Doctor incorrectly coded a diabetes diagnosis for my insurance to pay for HgA1c screening labs. What should I do?

I went to a new primary care provider recently. After a couple of years without healthcare due to the pandemic etc, I wanted to get all my concerns sorted out. I have a family history of diabetes so specifically asked to have my HgA1C checked. It turned out within normal range.

Later on looking at my records I found that under “assessments” for both my initial visit and the follow-up visit the doctor put a diagnosis code of “Type 2 diabetes mellitus without complication, without long-term current use of insulin – E11.9.” I have never been diagnosed with diabetes and the results he ordered were totally normal. I reached out to the office on the portal asking about this and their reply was “To order the lab to check for diabetes the code for diabetes has to be entered otherwise your insurance would not have covered the lab.”

I’ve done a bit of checking and it looks like actually it should have been coded “Z13.1 Encounter for screening for diabetes mellitus”. I am really worried that now I have an incorrect diabetes diagnosis in my records following me around. I am concerned this could impact my eligibility for life insurance, non-ACA insurance, and work deployability, and somehow affect or complicate future medical care.

I feel really sketched out that they put this code to get insurance to pay. If they were concerned insurance would not pay they could have spoken to me about it – I could have paid out of pocket or gotten the test directly through a lab or something.

What should be my next steps with this? Can the doctor correct the diagnosis in my records? How could this impact me?

submitted by /u/wisteria_tempura
[link] [comments]I went to a new primary care provider recently. After a couple of years without healthcare due to the pandemic etc, I wanted to get all my concerns sorted out. I have a family history of diabetes so specifically asked to have my HgA1C checked. It turned out within normal range. Later on looking at my records I found that under “assessments” for both my initial visit and the follow-up visit the doctor put a diagnosis code of “Type 2 diabetes mellitus without complication, without long-term current use of insulin – E11.9.” I have never been diagnosed with diabetes and the results he ordered were totally normal. I reached out to the office on the portal asking about this and their reply was “To order the lab to check for diabetes the code for diabetes has to be entered otherwise your insurance would not have covered the lab.” I’ve done a bit of checking and it looks like actually it should have been coded “Z13.1 Encounter for screening for diabetes mellitus”. I am really worried that now I have an incorrect diabetes diagnosis in my records following me around. I am concerned this could impact my eligibility for life insurance, non-ACA insurance, and work deployability, and somehow affect or complicate future medical care. I feel really sketched out that they put this code to get insurance to pay. If they were concerned insurance would not pay they could have spoken to me about it – I could have paid out of pocket or gotten the test directly through a lab or something. What should be my next steps with this? Can the doctor correct the diagnosis in my records? How could this impact me? submitted by /u/wisteria_tempura [link] [comments]Read Morer/HealthInsurance

Leave a Reply

Your email address will not be published.