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What does ADOC reimburse in ear, nose and throat (ENT)? 11 worked scenarios

Worked examples of which ENT encounters ADOC reimburses: consultations, clinic procedures, audiology 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
ENT-1 Vertigo and tinnitus: consultation, vestibular recording, audiometry and tonometry No procedure event
Reimbursed
No nursing and allied health event
Reported, not reimbursed
ENT-2 Hoarseness: consultation plus flexible laryngoscopy, own note
Reimbursed
Reimbursed
No nursing and allied health event No diagnostic event
ENT-3 Same, nasal endoscopy only mentioned in the plan
Not reimbursed
Reimbursed
No nursing and allied health event No diagnostic event
ENT-4 Consultation plus audiology in the same visit No procedure event
Reimbursed
Not reimbursed
No diagnostic event
ENT-5 Hearing test only, referred, no ENT consultation Being confirmed No procedure event No consultation event
Reimbursed
No diagnostic event
ENT-6 Ear microsuction or wax removal, with a note Being confirmed
Not reimbursed
Reimbursed
No nursing and allied health event No diagnostic event
ENT-7 Nasal cautery for nosebleed, with a note Being confirmed
Not reimbursed
Reimbursed
No nursing and allied health event No diagnostic event
ENT-8 Chronic sinusitis: CT sinuses ordered No procedure event
Reimbursed
No nursing and allied health event
Reported, not reimbursed
ENT-9 Return on day 5, 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
ENT-10 Child under 18 with otitis media, back on day 5 No procedure event
Day 1 Reimbursed
Day 5 Reimbursed
No nursing and allied health event No diagnostic event
ENT-11 Tonsillectomy or septoplasty
Outside ADOC
No consultation event No nursing and allied health event No diagnostic event

The 11 scenarios

ENT-1

Vertigo and tinnitus: consultation, vestibular recording, audiometry and tonometry

An ENT specialist sees a patient with vertigo and tinnitus. Vestibular evaluation with recording, audiometry and tonometry are done.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) 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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ENT-2

Hoarseness: consultation plus flexible laryngoscopy, own note

An ENT specialist consults a patient with hoarseness and does a flexible laryngoscopy with its own procedure note.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Procedure series
      P06 Bronchoscopy, nasendoscopy or laryngoscopy The treating doctor
      Reimbursed

      Not part of the consultation, so it is reimbursed as a separate event alongside it.

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ENT-3

Same, nasal endoscopy only mentioned in the plan

As ENT-2, but the endoscopy is only a line in the plan, with no procedure note.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Procedure series
      P06 Bronchoscopy, nasendoscopy or laryngoscopy The treating doctor
      Not reimbursed

      The procedure appears only as a line in the consultation plan, with no procedure note of its own. It is treated as part of the consultation, not as a separate event.

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ENT-4

Consultation plus audiology in the same visit

The ENT specialist consults and an audiologist does a hearing test in the same visit.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Nursing and allied health series
      S12 Audiology Audiologist
      Not reimbursed

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

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ENT-5 Being confirmed

Hearing test only, referred, no ENT consultation

The patient is referred for a hearing test only, with no ENT consultation.

  1. Day 1
    • Nursing and allied health series
      S12 Audiology Audiologist
      Reimbursed

      A separate outpatient service event.

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ENT-6 Being confirmed

Ear microsuction or wax removal, with a note

The ENT specialist consults and removes wax by microsuction, with a procedure note.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Procedure series
      ENT foreign body removal, nasal cautery or turbinate ablation The treating doctor
      Not reimbursed

      Included in the consultation. Only the consultation is reimbursed.

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ENT-7 Being confirmed

Nasal cautery for nosebleed, with a note

The ENT specialist consults and cauterises a bleeding point, with a procedure note.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Procedure series
      ENT foreign body removal, nasal cautery or turbinate ablation The treating doctor
      Not reimbursed

      Included in the consultation. Only the consultation is reimbursed.

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ENT-8

Chronic sinusitis: CT sinuses ordered

The ENT specialist sees a patient with chronic sinusitis and orders a CT of the sinuses.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Diagnostic series
      D03 CT or CT 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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ENT-9

Return on day 5, then day 10

The patient returns once on day 5, and on another occasion on day 10, same problem.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 5
    • Consultation series
      C22 Ear, nose and throat (ENT) 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
      C22 Ear, nose and throat (ENT) 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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ENT-10

Child under 18 with otitis media, back on day 5

A child with otitis media returns on day 5.

  1. Day 1
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 5
    • Consultation series
      C22 Ear, nose and throat (ENT) consultation The treating doctor
      Reimbursed

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

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ENT-11

Tonsillectomy or septoplasty

The patient has a tonsillectomy or septoplasty.

  1. Day 1
    • Procedure series
      P03 Excision of lesion, cyst or lump The treating doctor
      Outside ADOC

      Day-surgery and day-case care is outside ADOC and is billed through a separate system.

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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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