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What does ADOC reimburse in cardiology? 11 worked scenarios

Worked examples of which cardiology encounters ADOC reimburses: consultations, ECG and echo, nursing and follow-up visits.

Key

  • Reimbursed
  • Reduced follow-up rate
  • Not reimbursed
  • Reported, not reimbursed
  • Outside ADOC

P procedures · C consultations · S nursing and allied health · D diagnostics

Summary

Each row is one scenario. Select a row to jump to its card.
Scenario PProcedureCConsultationSNursing and allied healthDDiagnostic
CA-1 Chest pain: consultation, ECG and echocardiogram No procedure event
Reimbursed
No nursing and allied health event
Day 1 Reported, not reimbursed
Day 1 Reported, not reimbursed
CA-2 Cardiology clinic visit with a nurse in the same visit No procedure event
Reimbursed
Not reimbursed
No diagnostic event
CA-3 Hypertension follow-up with a 24-hour monitor No procedure event
Reimbursed
No nursing and allied health event
Reported, not reimbursed
CA-4 Stress ECG booked as its own visit No procedure event No consultation event No nursing and allied health event
Reported, not reimbursed
CA-5 Cardiac blood tests (troponin, lipids) No procedure event
Reimbursed
No nursing and allied health event
Reported, not reimbursed
CA-6 Nurse education or injection visit on day 8 No procedure event
Reimbursed
Reduced follow-up rate
No diagnostic event
CA-7 Return on day 5 for results, then day 10 No procedure event
Day 1 Reimbursed
Day 5 Not reimbursed
Day 10 Reduced follow-up rate
No nursing and allied health event No diagnostic event
CA-8 Child (age 8) with a murmur No procedure event
Day 1 Reimbursed
Day 5 Reimbursed
No nursing and allied health event No diagnostic event
CA-9 Pacemaker check clinic visit Being confirmed No procedure event
Reimbursed
No nursing and allied health event
Reported, not reimbursed
CA-10 Diagnostic coronary angiography as an outpatient Being confirmed No procedure event No consultation event No nursing and allied health event
Reported, not reimbursed
CA-11 Chest pain arriving through the emergency department No procedure event
Outside ADOC
No nursing and allied health event No diagnostic event

The 11 scenarios

CA-1

Chest pain: consultation, ECG and echocardiogram

A cardiologist sees a patient with chest pain and orders an ECG and an echocardiogram.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Diagnostic series
      D08 ECG, stress ECG or Holter The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

    • Diagnostic series
      D08 Echocardiography (incl. Doppler, stress) The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

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CA-2

Cardiology clinic visit with a nurse in the same visit

In a cardiology clinic visit the cardiologist and a nurse both provide care.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Nursing and allied health series
      S42 General nursing Nurse
      Not reimbursed

      Support given within the consultation is part of that service, so it counts as one event.

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CA-3

Hypertension follow-up with a 24-hour monitor

A cardiologist sees a patient with hypertension and a 24-hour monitor is done.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Diagnostic series
      D08 ECG, stress ECG or Holter The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

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CA-4

Stress ECG booked as its own visit

A stress ECG ordered by the cardiologist is done on a separate day with no consultation.

  1. Day 1
    • Diagnostic series
      D08 ECG, stress ECG or Holter The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

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CA-5

Cardiac blood tests (troponin, lipids)

The cardiologist orders troponin and lipids.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Diagnostic series
      D05 Blood tests (e.g. LFT, CBC) or culture The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

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CA-6

Nurse education or injection visit on day 8

Seven days after the consultation (day 8) the nurse sees the patient for education or an injection.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 8
    • Nursing and allied health series
      S42 General nursing Nurse
      Reimbursed at a reduced follow-up rate

      Nursing ordered by the consultant and given between days 8 and 14 is reimbursed at a reduced follow-up rate.

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CA-7

Return on day 5 for results, then day 10

The patient returns once on day 5 for results, and another time on day 10.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 5
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Not reimbursed

      A related return within 7 days of the consultation counts as part of that consultation, so it is not reimbursed.

  3. Day 10
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed at a reduced follow-up rate

      The first related return, between days 8 and 14, is reimbursed at a reduced follow-up rate.

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CA-8

Child (age 8) with a murmur

A child aged 8 is seen by the cardiologist for a murmur and returns within the window.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 5
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate service event. The follow-up rules do not apply to patients under 18.

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CA-9 Being confirmed

Pacemaker check clinic visit

The patient attends for a pacemaker check.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Diagnostic series
      D08 Clinical measurement The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

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CA-10 Being confirmed

Diagnostic coronary angiography as an outpatient

The patient has a diagnostic coronary angiogram.

  1. Day 1
    • Diagnostic series
      D01 Diagnostic angiography The treating doctor
      Reported, not reimbursed

      Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.

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CA-11

Chest pain arriving through the emergency department

A patient with chest pain presents through the emergency department.

  1. Day 1
    • Consultation series
      C26 Cardiology consultation The treating doctor
      Outside ADOC

      Emergency department care is outside ADOC and is billed through the emergency pathway.

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These worked scenarios show how the Abu Dhabi DoH ADOC outpatient classification treats each encounter. They are general guidance, not billing advice for a particular claim. Whether and how an encounter is paid also depends on your hospital's contract and the current DoH rules. Always check the DoH ADOC manual and your own price list. See the site disclaimer.

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