What exactly is an "Official Diagnosis"?

A couple of questions for my medically-savvy friends:

Does a doctor have to spell out "Patient has Hashimoto's Thyroiditis" before a diagnosis is official or is it enough to have the lab results showing two elevated thyroid antibodies in the positive range?

Is a surgical report that states "4-5 cm endometrioma" proof of endometriosis or is an additional statement needed?

What about scoliosis? Is the x-ray enough or again, does the doctor have to write something up before it's an official diagnosis?

Thanks for your help... I'm hoping I don't have to track down doctors all over the U.S. and Canada!

Technically Hashimotos is autoimmune, so I would think if you have documentation of thyroid antibodies that would be enough. I'm not sure though.

I have no clue about the other ones. Sorry!

If your trying to get an insurance company or government agency to pay ... YES it needs to be VERY simple and SPELLED out ... If it is merely a specialist referral then no ..

Originally Posted by sharky

If your trying to get an insurance company or government agency to pay ... YES it needs to be VERY simple and SPELLED out ... If it is merely a specialist referral then no ..

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has been my experience with WSIB, as well as a disability insurance company when I had the carpal tunnel surgery. It had to state I had carpal tunnel syndrome instead of the results of my emg show blah blah blah.

Originally Posted by SwampWitch

A couple of questions for my medically-savvy friends:

Does a doctor have to spell out "Patient has Hashimoto's Thyroiditis" before a diagnosis is official or is it enough to have the lab results showing two elevated thyroid antibodies in the positive range?

Is a surgical report that states "4-5 cm endometrioma" proof of endometriosis or is an additional statement needed?

What about scoliosis? Is the x-ray enough or again, does the doctor have to write something up before it's an official diagnosis?

Thanks for your help... I'm hoping I don't have to track down doctors all over the U.S. and Canada!

Click to expand...

If I am understanding query:

"In the perfect world": You are seeing a doctor who SUSPECTS you have x,y,z conditions. He codes your paperwork (visit slip, medical record, lab slip, etc) as such. For ex, for thyroid, the ICD9 code might be "unexplained weight gain". Once the OFFICIAL dx is determined, e.g. your lab tests prove you have a hypoactive thyroid, your paperwork will then be coded with the ICD9 that belongs to it.

For endometriosis (sp?): BEFORE confirmation your ICD9 might be "Menstrual pain". If they can confirm your condition, only then will your coding be official endometriosis. (btw, my gyn said it could only be confirmed via laproscopic surgery so I opted not to have verified since tx would be the same as suspected endometriosis. Dont know if that is helpful, thought I'd just mention it)

I hope that answers your question.

It has to be actually written out as the diagnosis - I'm not sure it even counts if mentioned in the doctors notes.
But then there's the fun part, if you go to another doctor who disagrees despite the evidence or maybe even because a) they simply do not believe such a thing exist b) something in your medical history that is negative about you. - or the really fun one c) they have something against your previous doctor and will disagree with any diagnosis that doctor has made.

Sadly, I've seen people deal with all three of those issues.


I have lots of stuff mentioned from my previous visits with a rheumatologist - scoliosis, kyphosis, swelling found in my hands, and several hypermobile joints - among other things. The only official diagnosis I walked out of there to explain some of my pain (just my neck and back) was DDD. The rest was ignored. Even the spine doctor I've been too didn't pay any attention or mention the scoliosis or kyphosis, despite that it's obvious those do cause me some pain.

Xrays and lab tests are just that...tests. Until a doctor looks at those test results and gives a verbal or written diagnosis, your condition remains "unknown".

For insurance purposes, a doctor has to fill out a medical form listing your illnesses. You simply attaching an xray or a lab print out is not a diagnosis.

You have to remember that the people processing your claims have zero medical background. They simply read the medical form, follow guidelines given to them by their employer and go from there. It isn't their job to look at an xray and decide that you have a certain condition.