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What does ADOC reimburse in internal medicine? 12 worked scenarios

Worked examples of which internal medicine encounters ADOC reimburses: consultations, follow-ups, nursing and tests.

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
IM-1 New patient with breathlessness, many blood tests and an ECG No procedure event
Reimbursed
No nursing and allied health event
Day 1 Reported, not reimbursed
Day 1 Reported, not reimbursed
IM-2 Diabetes review with HbA1c and lipids No procedure event
Reimbursed
No nursing and allied health event
Reported, not reimbursed
IM-3 Return on day 6 for results No procedure event
Day 1 Reimbursed
Day 6 Not reimbursed
No nursing and allied health event No diagnostic event
IM-4 Return on day 12, same problem No procedure event
Day 1 Reimbursed
Day 12 Reduced follow-up rate
No nursing and allied health event No diagnostic event
IM-5 Same problem on day 20 No procedure event
Day 1 Reimbursed
Day 20 Reimbursed
No nursing and allied health event No diagnostic event
IM-6 Consultation plus IV fluids given in the clinic
Not reimbursed
Reimbursed
No nursing and allied health event No diagnostic event
IM-7 Four nurse IV antibiotic infusions after the consultation No procedure event
Reimbursed
Day 1 Not reimbursed
Day 2 Reimbursed
Day 3 Reimbursed
Day 4 Reimbursed
No diagnostic event
IM-8 Independent flu vaccine by the nurse 2 days after a consultation No procedure event
Reimbursed
Reimbursed
No diagnostic event
IM-9 Diabetic foot: nurse dresses the wound on day 3 No procedure event
Reimbursed
Reimbursed
No diagnostic event
IM-10 Dietitian sees the patient the same day Being confirmed No procedure event
Reimbursed
Reimbursed
No diagnostic event
IM-11 Blood tests ordered, no visit on the claim No procedure event No consultation event No nursing and allied health event
Day 1 Outside ADOC
Day 1 Reported, not reimbursed
IM-12 Telemedicine consultation Being confirmed No procedure event
Reimbursed
No nursing and allied health event No diagnostic event

The 12 scenarios

IM-1

New patient with breathlessness, many blood tests and an ECG

A physician sees a new patient with breathlessness, hyperlipidaemia and anaemia, and orders many blood tests and an ECG.

  1. Day 1
    • Consultation series
      C03 General medicine 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
      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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IM-2

Diabetes review with HbA1c and lipids

A physician reviews a patient with diabetes and orders HbA1c and lipids.

  1. Day 1
    • Consultation series
      C03 General medicine 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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IM-3

Return on day 6 for results

The patient returns on day 6 to discuss results, same problem.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 6
    • Consultation series
      C03 General medicine 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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IM-4

Return on day 12, same problem

The patient returns on day 12 with the same problem.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 12
    • Consultation series
      C03 General medicine 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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IM-5

Same problem on day 20

The patient returns on day 20.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 20
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

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IM-6

Consultation plus IV fluids given in the clinic

The physician consults and the patient receives IV fluids in the clinic.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

    • Procedure series
      Infusion or injection (diagnostic, therapeutic, prophylactic) The treating doctor
      Not reimbursed

      Included in the consultation. Only the consultation is reimbursed.

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IM-7

Four nurse IV antibiotic infusions after the consultation

After a consultation the nurse gives four IV antibiotic infusions.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

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

      The first visit of a multi-visit course ordered by the consultant stays part of the original consultation.

  2. Day 2
    • Nursing and allied health series
      S42 General nursing Nurse
      Reimbursed

      A later visit in a clinically necessary course of treatment is reimbursed in full. The note should say why it was needed.

  3. Day 3
    • Nursing and allied health series
      S42 General nursing Nurse
      Reimbursed

      A later visit in a clinically necessary course of treatment is reimbursed in full. The note should say why it was needed.

  4. Day 4
    • Nursing and allied health series
      S42 General nursing Nurse
      Reimbursed

      A later visit in a clinically necessary course of treatment is reimbursed in full. The note should say why it was needed.

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IM-8

Independent flu vaccine by the nurse 2 days after a consultation

Two days after a consultation the patient has an independent flu vaccine from the nurse.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 3
    • Nursing and allied health series
      S42 General nursing Nurse
      Reimbursed

      Nursing that was not ordered by a recent consultation is a separate service event.

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IM-9

Diabetic foot: nurse dresses the wound on day 3

Day 1 consultation. On day 3 the nurse dresses a diabetic foot wound.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

  2. Day 3
    • Nursing and allied health series
      S09 Wound management Nurse
      Reimbursed

      A separate service event. Wound and burn care is exempt from the follow-up rules.

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IM-10 Being confirmed

Dietitian sees the patient the same day

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

  1. Day 1
    • Consultation series
      C03 General medicine 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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IM-11

Blood tests ordered, no visit on the claim

A doctor orders blood tests and there is no visit on the claim.

  1. Day 1
    • Diagnostic series
      D05 Blood tests (e.g. LFT, CBC) or culture Another doctor
      Outside ADOC

      A test that cannot be linked to the visit that ordered it is not counted.

    • Diagnostic series
      D05 Blood tests (e.g. LFT, CBC) or culture A third 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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IM-12 Being confirmed

Telemedicine consultation

The physician consults the patient by telemedicine.

  1. Day 1
    • Consultation series
      C03 General medicine consultation The treating doctor
      Reimbursed

      A separate outpatient service event.

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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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