Question

Patient, Demi Daniels, calls to ask you to change her diagnosis in her medical record from R/O (rule out) bladder infection to “bladder infection” because her insurance will not pay for a R/O diagnosis. In fact, she tested negative for an infection, but the physician placed her on antibiotics anyway.

What do I do?

Answer 1

it's illegal to change medical records can suggest anybody to do anything is up to the doctor she's under doctor's care as far as an antibiotics she has to discuss that with the doctor the only thing that can be done is you can suggest her to go to another doctor

Answer 2

New ICD codes don’t even have a R/O, so while a practitioner, in theory, may be suspecting a diagnosis, insurance wants the diagnosis- and the code- before the patient leaves the initial consult.

Do not change a diagnosis, but perhaps don’t commit to UTI? Abdominal pain, fever, elevated WBC- start you on the path without locking you to it. Educate your patient how to appeal and write a letter of support, be their advocate but cover your license.