Worked examples of which general surgery encounters ADOC reimburses: consultations, minor procedures done in clinic, nurse dressings and tests. Emergency department care, day cases and endoscopy sit outside these examples.
P procedures · C consultations · S nursing and allied health · D diagnostics
| Scenario | PProcedure | CConsultation | SNursing and allied health | DDiagnostic |
|---|---|---|---|---|
| GS-1 Groin lump, hernia repair advised | No procedure event | Reimbursed | No nursing and allied health event | No diagnostic event |
| GS-2 Lipoma excised the same day, with its own procedure note | Reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| GS-3 Same excision, written only in the plan | Not reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| GS-4 Skin-tag removal booked for a later visit (general surgery) | Reimbursed | Day 1 Reimbursed Day 16 Reimbursed | No nursing and allied health event | No diagnostic event |
| GS-5 Two lesions excised in one session Being confirmed | Day 1 Reimbursed Day 1 Not reimbursed | No consultation event | No nursing and allied health event | No diagnostic event |
| GS-6 Nurse changes the wound dressing on day 3 | No procedure event | Reimbursed | Reimbursed | No diagnostic event |
| GS-7 Nurse removes sutures on day 8 Being confirmed | No procedure event | Reimbursed | Reimbursed | No diagnostic event |
| GS-8 Burn dressings on days 1, 4 and 9 | No procedure event | No consultation event | Day 1 Reimbursed Day 4 Reimbursed Day 9 Reimbursed | No diagnostic event |
| GS-9 Surgeon sees the patient on day 5, post-op wound check | No procedure event | Day 1 Reimbursed Day 5 Not reimbursed | No nursing and allied health event | No diagnostic event |
| GS-10 Surgeon sees the patient on day 10, same problem | No procedure event | Day 1 Reimbursed Day 10 Reduced follow-up rate | No nursing and allied health event | No diagnostic event |
| GS-11 Ultrasound and bloods for upper abdominal pain | No procedure event | Reimbursed | No nursing and allied health event | Day 1 Reported, not reimbursed Day 1 Reported, not reimbursed |
A surgeon assesses a groin lump and advises a hernia repair.
C04 General surgery consultation The treating doctor A separate outpatient service event.
A surgeon sees a patient with a lipoma on the back and excises it the same day. A separate procedure note records consent, technique and findings.
C04 General surgery consultation The treating doctor A separate outpatient service event.
P03 Excision of lesion, cyst or lump The treating doctor Not part of the consultation, so it is reimbursed as a separate event alongside it.
As GS-2, but the note says only "lipoma excised" in the plan. There is no procedure note.
C04 General surgery consultation The treating doctor A separate outpatient service event.
P03 Excision of lesion, cyst or lump The treating doctor 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.
A surgeon sees a patient with a skin tag and books removal 16 days later.
C04 General surgery consultation The treating doctor A separate outpatient service event.
C04 General surgery consultation The treating doctor A separate outpatient service event.
P03 Skin tag removal The treating doctor Not part of the consultation, so it is reimbursed as a separate event alongside it. (In dermatology the same procedure would be included in the consultation.)
A surgeon excises two separate lesions (a lipoma and a sebaceous cyst) in one session, each with a note.
P03 Excision of lesion, cyst or lump The treating doctor Not part of the consultation, so it is reimbursed as a separate event alongside it.
P03 Excision of lesion, cyst or lump The treating doctor Only one procedure event is reimbursed per patient, per clinician, per day. The other goes on the claim but is not reimbursed.
Day 1 surgical consultation. On day 3 the nurse changes the wound dressing, ordered by the surgeon.
C04 General surgery consultation The treating doctor A separate outpatient service event.
S09 Wound management Nurse A separate service event. Wound and burn care is exempt from the follow-up rules.
Sutures removed by the nurse on day 8 after a day-1 surgical consultation.
C04 General surgery consultation The treating doctor A separate outpatient service event.
S09 Wound management Nurse A separate service event. Wound and burn care is exempt from the follow-up rules.
A patient with a burn is dressed by the nurse on day 1, day 4 and day 9.
S45 Burns management Nurse A separate service event. Wound and burn care is exempt from the follow-up rules.
S45 Burns management Nurse A separate service event. Wound and burn care is exempt from the follow-up rules.
S45 Burns management Nurse A separate service event. Wound and burn care is exempt from the follow-up rules.
The patient returns on day 5 for a routine wound check, same problem.
C04 General surgery consultation The treating doctor A separate outpatient service event.
C04 General surgery consultation The treating doctor A related return within 7 days of the consultation counts as part of that consultation, so it is not reimbursed.
First related return to the surgeon on day 10.
C04 General surgery consultation The treating doctor A separate outpatient service event.
C04 General surgery consultation The treating doctor The first related return, between days 8 and 14, is reimbursed at a reduced follow-up rate.
A surgeon orders an abdominal ultrasound and blood tests for right upper abdominal pain.
C04 General surgery consultation The treating doctor A separate outpatient service event.
D01 Ultrasound (non-cardiac) The treating doctor Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.
D05 Blood tests (e.g. LFT, CBC) or culture The treating doctor Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.
Describe a visit in your own words and the checker shows what ADOC reimburses, what it does not, and the reason for each answer.
Open the ADOC Claim CheckerThese 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.