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	Welcome   | My Account | E-mail Alerts | Access Rights | Sign In Vol. 3 No. 4, April 1994   Archives  •  Online Features ARTICLE  This Article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal The deliberate misdiagnosis of major depression in primary care K. Rost, R. Smith, D. B. Matthews and B. Guise Department of Veterans Affairs Health Services Research, University of Arkansas for Medical Sciences, Little Rock. OBJECTIVE: Because the correct diagnosis of a psychiatric condition can jeopardize reimbursement and other benefits, physicians deliberately substitute alternative diagnoses. We estimated the prevalence of alternative coding for major depression by primary care physicians and the reasons for its occurrence. DESIGN: Cross-sectional mail survey with telephone follow-up of nonresponders. SETTING: Primary care practices in communities across the nation. PARTICIPANTS: Physicians were eligible to participate if they were randomly selected from membership lists of two professional organizations of primary care clinicians. Four hundred forty-four physicians (70.0% of eligible physicians and 89.5% of eligible physicians we could locate) completed the survey by mail or telephone. MAIN OUTCOME MEASURE: Substitution of an alternative code for major depression within a 2-week period. RESULTS: Of our respondents, 50.3% (SE, +/- 2.5%) reported that they had substituted another diagnostic code during a 2-week period for one or more patients whom they recognized met the criteria for major depression in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Thirty-one percent of depressed patients received alternative codes. The most common reasons for these substitutions involved physician uncertainty about the diagnosis and problems with reimbursement for services if a diagnosis of major depression was coded. CONCLUSION: The practice of deliberately substituting another diagnostic code for major depression is widespread among primary care providers. Physicians who employ deliberate misdiagnosis circumvent inequitable policies for particular patients, but the impact of substitution on the health care system as a whole deserves more careful consideration. THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Spillover Effects on Treatment of Adult Depression in Primary Care After FDA Advisory on Risk of Pediatric Suicidality With SSRIs Valuck et al. Am. J. Psychiatry 2007;164:1198-1205. ABSTRACT | FULL TEXT   Decline in Treatment of Pediatric Depression After FDA Advisory on Risk of Suicidality With SSRIs Libby et al. Am. J. Psychiatry 2007;164:884-891. 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