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What does ADOC reimburse in gastroenterology? 8 worked scenarios

Worked examples of which gastroenterology clinic encounters ADOC reimburses. Scopes are done as day cases after approval, so they sit outside ADOC.

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
GI-1 Dyspepsia: consultation, blood tests and abdominal ultrasound No procedure event
Reimbursed
No nursing and allied health event
Day 1 Reported, not reimbursed
Day 1 Reported, not reimbursed
GI-2 Consultation, scope booked and done later as a day case
Outside ADOC
Reimbursed
No nursing and allied health event No diagnostic event
GI-3 Return exactly 7 days after the consultation (day 8) No procedure event
Day 1 Reimbursed
Day 8 Reduced follow-up rate
No nursing and allied health event No diagnostic event
GI-4 Return 14 days after the consultation (day 15) No procedure event
Day 1 Reimbursed
Day 15 Reimbursed
No nursing and allied health event No diagnostic event
GI-5 Return on day 5 for results No procedure event
Day 1 Reimbursed
Day 5 Not reimbursed
No nursing and allied health event No diagnostic event
GI-6 Clinic visit to discuss the histology after a day-case scope Being confirmed No procedure event
Day 1 Reimbursed
Day 10 Reduced follow-up rate
No nursing and allied health event No diagnostic event
GI-7 Dietitian sees the patient the same day Being confirmed No procedure event
Reimbursed
Reimbursed
No diagnostic event
GI-8 Liver blood tests and ultrasound ordered No procedure event
Reimbursed
No nursing and allied health event
Day 1 Reported, not reimbursed
Day 1 Reported, not reimbursed

The 8 scenarios

GI-1

Dyspepsia: consultation, blood tests and abdominal ultrasound

A gastroenterologist sees a patient with dyspepsia and orders blood tests and an abdominal ultrasound.

  1. Day 1
    • Consultation series
      C29 Gastroenterology 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.

    • Diagnostic series
      D01 Ultrasound (non-cardiac) 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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GI-2

Consultation, scope booked and done later as a day case

The gastroenterologist consults and books a scope. After approval it is done later as a day case.

  1. Day 1
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Procedure series
      P04 GI endoscopy (gastroscopy, colonoscopy, sigmoidoscopy) 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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GI-3

Return exactly 7 days after the consultation (day 8)

The patient returns 7 days after the consultation, which is day 8.

  1. Day 1
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 8
    • Consultation series
      C29 Gastroenterology 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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GI-4

Return 14 days after the consultation (day 15)

The patient returns 14 days after the consultation, which is day 15.

  1. Day 1
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 15
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

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GI-5

Return on day 5 for results

The patient returns on day 5 for results.

  1. Day 1
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 5
    • Consultation series
      C29 Gastroenterology 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.

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GI-6 Being confirmed

Clinic visit to discuss the histology after a day-case scope

After a day-case scope, the patient comes to clinic to discuss the histology.

  1. Day 1
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 10
    • Consultation series
      C29 Gastroenterology 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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GI-7 Being confirmed

Dietitian sees the patient the same day

The patient sees the gastroenterologist and, the same day, a dietitian.

  1. Day 1
    • Consultation series
      C29 Gastroenterology consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Nursing and allied health series
      S14 Nutrition/dietetics Dietitian
      Reimbursed

      A separate outpatient service event.

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GI-8

Liver blood tests and ultrasound ordered

The gastroenterologist orders liver blood tests and an abdominal ultrasound.

  1. Day 1
    • Consultation series
      C29 Gastroenterology 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.

    • Diagnostic series
      D01 Ultrasound (non-cardiac) 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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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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