Worked examples of which orthopaedic clinic encounters ADOC reimburses: consultations, joint injections, casts, physiotherapy and imaging.
P procedures · C consultations · S nursing and allied health · D diagnostics
| Scenario | PProcedure | CConsultation | SNursing and allied health | DDiagnostic |
|---|---|---|---|---|
| OR-1 Knee osteoarthritis assessed | No procedure event | Reimbursed | No nursing and allied health event | No diagnostic event |
| OR-2 Osteoarthritis plus a pain plan in the same consultation Being confirmed | No procedure event | Day 1 Reimbursed Day 1 Not reimbursed | No nursing and allied health event | No diagnostic event |
| OR-3 X-ray ordered for joint pain | No procedure event | Reimbursed | No nursing and allied health event | Reported, not reimbursed |
| OR-4 Consultation plus steroid joint injection, with its own note Being confirmed | Not reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| OR-5 Same injection, only mentioned in the plan | Not reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| OR-6 Consultation plus cast or splint, with its own note Being confirmed | Not reimbursed | Reimbursed | No nursing and allied health event | No diagnostic event |
| OR-7 Same visit: surgeon, physiotherapist and radiographer | No procedure event | Reimbursed | Not reimbursed | Reported, not reimbursed |
| OR-7b Physiotherapy session on a different day, referred by the surgeon Being confirmed | No procedure event | Reimbursed | Reimbursed | No diagnostic event |
| OR-8 Flu vaccine two days after the consultation | No procedure event | Reimbursed | Reimbursed | No diagnostic event |
| OR-9 Nurse injection visit on day 8 | No procedure event | Reimbursed | Reduced follow-up rate | No diagnostic event |
| OR-10 Surgeon sees the patient again on day 5 | No procedure event | Day 1 Reimbursed Day 5 Not reimbursed | No nursing and allied health event | No diagnostic event |
| OR-11 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 |
| OR-12 Nurse wound dressing on day 3 | No procedure event | Reimbursed | Reimbursed | No diagnostic event |
| OR-13 Consultation plus joint aspiration, with its own note Being confirmed | Not reimbursed | Reimbursed | No nursing and allied health event | Reported, not reimbursed |
An orthopaedic surgeon assesses a patient with knee osteoarthritis and gives advice.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
In the same consultation the surgeon also assesses chronic pain and writes a pain management plan.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
C02 Pain management consultation The treating doctor Only one consultation event is reimbursed per patient, per clinician, per day. The other goes on the claim but is not reimbursed.
The surgeon orders a knee or shoulder X-ray for joint pain.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
D01 X-ray / radiography The treating doctor Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.
The surgeon consults, then injects a joint with steroid and writes a separate procedure note.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
Included in the consultation. Only the consultation is reimbursed.
As OR-4, but the note says only "steroid injection given" in the plan. There is no procedure note.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
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 patient with a wrist fracture is seen in clinic. The surgeon consults and applies a cast or splint, with a procedure note.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
Included in the consultation. Only the consultation is reimbursed.
In one orthopaedic visit the surgeon consults, a physiotherapist treats the patient, and a radiographer takes an X-ray.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
S06 Physiotherapy Physiotherapist Support given within the consultation is part of that service, so it counts as one event.
D01 X-ray / radiography The treating doctor Tests feed into the visit that ordered them. They go on the claim, but are never reimbursed on their own.
The surgeon refers the patient to physiotherapy, which is done on a separate day.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
S06 Physiotherapy Physiotherapist A separate outpatient service event.
The patient has an orthopaedic consultation, and two days later the nurse gives an independent flu vaccine.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
S42 General nursing Nurse Nursing that was not ordered by a recent consultation is a separate service event.
Seven days after the consultation (day 8) the patient has a nurse injection visit.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
S42 General nursing Nurse Nursing ordered by the consultant and given between days 8 and 14 is reimbursed at a reduced follow-up rate.
The patient returns to the surgeon on day 5 with the same problem.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
C32 Orthopaedics 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.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
C32 Orthopaedics consultation The treating doctor The first related return, between days 8 and 14, is reimbursed at a reduced follow-up rate.
Day 1 surgical consultation. On day 3 the nurse dresses a wound or abrasion, ordered by the surgeon.
C32 Orthopaedics 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.
The surgeon consults and aspirates a joint effusion, with a procedure note. The fluid may be sent for analysis.
C32 Orthopaedics consultation The treating doctor A separate outpatient service event.
Included in the consultation. Only the consultation is reimbursed.
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.