Diagnosis coding for possible malignancy

How would you feel if your primary care physician and your general surgeon told you-and told your insurance company on a claim form-that you had breast cancer, when you didn’t have breast cancer?

You actually had atypical ductal hyperplasia, not breast cancer. Not only have they told you, the claim has gone to your insurance company and the insurance company thinks you have breast cancer. And, it is listed in your electronic medical record on your problem list.

Anyone who works in healthcare knows that removing a diagnosis from a medical record at the physician office, at the hospital, and in the insurance company’s records will be difficult.

Think about the repercussions for this patient if she later needs to buy life insurance, disability insurance, or a health insurance in a state that allows charing higher rates based on pre-existing conditions.

How did this happen?