations come into force with effect from 01.01.2017. Old forms may not be used up.
Berlin, 05/05/2016
National Association of Statutory Health Insurance Physicians, Kdö.R., Berlin GKV-Spitzenverband, Kdö.R., Berlin
1 Das The table of contents changes accordingly
1 ICD-10-GM, International Statistical Classification of Diseases and Related Health Problems (DIMDI), currently valid version.
ICD-10-GM, International Statistical Classification of Diseases and Related Health Problems (DIMDI), as amended.
ICD-10-GM, International Statistical Classification of Diseases and Related Health Problems (DIMDI), current version.
5
0
Do you want a website?