Abdominal pain (POAC)

All Pinnacle practices in the Te Whatu Ora Waikato area.

Patients with abdominal pain, who are haemodynamically stable.

Patients domiciled in Te Whatu Ora Lakes area.

• Any patient with an acute abdomen/severe abdominal pain/ suspected bowel obstruction – refer acutely to general surgery or gynaecology as appropriate.
• Suspected ruptured abdominal aortic aneurysm – refer acutely to vascular surgery.
• Suspected appendicitis – refer acutely to general surgery or paediatric surgery. Investigation by ultrasound not funded by POAC as hospital admission is inevitable.
• Investigation of an abdominal mass/suspected malignancy – urgent scans through primary referred radiology via high suspicion of cancer pathway should be used.
• Investigation by ultrasound of a large post-operative collection that would necessitate a hospital admission. As the hospital admission in such a case is inevitable, POAC cannot fund this.
• Hernia management – strangulated or obstructed hernia – refer acutely to general surgery. Certain hernias may be accepted by ACC for funding.
• Surveillance scans of known AAA – scan via vascular surgery.
• Investigation of incidental finding of abnormal liver enzymes with no abdominal pain with an ultrasound.
• Post-operative wound dressings.
• Constipation.
• Pregnancy related conditions including suspected ectopic pregnancy and heavy bleeding due to miscarriage. Please use maternity funding stream for investigations and management related to TOP/miscarriage for up to 14 days post event, and vaginal delivery for up to six weeks post-delivery. If acutely unwell, refer to O&G.  
• PID: 
  • Mild PID: considered to be routine GP business.  
  • Moderate PID: considered routine GP business. Refer acutely to gynaecology if no response to treatment within 72 hrs.  
  • Severe PID (acute abdomen, systemically unwell, mass suggestive of tubo-ovarian abscess) - refer acutely to gynaecology. 
• Abnormal uterine bleeding - investigation and management of this condition is routine GP business. 
• PCOS - investigation and management of this condition is routine GP business.  
• Endometriosis - investigation and management of this condition is routine GP business. 
• STI screening and treatment.    

Exclusion criteria to access POAC funding should not preclude emergency treatment of any medical conditions. 

Once the episode of care is completed and the patient is no longer acutely unwell, they exit the POAC programme.  

Once the patient exits the POAC programme, the case requires a clinical outcome to be lodged. No payment can be made for any claims unless the outcome is completed.  

Where treatment in the community is no longer clinically appropriate, the patient may be admitted to hospital during a POAC plan of care. Please indicate this in the clinical outcome. 

The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. If the claim cannot be funded by POAC, the patient may be liable to the practice for the fees incurred. 

Prices listed below are GST inclusive.  

Rehydration: $158 
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables. It cannot be claimed along with any other claims. This funding is for IV rehydration only in adults and oral rehydration only in children.
or
IV medication: $87
This invoice is a package of care i.e. it includes an allocation for staff time as well as consumables. It cannot be claimed along with any other claims.

GP/NP/CP follow up: $79 or RN follow up: $39 or

Rural GP/NP/CP follow up: $89 or RN follow up: $49 or

This funding is available to those practices that receive rural funding. 

Afterhours GP/NP/CP follow up: $99 or RN follow up $59

This funding can be claimed when care is provided after 5pm, on weekends or on public holidays.

A follow-up visit may be funded (based on treatment provided as evidenced in clinical notes).

This is limited to one consult within the acute episode of care. While follow up consultations can be virtual, to be eligible for funding, documentation needs to include a two-way conversation between the practice and the patient. A sent message with no documented response does not meet the definition of a consultation.

Funded via third party providers
An abdominal ultrasound is funded under this service to support management and avoid acute admission.  

Patients who are not acutely unwell and do not require a same day ultrasound are not funded under POAC and should be referred to primary referred radiology. Radiology is only funded for same-day investigations (within a 24-hour period). 

GP provided point of care ultrasound is excluded from POAC services – it is expected that patients will be charged for this service. 

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of POAC funding.  

It has been recommended that in addition to a good assessment and history, the full range of appropriate observations should be documented, especially where the diagnosis is undetermined. It is important to state the time of consultations and interactions with the patient.  

The initial 15-minute GP/NP consultation incurs the usual consultation fee paid by the patient. All POAC services thereafter are provided at no cost to the patient. 

The service is funded by Te Whatu Ora.