Worked examples of which obstetric and gynaecological encounters ADOC reimburses, including pregnancy follow-up and what sits outside ADOC.
P procedures · C consultations · S nursing and allied health · D diagnostics
| Scenario | PProcedure | CConsultation | SNursing and allied health | DDiagnostic |
|---|---|---|---|---|
| OG-1 Abnormal bleeding, pelvic ultrasound ordered | No procedure event | Reimbursed | No nursing and allied health event | Reported, not reimbursed |
| OG-2 Consultation plus office hysteroscopy, own note | Reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| OG-3 Same hysteroscopy, only mentioned in the plan | Not reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| OG-4 Consultation, hysteroscopy and pelvic floor physio the same day | Reimbursed | Reimbursed | Reimbursed | No diagnostic event |
| OG-5 Cervical smear taken at the consultation Being confirmed | No procedure event | Reimbursed | No nursing and allied health event | Day 1 Reported, not reimbursed Day 1 Reported, not reimbursed |
| OG-6 Intrauterine device inserted, with a procedure note Being confirmed | Not reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| OG-7 Routine antenatal visit, uncomplicated pregnancy | No procedure event | Reimbursed | No nursing and allied health event | Day 1 Reported, not reimbursed Day 1 Reported, not reimbursed |
| OG-8 Antenatal visit with a complication Being confirmed | No procedure event | Reimbursed | No nursing and allied health event | No diagnostic event |
| OG-9 Antenatal visit with a midwife the same day Being confirmed | No procedure event | Reimbursed | Reimbursed | No diagnostic event |
| OG-10 Antenatal return on day 5 | No procedure event | Day 1 Reimbursed Day 5 Reimbursed | No nursing and allied health event | No diagnostic event |
| OG-11 Gynaecology problem, back on day 10 | No procedure event | Day 1 Reimbursed Day 10 Reduced follow-up rate | No nursing and allied health event | No diagnostic event |
| OG-12 Infertility work-up consultation | Outside ADOC | Reimbursed | No nursing and allied health event | No diagnostic event |
| OG-13 Premarital genetic screening | Outside ADOC | No consultation event | No nursing and allied health event | No diagnostic event |
A gynaecologist assesses a patient with abnormal uterine bleeding and orders a pelvic ultrasound.
C08 Gynaecology 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.
The gynaecologist consults and does an office hysteroscopy with its own procedure note.
C08 Gynaecology consultation The treating doctor A separate outpatient service event.
P05 Cystoscopy, hysteroscopy or colposcopy The treating doctor Not part of the consultation, so it is reimbursed as a separate event alongside it.
As OG-2, but the note says only "hysteroscopy done" in the plan, with no procedure note.
C08 Gynaecology consultation The treating doctor A separate outpatient service event.
P05 Cystoscopy, hysteroscopy or colposcopy 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.
The gynaecologist consults and does a hysteroscopy with its own note. The same day the patient sees a physiotherapist for pelvic floor treatment.
C08 Gynaecology consultation The treating doctor A separate outpatient service event.
P05 Cystoscopy, hysteroscopy or colposcopy The treating doctor Not part of the consultation, so it is reimbursed as a separate event alongside it.
S06 Physiotherapy Physiotherapist A separate outpatient service event.
The gynaecologist takes a cervical smear during the consultation.
C08 Gynaecology consultation The treating doctor A separate outpatient service event.
D05 Specimen collection The treating doctor Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.
D05 Histopathology or cytology of a specimen The treating doctor Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.
The gynaecologist consults and inserts an intrauterine device, with a procedure note.
C08 Gynaecology consultation The treating doctor A separate outpatient service event.
Included in the consultation. Only the consultation is reimbursed.
A routine antenatal visit in an uncomplicated pregnancy, with bloods and a scan ordered.
C11 Obstetrics consultation (uncomplicated pregnancy) The treating doctor A separate outpatient service event.
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.
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.
An antenatal visit in a pregnancy with a complication, for example gestational diabetes.
C12 Obstetrics consultation (complex pregnancy) The treating doctor A separate outpatient service event.
The patient sees the obstetrician and, in the same visit, a midwife.
C11 Obstetrics consultation (uncomplicated pregnancy) The treating doctor A separate outpatient service event.
S17 Midwifery and maternity Midwife A separate outpatient service event.
The patient returns to the obstetrician on day 5.
C11 Obstetrics consultation (uncomplicated pregnancy) The treating doctor A separate outpatient service event.
C11 Obstetrics consultation (uncomplicated pregnancy) The treating doctor A separate service event. The follow-up rules do not apply in pregnancy.
The patient returns on day 10 with the same gynaecology problem.
C08 Gynaecology consultation The treating doctor A separate outpatient service event.
C08 Gynaecology consultation The treating doctor The first related return, between days 8 and 14, is reimbursed at a reduced follow-up rate.
A couple is seen for an infertility work-up consultation.
C10 Assisted reproductive technology consultation The treating doctor A separate outpatient service event.
IVF procedures are outside ADOC and are billed separately. The consultation itself is still an ADOC event.
A patient attends for premarital genetic screening.
Premarital and similar genetic screening is outside ADOC and is billed separately.
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.